CQC insight on Covid-19 and adult social care: our reflections for patient safety

  • 28th May 2020

The Care Quality Commission (CQC) last week published its first in a series of insight reports looking at the impact of Covid-19 on the sectors that it regulates, with their initial report focusing on adult social care in England.[1] Their report reviews the data on outbreaks, deaths and availability of Personal Protective Equipment (PPE), while also looking at the pandemic’s effect on staff wellbeing and the financial viability of services.[2]

At Patient Safety Learning, we have previously set out the emerging patient safety issues affecting the social care sector as a result of the Covid-19 outbreak and recommended some essential steps required to tackle these concerns.[3] In this blog, we’ll reflect on the findings of this CQC report and consider the implications it has for patient safety and staff safety, focusing on the following areas:

  1. Access to PPE
  2. Staff absences
  3. Impact on non Covid-19 care and treatment
  4. Staff wellbeing

Access to PPE

The availability of PPE in social care has proved to be a persistent problem during the pandemic, with a direct impact on the safety of patients and staff. The Government has sought to step up its efforts to address this issue, however, there continues to be a steady stream of reports concerning procurement issues and supply shortages.[4]

In their report, the CQC highlights these problems with specific reference to domiciliary care, where social care services support people living at home. They state that in the first week of May, ‘6% of agencies in London had only enough PPE to last two days or less; 28% of agencies in London and the North West had only enough PPE to last up to a week’.[5] These concerns about potential shortages are particularly worrying when coupled with the latest statistics concerning Covid-19 rates in domiciliary care, which indicate that around a fifth of all agencies were caring for at least one person with suspected or confirmed Covid-19.[6]

Impact on patient safety and staff safety

While there has been much recent focus on the spread of Covid-19 in residential care homes and nursing homes, this is an equally significant issue in domiciliary care. Without adequate PPE, staff are at risk of spreading the infection among a geographically dispersed group of vulnerable individuals during a single working day. The potential for supply shortages raises a safety risk for both patients and staff, heightening the risk of Covid-19 transmission. This not only impacts patients and staff but could potentially impact their families and the wider community too.

Staff absences

Covid-19 is having a significant impact on an over-stretched social care workforce, creating risks around safe staffing levels. This was already an area of concern prior to the pandemic, with an average vacancy rate in the adult social care workforce in England of 7.8%, equating to around 122,000 vacancies.[7]

The CQC report indicates that the number of staff not working due to Covid-19 is at 9% of the workforce in domiciliary care.[8] This increased absence rate, coupled with the existing vacancy levels, raises serious questions about the standards of care that can be provided under these constraints. Particularly alarming is a comment in the report which suggests that, in some cases, preventing the infection is being traded off against maintaining staffing levels, with the report noting that ‘managers of smaller providers are having to choose whether to self-isolate or continue working due to the levels of staff sickness’.[9]

Impact on patient safety and staff safety

These high absence levels in domiciliary care come at a time where those providing care at home are likely to face an increased workload due to an acceleration in hospital discharges to free up acute beds in the NHS for Covid-19 care and treatment. In a joint submission with CECOPS to the Health and Social Care Select Committee, we recently highlighted the impact of this on community support services.[10] If we are to expect social care to absorb an increasing numbers of discharged patients, it is vital that we have safe staffing levels in areas such as domiciliary care.

Impact on non Covid-19 care and treatment

As the health and social care system focuses on tackling the pandemic, it is vital that we do not overlook the impact that this is having on care and treatment not related to Covid-19. At Patient Safety Learning, we have been gathering evidence of the impact of this and highlighting emerging safety issues we hear from patients, family members and carers through our #safetystories campaign. We have also recently responded to an Inquiry by the Health and Social Care Select Committee looking at this across a number of key themes and areas, including social care.[11]

In their report, the CQC highlights this issue, noting that ‘additional deaths being recorded in England are clear evidence of the wider effects of the virus, as the health and care system has had to respond and reshape the way it provides care and treatment’.[12] Rosie Benneyworth, the CQC’s Chief Inspector of Primary Medical Services and Integrated Care, states:

‘Older people, people with long-term conditions and people who are experiencing poor mental health may be both at increased risk from COVID-19, but also face difficulties and anxieties around accessing non-COVID care.’[13]

Impact on patient safety and staff safety

As we identified in our response to the Select Committee, there will be a significant impact stemming from delays in diagnosis and treatment during the pandemic for non Covid-19 conditions.[14] For those living with existing healthcare conditions, these may become more severe due to a lack of earlier intervention. This is likely to be particularly significant for those in social care, with areas of care and treatment that may be neglected in this period, such as chronic disease management, much more likely to impact on these individuals accessing these services.[15]

Staff wellbeing

Another area the report highlights is concerns around the morale and wellbeing of staff, pointing to them feeling undervalued compared to healthcare workers. It also describes increasing levels of stress being place on those tasked with maintaining services:

‘Some registered managers of adult social care services are suffering from burn out and extreme anxiety. Our inspection teams are dealing with an increase in care home managers suffering from distress due to multiple deaths and financial worries. Inspectors are liaising with them regularly for support and advice.’[16]

Impact on patient safety and staff safety

The pandemic has placed huge pressure on those working in the social care sector and, as we emerge from this, serious thought will need to be given to issues of staff welfare and burnout if major retention problems are to be avoided. As noted by the CQC, this is not limited to frontline workers, but also those responsible for running services, who play a crucial role in ensuring these are fit for purpose and safe for those who access them.

