Care Quality Commission

We are the independent regulator of health and adult social care services in England. Our purpose is to make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve. We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find, including performance ratings to help people choose care.

Updated:
6 July 2016
Location:
National
Sectors:
Care, Health

1. Action Plan

1. The National Dementia Declaration lists seven outcomes that the DAA are seeking to achieve for people with dementia and their carers. How would you describe your organisation’s role in delivering better outcomes for people with dementia and their carers?

At the Care Quality Commission (CQC) we are determined to play our part in making sure that people living with dementia receive care that is safe, effective, compassionate and high-quality. We will hold services to account by setting clear expectations, monitoring and inspecting against those standards, sharing our ratings on how services are performing and taking action to encourage services to improve where that is necessary.

CQC is engaging with people who use services, including those living with dementia and those who care for someone with dementia, providers of services, and others, to make sure we focus on what matters to people. 

Further information on CQC’s approach, consultations and how we involve the public and people who receive care in our work, can be found on our website. http://www.cqc.org.uk/content/get-involved   

2. What are the challenges to delivering these outcomes from the perspective of your organisation?

There will inevitably be challenges during this period of financial constraints and restructuring across the health and social care system. CQC’s regulatory role will help ensure that people can nevertheless expect certain outcomes. It is also important we work closely with dementia organisations such as the DAA to better understand people’s experiences of care. As well as to continue to explore with other agencies how we can best work together across the system as a whole to encourage improvement in services.

Member website

www.cqc.org.uk

2. Actions

  • Report on the use of Deprivation of Liberty Safeguards

    CQC has a duty to monitor the operation of the Deprivation of Liberty Safeguards in England.  It does this through its existing programme of inspections together with some developing supplementary activity and produces an annual report that details its findings.  The Deprivation of Liberty Safeguards aim to protect the rights of people in hospital and care homes in circumstances where they cannot consent to their treatment or care.  53% of all applications to use the Deprivation of Liberty Safeguards in 2011/12 involved people identified as living with dementia.

    Status:
    Completed

    2015 - Fourth Quarter Update

    In December 2015, CQC published the sixth annual monitoring report on how hospitals and care homes in England are using the Deprivation of Liberty Safeguards.

    2015 - First Quarter Update

    In January 2015, CQC published the fifth annual report on the operation of the Deprivation of Liberty Safeguards (DoLS) in England.  The report noted that, for the first five years of the implementation of the DoLS, there were persistently low rates of application for use of these Safeguards, together with ongoing marked regional variation in their use. 

    The report also discusses the changing position since March 2014.  In that month, the House of Lords Select Committee on the Mental Capacity Act 2005 published a report that was critical of the poor implementation of the MCA throughout health and social care.  A high proportion of people who lack mental capacity to make specific decisions when they need to be made are those who are living with dementia, and it is essential that their rights are protected by use of the MCA.  The House of Lords committee specifically recommended to CQC that it should inspect against the MCA as well as its DoLS monitoring responsibilities.   CQC accepted this recommendation, and has been working to embed the MCA into the transformed inspection model. 

    Also in March 2014, the Supreme Court clarified that people lacking mental capacity are deprived of their liberty if they are both:

    *Not free to leave; and

    *Subject to continuous supervision and control.

    Following this judgement, the numbers of applications from care homes and hospitals for assessment under the DoLS rose from around 13,000 in the whole of 2013/14 to more than 90,000 in the first three quarters alone of the year 2014/15.  This unexpected vast increase has put local authorities under great stress, but CQC welcomes the clarity provided by the Supreme Court and expects that far more people will receive the protection of the DoLS.  Full analysis of these figures will be presented in the next DoLS monitoring report, covering the whole of 2014/15 in detail.  However, it is likely that the majority of people for whom authorisations are being requested are older people living with dementia.

    2014 - First Quarter Update

    CQC published its fourth annual report into how the Deprivation of Liberty Safeguards (DoLS) have been applied during 2012/13 in January 2014. The report cites concern that the Mental Capacity Act (MCA) is still not understood and implemented consistently across health and social care services. There has been a significant increase in the number of applications for the use of DoLS to protect the rights of people aged over 85.

    Checks on the implementation of the MCA will become a routine part of hospital and care home inspection in CQC’s new approach.

