As we head into the new year, we are planning to attend the Digital Health and Social Care 2019 in Edinburgh in February. As a result of this, we decided to take a look at how Scotland deals with their care environment.
Where the CQC operate in England, a body called The Care Inspectorate is responsible for the quality of care North of the border. We have been very impressed with the quality of the CQC reports and the data that it provided. It gave us the opportunity as a software vendor looking to enter the UK market, to gain a significant insight into the issues that many residential and domiciliary care services are facing.
Comparing Apples with Apples
The Care Inspectorate publishes reports from their inspections, however they have recently changed their inspection process. We looked at data from May 2018 (we have assumed this to be the old inspection framework) and data analysed in January 2019, relating to the second quarter of 2018/19 (assumed to be new inspection framework). Care Inspectorate Scotland have indicated that they will start using the new approach in care homes for older people from July 2018.
The old system assessed the quality of services against 4 criteria, with no overall quality assessment score being given. The criteria were: Environment; Staff; Care & Support; Management & Leadership.
There are 6 quality scores, plus a ‘Not Assessed’ option which was frequently used:
The new framework is structured around five key questions with the same score system and again, no overall grading:
- How well do we support people’s wellbeing?
- How good is our leadership?
- How good is our staff team?
- How good is our setting?
- How well is our care and support planned?
Even looking at a small data set of 17 care services, we have been able to see that the percentage of ‘Weak’ and ‘Unsatisfactory’ assessments is very low for both residential and domiciliary care services. Something like 3-4%. This corresponds to figures in the CQC data of 20-25% of similar ratings of ‘Inadequate’ or ‘Requires Improvement’.
How Accurate is the Data?
We also see some significant improvements as we move between the old and the new inspection system. One thing we observed, is that comparisons are difficult to make due to the fact that the assessment criteria in Scotland changed, but it is also quite different to the way the CQC carry out their inspections. One aspect of both the old and new reporting system that makes the data difficult to interpret, is the use of ‘Not Inspected’ in the reports. We saw many reports that didn’t seem to carry out a complete inspection. This was concerning, since many issues are interconnected. For instance, not inspecting ‘Management & Leadership’ will not give a complete picture of how the overall service is run. The lack of a single aggregate score also makes it harder to get a quick view of how well the service is performing.
The Digital Solution Still Makes Sense
The reports also showed an apparent lack of authority on the part of the Care Inspectorate to bring about change within services. Many reports made recommendations which were still being raised as issues, in follow-up reports. It seems that there is little point to having an inspection system, if the inspections are incomplete and any recommendations are not enforced.
The overall feeling from looking at the reports, is that the inspection system in Scotland is not as demanding as the CQC in England. The percentage of services that are Weak or Unsatisfactory is much lower, which begs the question – Are the care services in Scotland doing much better than those in England? Or is the inspection system just more rigorous in England?
We are very keen to learn more about how care services are regulated in Scotland, since we are sure that many of the issues faced in Scotland will be the same as those seen in England, and as we have pointed out in our White Paper, most of the most severe issues can be solved with the implementation of a good care management software system such as Real-Time Care from Fastroi.
We will be attending the Digital Health & Care conference at Dynamic Earth in Edinburgh on the 20th and 21st of February. We look forward to meet you there!