David Finney guides you through the new CQC inspections
The Care Quality Commission has just published guidance on the new way in which treatment services will be inspected. The process will be very different from before, because the inspections are now organised by the Hospital Directorate.
The first major change is the introduction of a ‘briefing and planning session’ with an inspector at the outset of the inspection process. This will be an opportunity for you to explain how your service works, and will enable the inspector to plan the site visit appropriately.
At this stage you will also be asked for contact information for your stakeholders, who will be surveyed by CQC. These will include commissioners, local authorities, referrers from drug and alcohol teams, doctors, social workers and care managers.
Then an ‘intelligent monitoring’ phase will start, during which CQC will gather data. Some of this will be provided by you, such as:
- Outcome data, eg on completion or return to treatment, abstinence rates, safeguarding alerts.
- Information from service users and the public (usually obtained through surveys).
- Information from and about staff, eg turnover, stability, sickness rates and concerns raised.
Furthermore, you will be asked questions in a ‘provider information return’, which will include specific questions about:
- Safety and effectiveness, including serious incidents, DoLS (Deprivation of Liberty Safeguards) or medication errors.
- Complaints and how governance is exercised (do you learn from incidents and mistakes?)
- Equality and diversity, ie examples of how it is evidenced, or data to show that specific groups are not discriminated against.
- How improvements are made in the service.
Another major change is that you will be given a date for a site visit and CQC will seek information about your service in the intervening period. This will give you an opportunity to audit your service thoroughly before the site visit takes place.
At the beginning of the visit, there will be an opportunity for you to give a ‘provider presentation’, in which you can:
- Outline the background to your organisation. I suggest that you include an explanation of your treatment philosophy.
- Show that you provide quality care. Demonstrating an understanding of the five key questions (safe, effective, caring, responsive and well led) will be helpful.
- Demonstrate what is working well or is outstanding. You could focus the success rate in terms of completions and the compliments you have received.
- Highlight any areas of concern or risk. For example, you could mention any boundary issues such as transition, or any issues you may have with mental health teams.
Then, during the visit, the Inspection team will observe interactions between staff and service users, talk with service users, staff and the manager, and look at some records.
There are actually very few questions in the methodology that are specific to substance misuse treatment. However, those that are include:
- Identification of drug and alcohol-related harm, and deteriorating health.
- An opportunity to explain the restrictions on movement usually imposed as part of a treatment programme.
- The involvement of recovery champions.
- Processes in place for unexplained or unplanned discharges.
- The planning of services to take account of people with complex needs or vulnerabilities – such as dual diagnosis, multiple drug use, homelessness, pregnancy, or criminal justice involvement.
Finally, it has now been decided that CQC will not be able to give ‘ratings’ for substance misuse treatment services. This is because they were not included in the list of services given to the Department of Health when drafting the regulations, so CQC has no legal power to provide ratings. This decision applies to everyone in the sector, so no specific group of services will be disadvantaged by it.
The full information about the new inspection process can be accessed at www.cqc.org.uk/content/guidance-providers. I wish you the very best of success in navigating this new system and will continue to update you through DDN as and when new information becomes available.
David Finney is an independent social care consultant. His workshop is on 6 October in London, details at www.drinkanddrugsnews.com/CQCtraining