    2013 - Fourth Quarter Update

    In 2012/13 CQC continued the work started last year to explore the activities of ‘supervisory bodies’ (local authorities and primary care trusts ) in the Deprivation of Liberty Safeguards (DoLS) system. A survey of all local authorities was carried out and followed up by interviews with a sample of respondents about the way they carry out their responsibilities under the DoLS system. The survey findings paint a mixed picture of what the DoLS system actually means to people, the extent to which it is being properly applied, and whether people are being treated with respect for their human rights. The report cites many examples of good practice found in local authorities but also some concerns – particularly about appropriate involvement of people receiving care in decision making. Eighty-five per cent of the local authorities that responded to the survey said that hospitals’ and care homes’ poor understanding of their role and function under the DoLS was a barrier to good practice.

    We will analyse the findings from compliance inspections into the use of the Deprivation of Liberty Safeguards to produce our third report on this topic for 2011/12.

    2013 - Second Quarter Update

    CQC is currently planning for next year’s report, due for intended publication in December 2013, and is scoping projects that will feed into the report’s findings.

    A pilot project with Supervisory Bodies carried out last year is being built upon to gain a more detailed understanding of the operation of Supervisory Bodies. This is due to launch in June 2013.

    CQC is building on learning from a pilot project that looked to gather the experiences of people lacking capacity with direct experience of the Deprivation of Liberty Safeguards, and their friends, families and carers. A new project is currently being scoped and will be delivered later in the year.

    2013 - First Quarter Update

    CQC published its annual report, ‘Monitoring the use of the Mental Capacity Act Deprivation of Liberty Safeguards in 2011/12’, in March 2013. The report laid out expectations that CQC placed on providers and commissioners and actions covering how CQC can improve its internal understanding of the Mental Capacity Act and monitoring responsibilities of the Safeguards.

    http://www.cqc.org.uk/public/reports-surveys-and-reviews/reports/deprivation-liberty-safeguards-2011/12

  • Themed review of integrated care for older people

    Older people living with dementia often experience fragmented care. CQC is undertaking a thematic review which is looking at how care is coordinated for older people, the quality of care they are provided and whether information is being shared effectively to support good integration. The review will also look for examples of good and outstanding care, identify barriers which prevent older people receiving quality integrated care and propose actions that national and local providers can take to address poor integrated care for older people.

    Status:
    Delivery

    2016 - Second Quarter Update

    The review is completed and we will shortly be publishing our report into integrated care for older people. The findings of the review will feed directly into the development of CQC’s future regulatory approach across all sectors.

    2015 - Second Quarter Update

    Initial scoping and engaging with stakeholders has occurred to help define the focus of the themed inspection activity. Planning for fieldwork is now underway.

  • Training inspectors in the use of the Short Observational Framework for Inspection (SOFI)

    CQC is committed to training all of its inspectors to use the SOFI tool. This is mandatory training. The SOFI tool has been developed with the Bradford Dementia Group. The tool enables inspectors to capture the experiences of any person who may have cognitive or communication difficulties which means they cannot give their opinions verbally on the services they receive. It is one of a range of tools and methods which can be used to collect and triangulate evidence, to help us judge whether a service complies with the regulations and meets outcomes for people using the service.

    Status:
    Completed

    2013 - Second Quarter Update

    CQC had a large recruitment drive and all new inspectors recruited for 2012/13 have been trained to use the SOFI 2 tool.

    SOFI training is now ongoing for business as usual recruitment purposes for new inspectors.

  • Evaluation of the use of the SOFI tool

    SOFI training is mandatory for all inspectors. We are keen to carry out an evaluation to find out how widely the tool is being used, what the benefits are of using the tool, and to identify if there are any barriers to being able to use it effectively. Now the training is being rolled out, we are keen to start evaluating its use.

    Status:
    Completed

    2014 - Second Quarter Update

    The SOFI tool was used extensively as part of the dementia themed inspection programme. 

    2014 - First Quarter Update

    We are evaluating the use of the SOFI tool as part of our general evaluation of staff induction and also as part of our ongoing work to transform and improve our approach to inspection of services.

    2013 - Second Quarter Update

    We are in the early scoping phase of evaluating the use of the SOFI 2 tool.

  • Review and meet the support and learning needs of CQC staff on dementia

    We are undertaking a review of what level of awareness and knowledge about dementia is required by people in different roles across CQC. This could range from general dementia awareness raising to support all staff across the organisation, both professionally and personally, to more detailed and bespoke training and support required to enable inspectors to carry out their functions.