More support needed

This latest CQC report further illustrates several patient safety themes that we have previously identified as issues that are being reflected across the health and social care system during the pandemic. Patient Safety Learning is calling on the Department of Health and Social Care to:

  1. Respond to the issues raised in this CQC report and set out actions to address the safety concerns that have been identified.
  2. Focus on addressing the PPE distribution problems in social care, working to continuously improve the speed and delivery of these items, and treating this with the same urgency as supplies for healthcare.
  3. Work with care providers to support the continued provision of services and ensure adequate staffing levels in this period.
  4. Implement the eight-point action plan recommended by Patient Safety Learning and CECOPS to the Health and Social Care Select Committee to support community services in responding to rapid hospital discharge requirements.

While in the initial phase of the pandemic, resources were redirected and focused on acute care in hospitals. As we move forward, it is vital that social care, in both care settings and in the home, become a key area of focus for the Government. As noted by Kate Terroni, CQC’s Chief Inspector of Adult Social Care, states in this report:

‘As acute services start to move towards a more stable position, the community health offer – both to care homes and people who have care and support needs met in their own homes – must be a priority. It is critical that the right focus is placed on social care to ensure that those on the front line get the assistance they need to protect the people they care for. We’ve seen what can be achieved and the impact that this has on people’s care – the challenge now is to make sure it is achieved consistently.’[17]

[1] CQC, Sharing insight, asking questions, encouraging collaboration: CQC publishes first insight document on COVID-19 pressures, 19 May 2020. https://www.cqc.org.uk/news/stories/sharing-insight-asking-questions-encouraging-collaboration-cqc-publishes-first-insight-document-on-covid-19-pressures

[2] CQC, Covid Insight: Focus on Adult Social Care, 19 May 2020. https://www.cqc.org.uk/sites/default/files/20200501%20COVID%20IV%20update%20number%201%20ACCESSIBLE.pdf

[3] Patient Safety Learning, Covid-19 and social care: we must act now to ensure patient safety, 14 April 2020. https://www.patientsafetylearning.org/blog/covid-19-and-social-care-we-must-act-now-to-ensure-patient-safety

[4] Gov.uk, Millions more items of PPE for frontline staff from new business partnerships, 9 May 2020. https://www.gov.uk/government/news/millions-more-items-of-ppe-for-frontline-staff-from-new-business-partnerships; The Guardian, UK care homes scramble to buy their own PPE as national deliveries fail, 9 May 2020. https://www.theguardian.com/world/2020/may/09/uk-care-homes-scramble-to-buy-their-own-ppe-as-national-deliveries-fail; Sky News, Coronavirus: Social care providers ‘about 24 hours away’ from running out of PPE’, 10 May 2020. https://news.sky.com/story/coronavirus-social-care-providers-about-24-hours-away-from-running-out-of-ppe-11985738

[5] CQC, Covid Insight: Focus on Adult Social Care, 19 May 2020. https://www.cqc.org.uk/sites/default/files/20200501%20COVID%20IV%20update%20number%201%20ACCESSIBLE.pdf

[6] Ibid.

[7] Skills for Care, The state of the adult social care sector and workforce in England, September 2019. https://www.skillsforcare.org.uk/adult-social-care-workforce-data/Workforce-intelligence/documents/State-of-the-adult-social-care-sector/State-of-Report-2019.pdf

[8] This figure includes those who are self-isolating and have care commitments. CQC, Covid Insight: Focus on Adult Social Care, 19 May 2020. https://www.cqc.org.uk/sites/default/files/20200501%20COVID%20IV%20update%20number%201%20ACCESSIBLE.pdf

[9] Ibid.

[10] Patient Safety Learning and CECOPS, Hospital Discharge Arrangements, 7 May 2020. https://www.pslhub.org/uploads/monthly_2020_05/1292880674_HospitalDischargeArrangements_AjointsubmissiontotheHSCSelectCommitteeInquiry_pdf.f281edcbda5ca6e059b1893719b58812

[11] Patient Safety Learning, Patient Safety Learning’s response to the Health and Social Care Select Committee Inquiry: Delivering Core NHS and Care Services during the Pandemic and Beyond, 8 May 2020. https://www.pslhub.org/uploads/monthly_2020_05/1073339515_PatientSafetyLearning-ResponsetoDeliveringCoreNHSandCareServicesduringthePandemicandBeyondInquiry_pdf.4f2fbe078c0a92418d07b75bb1edcf4a

[12] CQC, Covid Insight: Focus on Adult Social Care, 19 May 2020. https://www.cqc.org.uk/sites/default/files/20200501%20COVID%20IV%20update%20number%201%20ACCESSIBLE.pdf.

[13] Ibid

[14] Patient Safety Learning, Patient Safety Learning’s response to the Health and Social Care Select Committee Inquiry: Delivering Core NHS and Care Services during the Pandemic and Beyond, 8 May 2020. https://www.pslhub.org/uploads/monthly_2020_05/1073339515_PatientSafetyLearning-ResponsetoDeliveringCoreNHSandCareServicesduringthePandemicandBeyondInquiry_pdf.4f2fbe078c0a92418d07b75bb1edcf4a

[15] Dhalwani, N.N., O’Donovan, G., Zaccardi, F. et al. Long terms trends of multimorbidity and association with physical activity in older English population. International Journal of Behavioural Nutrition and Physical Activity - Volume 13 Article 8, 2016. https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-016-0330-9#citeas

[16] CQC, Covid Insight: Focus on Adult Social Care, 19 May 2020. https://www.cqc.org.uk/sites/default/files/20200501%20COVID%20IV%20update%20number%201%20ACCESSIBLE.pdf

[17] Ibid.

CQC COVID 19 Insight

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