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The impact of CQC remote inspections on UK care homes in 2022
15 February 2022

Over the past decade there has been a push towards digital transformation within UK care services due to changing technologies, government reform and a focus on quality of care. However, change was abruptly forced on the sector when the Covid-19 pandemic first began to affect the world and, subsequently, care homes at the beginning of 2020.

During this time, the government advised the reduction of face-to-face contact before issuing a nationwide lockdown. In order to continue maintaining a consistent level of care and safety, the Care Quality Commission (CQC), NHS and care services collaborated on the best course of action to protect patients, carers and staff using these services.

After undertaking a pilot in early 2020 for remote inspections, the CQC were confident in shifting towards wireless and remote methods as part of its digital strategy.

And on 16th March 2020 the CQC informed all registered health and social care providers that it would be suspending routine face-to-face inspections as a precaution due to Covid-19, before resuming with remote inspections in July 2020.

To ensure quality of care could still be measured effectively, providers worked collaboratively to improve their digital infrastructure by investing in remote technologies that could:

  • monitor care home residents’ health
  • undertake an inspection remotely
  • communicate between care homes and CQC
  • improve CMS reporting and E-Records
  • offer detailed user training for staff, residents and carers
  • have a robust digital complaints and feedback process

This embedded digital solutions into the CQC’s overall inspection strategy, while giving the ability to adapt to changing circumstances impacted by the pandemic. Most importantly, it improved the care offered at care homes.

Fast forward to 2022 and the world is still dealing with the effects of Covid-19, with care homes across the UK continuing to perform remote inspections. But how successful have digital inspections been? And are they accurately identifying quality of care concerns to ensure vulnerable people living in care are protected?

How have inspections changed?

In line with section 46 of the Health and Social Care Act 2008, the CQC performs ‘inspections’ of health and social care services to ensure they are performing to or above a set standard of care. “Reviews” at care homes are conducted at least once every two years.

Previously, this would normally require a scheduled visit where the inspector/s would speak to staff, observe the care given, interview patients and family members, and check any records while onsite. This could take place over a couple of days or weeks depending on size and requirements of the provider.

Following the CQC’s announcement in 2020, inspections now taking place remotely, are conducted using email, phone and video calls to speak with care home managers, staff and people using the service. Additional feedback and evidence can also be submitted via an online feedback from.

This communication can be much shorter than previous contact, giving a far smaller snapshot of the care provided. However, due to digital technologies, additional reporting evidence can now be submitted such as remote monitoring care, improved data base reporting and digital feedback submissions.

As before, the CQC may also undertake additional or unannounced in-person inspections, if a service is under investigation due to an allegation of abuse or safety concerns being raised. However, this remains on case-by-case basis.

These changes have led care homes to invest in digital solutions such as video conferencing, wireless monitoring equipment, visual technology and improved CMS capabilities for reporting.

NHS remote reviews, which focus on reviewing individuals’ care, have also taken advantage of digital review methods. Research conducted by adam, has previously shown that the “sharing of e-records can lead to significant efficiency gains for care homes, with providers stating that NHS care reviews could take only a third of the time with the use of digital e-record sharing” (Improving Care Home Remote Reviews, 2021).

Demonstrating a duty of care via remote inspections

The key focus of the inspections is to ensure a care home is safe, effective, responsive, caring and upholds safety standards and regulations, with a focus on infection control measures. This, in turn, focuses on the management and demonstration of care within each care home, evidenced by the experience of staff, residents and family members. While this focus has not changed, the method of inspection may limit the CQC’s view of a care home demonstrating a consistent level of care. The added ‘view’ around care home residents’ health and wellbeing gives an indication of the care taken to monitor and look after residents. But is a remote inspection really enough to identify safety concerns or consistent care?

Alison Tarrant and Lydia Hayes at The London School of Economics and Political Science (LSE) raised concerns, early in 2020, about the reduction of inspections and Covid-19 impact. “In early April, our research found that a majority of care workers said that not enough was being done to keep them safe, and neither did they believe enough was done to protect the people for whom they cared.” They added; with friends and family excluded or restricted from visiting relatives in care homes, care practices could be hidden “from view and [make] care homes invisible to scrutiny”.

In an interview with GP, Solicitor Gemma Nicholas, from Ridouts law firm, echoed similar concerns “Due to the nature of remote inspections, the CQC cannot or may not query the legitimacy of or motivations behind negative feedback.“This means it is vital that providers do their best to explain events from the practice’s perspective.” Equally, positive feedback and changes may be dismissed due to a focus on past negative feedback which has become outdated.

Care homes should therefore focus on providing detailed evidence and adding commentary on the circumstances surrounding the evidence, with focus on the health and wellbeing of patients. This could be a demonstration of care through remote monitoring reporting or strong partnership results with Local Authorities via ratings or success of care.

Gemma adds that if providers are unsure, they can still insist on a physical inspection.

The future of remote and digital led care

The Covid-19 pandemic expediated digital transformation plans within businesses across the UK and care homes were no different. The investment in new technologies has had a positive impact across the sector, especially in the ability to act quicker to changing patient health requirements due to monitoring technology and produce more accurate up-to-date data sources.

As remote practices become more common and the demand for digital solutions increases, the care industry will need to continue investing in digital technology. However, relying on remote technology to perform vital inspections of care is still up for debate and may, in some cases, produce unreliable results. Care homes should, therefore, focus on an integration of digital tools which work together to demonstrate and provide a high level of patient care and
wellbeing.

Discover how NHS remote care reviews can be improved, in the latest report from the adam Provider Insights team: Improving Care Home Remote Reviews.

adam is proud to help support UK care homes partner with Local Authorities and the NHS to demonstrate a consistent level of care across their local area. Local Authorities who partner with adam, gain access to Quality Scoring tools within the adam platform, which allow the council to access the latest CQC ratings for each provider. Find out more about the adam social care solution and book a consultation with our team today.

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