    Status:
    Delivery

    2016 - Second Quarter Update

    Dementia awareness continues to be part of CQC’s induction programme for all regulatory staff.  In April, CQC’s Academy introduced an open programme for all staff in CQC to encourage their involvement in the programme, supported by the Chief Executive. 

    The Academy is also looking at other support materials for staff to access as part of CQC’s commitment to ongoing continuing professional development

    2015 - Second Quarter Update

    The CQC Academy continues to provide awareness training for new staff joining the CQC.

    The Alzheimer’s Society, Age UK, Sensory Loss Organisations and The Smart Enterprise have all contributed to our induction programme to help our inspectors be the best they can be in their role.

    Ten more staff have been trained to help us deliver more dementia awareness training sessions to a wider audience of staff within CQC.

    A range of learning materials are now available through our learning management system to support access to key research at the time that our inspectors need it

    2015 - First Quarter Update

    Dementia awareness is integrated into the Role Specific Induction Programme for all new inspectors joining CQC.

    In our 2015/16 Academy programme we are looking for ways to train inspectors across all teams to understand what good dementia care looks like so their judgements are consistent and robust. There will be an ongoing programme of dementia awareness training for all our staff at CQC.  We are also developing workshops which will enhance our staff knowledge and competence to recognise good and outstanding dementia care. 

    We are looking at ways to evaluate the impact of staff becoming Dementia Friends and what else we can do to support this role by our workforce. 

    We are working with a number of organisations to contribute to our learning programmes in 2015/16 so our frontline staff have access to the latest expertise.

    Our learning management system, introduced in November 2014, will provide access to key research and share best practice. We will continue to update this library of information once resources have been validated by experts within CQC.

    We continue to look for ways to ensure that our staff are kept up to date.

    During this quarter we have also continued to provide face to face training for inspectors in the Mental Capacity Act and Code of Practice.  This one day training event is delivered by inspection staff who have received advanced level training.  In addition, all new inspectors and inspection managers receive training as part of their Role Specific Induction programme.  An online training programme for all staff has been refreshed and will be made available to all staff from April 1st 2015. 

    2014 - Fourth Quarter Update

    The Academy continues to explore role specific training for CQC staff.

    2014 - Third Quarter Update

    The new corporate induction for all CQC staff features the Mental Capacity Act.

    2014 - Second Quarter Update

    Our new training Academy is developing the longer-term core learning and development programme for our frontline staff.  Whilst the development of learning related to dementia is in its early stages, we recognise the need to equip staff as soon as possible with information that can be applied practically during inspection.  To support this, we are piloting a dementia care pocket guide with inspectors in one of our regions. The Academy is also working to build its resources and capabilities so that we can effectively learn from the experience of people with dementia and their carers, using learning from research and evidence based practice, including NICE guidance, to inform our judgments about the quality of services.

    All of our new staff, irrespective of role, continue to participate in dementia awareness sessions.  Staff have also been encouraged by CQC’s Chief Executive to become a ‘Dementia Friend'.

    2014 - First Quarter Update

    We are scoping what sort of dementia specific learning and development some of our staff might need, beyond awareness raising, as part of our new staff training Academy. The development of the Academy is one of the ways in which we aim to achieve our priority of building a high performing organisation.

    2013 - Second Quarter Update

    Dementia awareness workshops continue to be delivered to all CQC staff. We have also started scoping for more detailed dementia training and support for operational staff.

    2013 - First Quarter Update

    The roll-out of mandatory dementia awareness workshops for all CQC staff commenced in March 2013. This is being provided by the Alzheimer's Society.

  • Themed review of dementia care

    CQC will be undertaking a themed inspection programme looking at the quality of dementia care in care homes and acute hospitals in 22 local authority areas across England between November 2013 and February 2014. During this inspection programme, we will look at the quality of support provided to people with dementia to enable them to maintain their physical and mental health and wellbeing; how the care provided aims to reduce admissions to hospitals from care homes and avoid unnecessary lengths of stay in hospital; and how services work together when people move from one service to another.

    We will publish a report for each service that we inspect and a national report that highlights key themes, what works well and what needs to improve.

    Status:
    Completed

    2015 - First Quarter Update

    We published our report of our review of dementia care, Cracks in the Pathway, in October 2014 and have started to deliver on our commitments.

