On 20 May 2020, the CQC published its first COVID-19 Insight document, said to be the first of its regular discussion documents on key issues affecting health and care.
The full document can be found here.
The CQC recognises that there needs to be a greater collective effort nationally and locally to tackle COVID-19 and the impact it is having on local communities across the country.
The report contains a data review which suggests that around 36% of care homes in England had been affected by COVID-19 as at week ending 10 May 2020. The most outbreaks are identified as having been seen in the North East, London and the North West. Of particular note is the fact that in the North West, there was a significant peak in outbreaks in the week commencing 6 April 2020.
Domiciliary care is also dealt with and identified that around a fifth of agencies around England had people who were caring for at least one person with suspected or confirmed COVID-19.
The Insight document confirms the impact on providers and staff and highlights that availability of PPE remains a big concern. Concerningly, the CQC tracker from 2 to 8 May showed that 6% of agencies in London had only enough PPE to last two days or less and 28% of agencies in London and the North West had only enough PPE to last up to 1 week. They highlight that there have been instances where wrong items have been delivered or items have been of poor quality.
Importantly, the CQC identifies that concerns now arise in relation to the cost of PPE and the impact of this and the financial viability of businesses moving forwards. The scale of this issue remains to be seen.
The document recognises that testing is a huge challenge. It confirms that the introduction of a Department of Health and Social Care portal for care homes to arrange Coronavirus testing with all care staff and residents now being eligible.
Staff absences are also dealt with and highlights that London has the largest proportion of care staff absent from domiciliary care services because of COVID-19 (over 10%) with the average in England being 9%.
The impact on care staff is a significant feature of the report highlighting various concerns raised with the CQC relating to self-isolation, levels of staff sickness, increasing vacancies in nursing homes and low morale. Care staff feeling under-valued when compared with healthcare counterparts largely contributes.
In a move which perhaps shifts the focus away from the regulatory and inspection activity by the CQC, their inspectors are liaising with care home managers to provide support and advice.
Not only do implications for care arise from the COVID-19 virus itself, there is clearly an impact on the provision of care and services for non COVID-19 related issues. The report highlights that hospital admissions for non COVID-19 related issues have now started to increase, together with a slight increase in paediatric A&E attendances. Mental health services are also said to be experiencing lower bed occupancy.
In our view, a validly held concern, is that there will be a large increase in mental health service referrals when the pandemic starts to slow. Separate emergency provision is to be provided in some London areas but it is to be queried whether this expansion of emergency provision should be implemented nationally.
In future reports, the CQC will be exploring and reporting on:
- How individual NHS and Adult Social Care organisations are managing infection control;
- How organisations are helping to control the spread of COVID-19 and managing the risk of infection when people move between services;
- How different local systems are engaging ASC organisations in the management of COVID-19;
- How care for people from different vulnerable groups is being managed through the COVID-19 crisis.
The CQC Chief Inspector of Primary Medical Services and Integrated Care ends the Insight document by stating “As the health and social care system reaffirms that it is open for routine services as well as COVID care, it is vital that we fully understand what issues might exist in the system and could have an impact on access, quality of life and dignity for everyone.”
It will be of interest to care providers to keep an eye on further CQC communications and to engage with the CQC in its efforts to obtain data and to provide support to care organisations moving forward. The report certainly appears to demonstrate a shift in the approach of CQC from the performance of its traditional regulatory functions.
Clare Chapman, Partner, BLM