    Our inspectors routinely ask about the care for people with dementia in each of the core services in hospitals for which this is relevant.  Where there is information on dementia care from the individual inspection, this is reported under the key question ‘Is the service responsive?’

    In our 2015-16 Academy programme we are looking for ways to train inspectors across all teams to understand what good dementia care looks like so their judgements are consistent and robust.   More information on our training plans can be found under the CQC action on 'Reviewing and meeting the support and learning needs of CQC staff on dementia'.

    2014 - Fourth Quarter Update

    We published our report of our review of dementia care, Cracks in the Pathway, in October 2014. 

    Overall we found more good care than poor care in the care homes and hospitals our inspectors visited. But the quality of dementia care across providers is variable, and transitions between services need to be improved.   People  living with dementia are likely to experience poor care at some point along their care pathway. This unacceptable situation cannot continue.  People living with dementia, their families and carers have every right to be treated with respect, dignity and compassion.

    Following the report, CQC has committed to:

    - Appointing a new national specialist adviser for dementia care.

    - Train inspectors across all teams to understand what good dementia care looks like so their judgements are consistent and robust.

    - Include a separate section in hospital inspection reports that shows how well the hospital cares for people living with dementia.

    2014 - Third Quarter Update

    Preparation for publication of our national report of our review of dementia care.

    We will be continuing a focus on the experience of people living with dementia in a new themed review of end of life care.

    2014 - Second Quarter Update

    We have published reports for each of the services that we have inspected under the themed inspection programme looking at the quality of dementia care in care homes and acute hospitals.   We are planning to publish a national report highlighting the key themes in the autumn.

    The report will include examples of good practice we came across as well as examples of where things could have been improved for people living with dementia. We hope that providers, care workers, professionals and commissioners of services can learn from these case examples and help them to identify their own areas of strength and areas for improvement, and to see how some small changes can achieve much better outcomes for people.

    2014 - First Quarter Update

    The themed inspections started in November 2013 and will run until February 2014.

    As part of the inspection process, local groups in the 22 local authority areas targeted have been approached directly to tell CQC about dementia care in their area. The Race Equality Foundation is also running four focus groups directly targeting some Black, Asian and Minority Ethnic groups to understand their experiences of dementia care. Regional Voices are also holding some local group discussions through local CVS and other groups to better understand the pathways of care for people with dementia.

    Family carers of people with dementia have joined our inspectors on their inspections to hospitals and care homes. They will have participated in the majority of the 200 inspections which form this part of the review.

    2013 - Fourth Quarter Update

    Scoping work has included advice from a range of voluntary and community organisations including local Healthwatch, representatives from the Dementia Action Alliance and issues identified from local scrutiny of dementia care by Overview and Scrutiny Committees.

    Partnership working with a range of voluntary organisations including Age UK, Dementia Action Alliance members, and the Race Equality Foundation and latterly Carers UK and the national Lesbian Gay Bisexual and Transgender partnership has enabled CQC to call for evidence for the review from a wide range of national and regional networks to help shape the national report.

    2013 - Second Quarter Update

    Initial scoping and engaging with stakeholders has started, to help define the final focus of the themed inspection activity. Our advisory group, which provides expertise and experience to the programme, includes people living with dementia and family carers, experts by experience and user organisations.

  • Themed review of end of life care

    Following on our themed review of dementia care, CQC continues to reflect the experience of people with dementia in our thematic work across sectors. We know that people with dementia do not always have good quality end of life care. Our thematic review of inequalities in end of life care is looking at the experience of people from groups which have less good experiences at the end of life. As part of the review, we will ask Clinical Commissioning Groups (CCGs) how they are addressing the needs of people with dementia and their families, as well as other groups, and will engage with people with experience of dementia and end of life care to understand and share their perspective.  

    Status:
    Completed

    2016 - Second Quarter Update

    In  May 2016, we published a national report of our review looking at the quality of care for people from different groups at the end of life, including people living with dementia: A different ending: Addressing inequalities in end of life care.

    Overall, we found that the quality of care is variable - people from certain groups experience poorer quality care at the end of their lives than others because providers and commissioners do not always understand or fully consider their individual needs. People from the groups included in the review told us about mixed experiences of end of life care, and highlighted barriers that sometimes prevented them from experiencing good, personalised end of life care.

    For people living with dementia, we found that:

    - People, including professionals, were unsure about when the end of life phase began.
    - Although early conversations are important, they often don’t happen - communication with people and those important to them was often poor.
    - Health professionals’ understanding of the Mental Capacity Act 2005 is patchy.
    - Initiatives such as Deciding Right support people to make choices through advance care planning.
    - People with dementia are sometimes not able to access the right care, including hospice care.
    -Being cared for in the right environment, by staff who have the right skills, is crucial.

     The findings of the review will feed directly into the development of CQC’s future regulatory approach across all sectors.

    CQC encourages:

    - Health professionals, including GPs, to facilitate early conversations with people with dementia and those who are important to them about their wishes and choices for end of life care, and help them to contribute to an advance care plan wherever possible.
    - Commissioners and providers to make sure staff have the training and support they need to care for people with dementia who are approaching the end of life, and to understand and implemental the requirements of the Mental Capacity Act 2005.
    - Hospices to consider to what extent  they are meeting the end of life care needs of people with dementia and take action where required in line with our definition of good end of life care in hospice services.

     

    More information along with good practice examples can be found on the CQC website.

    2015 - Second Quarter Update

    We have completed the analysis of responses to our online survey on the experience of people with dementia at the end of life, as well as the information we requested from 43 Clinical Commissioning Groups (CCGs). Over half of the CCGs which responded said that they were making specific provision for people with dementia. However, in our survey, people told us that people with dementia at the end of life are not receiving opportunities to express their wishes, preferences and care choices, and the majority of respondents told us that they were not at all confident that the needs of people with dementia at the end of life are being met.We will follow up these findings through our fieldwork in 20 local areas, which is now scheduled to take place during October and November 2015. We are working with National Council for Palliative Care, Race Equality Foundation, and National Voices who are engaging with community groups on our behalf to find out about the experience of people, including those with dementia, at the end of life. We will look at the quality of care for people at the end of life, including people with dementia, across services in the local area. We plan to publish a national report in early 2016.

    2015 - First Quarter Update

    We are finishing off the Clinicial Commissioning Groups (CCGs) information request.  We are planning the involvement work and fieldwork currently.   This has included work led by the National Council for Palliative Care which has gathered evidence held by national voluntary sector organisations about people’s experiences of end of life care who have dementia. We have also run an online survey aimed at gathering feedback about the experiences of end of life care for people with dementia.  The fieldwork will take place in 20 CCG areas in August and September and as part of this we will be seeking evidence from local dementia groups about people’s experiences of end of life care. 

  • Gathering feedback from people living with dementia, including families and carers, for future inspections

    Develop our approach to be more effective in gathering feedback from people living with dementia, including families and carers, for future inspections.

    Status:
    Being implemented

    2016 - Second Quarter Update

    CQC continues to build partnerships with national organisations and engagement with community groups to increase our access to the experiences of people with dementia.  We have promoted announced inspections to local dementia groups to get feedback about services.

    CQC’s Experts by Experience programme,  includes people in the early stages of dementia and family carers of people with dementia.

    Through a partnership with Mumsnet and Gransnet, CQC are reaching hundreds of thousands of family carers and older women who may care for someone with dementia or be in the early stages of dementia. This valuable information informs CQC’s regulatory activities.

    2015 - Second Quarter Update

    Through ‘Tell us about your care’ partnerships work CQC is proactively increasing our access to people’s experiences of care – this includes the experiences of people living with dementia.  We currently work with the Relatives and Residents Association, Carers UK, Mind, The Silver Line, Patients Association and Action Against Medical Accidents. In August we will begin a new partnership with Age UK with similar objectives. Further information about these partnerships is available online http://www.cqc.org.uk/public/get-involved/tell-us-about-your-care-partnerships

    CQC will continue to explore ways of hearing from people living with dementia, including encouraging contributions from local dementia groups, as part of our forthcoming work.

    2015 - First Quarter Update

    We are gathering feedback about the experience of people living with dementia as part of our review of end of life care.  More information on this can be found under the CQC action on the 'Themed review of end of life care.'

    We have been promoting our announced inspections through Healthwatch and voluntary groups to encourage feedback from older people and carers groups to inform our inspection teams. We intend to extend this further in 2015/16.

    We have completed a development project to explore how we can work with volunteers to hear about people’s experiences of care - particularly those supporting people in residential care, working with CSV. We plan to roll this out to a volunteer engagement programme in 2015/16.