What the HealthTech?

Hi What the Health Tech listeners, I'm your host this week, Justine Abson. This is the podcast where we tackle some of the trending topics, ideas, and best practice across health and social care. This week I'm speaking to Louie Werth. Louie is director at Care Research, so we're going to have a little bit of a chat about that in our first question.

So Louie, it's great to have you here. Welcome to the podcast.

Great to be here. Thanks for having me.

So going into obviously Care Research, do you want to tell us a little bit about that and what you do there?

Yeah, so Care Research pretty much does what it's... says on the tin. It's a research company that focuses exclusively on the care sector.

So that involves kind of large national projects. We've done stuff with skills for care, done stuff for look ahead, National Association of Care and Support Workers. But it also focuses on doing research for small services to help them with their feedback to help them gain experiences from the people they support from staff from family members.

Um, from partners, and it's about helping services gain really great feedback that they can use for marketing, but also now for CQC evidence as well.

So not, not that much then.

Yeah, just a few bits to keep us busy, yeah.

So we're going to chat a little bit about the new CQC framework, um, and some of the things that you've put together to kind of help providers with that change, because there's obviously a lot to deal with, isn't there?

Yeah, so I think the main thing to understand about the CQC framework is that it's a huge shift in focus from CQC. So sometimes in the past, CQC changes have been, okay, we're going to frame this a bit differently or we're going to ask for different ideas. What we've got here is a shift not just in the organisation of kind of what CQC are looking for, but also how they're going to evidence and score and collect information from services.

So we've been doing quite a lot of work on helping services just shift their thinking first with the quality statements and then kind of thinking about these new evidence categories they've introduced. And some of the things that we've created, we've created a Chloe prompt sheet. So this allows people to basically focus on the old Chloe prompts that are going in the bin and see how they fit under the new quality statements. Um, we're also developing a big Excel sheet that will help services to kind of go through the scoring process, the new evidence scoring process themselves and kind of test it out and see what their service is looking at.

So those are some of the things we've been put together along with webinars and kind of other kind of various information sheets that we've been putting through.

It's really important though, isn't it? I mean, the, the Chloe prompt sheet that you've just mentioned, I think that sort of thing, you know, like you said, there's a big shift from, you know, the Chloe to the priority statements, um, to the quality statements, sorry.

And, you know, to kind of have that for, for those that work in care, you know, we've talked about the fact that everyone's Busy, everyone's on their hamster wheels, so to kind of get off that and learn something new and really understand it.

I think one of the things, it's about time. It's about, you know, thinking and change management is always a time process.

And there's one, that's one thing that a lot of services and a lot of service managers don't have a lot of space for, which is to take time. So we're trying to do some of that thinking to help services move their processes along. If we know that Chloe prompts are, you know, they're gone, they're going to be in that C 1.4 C 1. 3 that that's not going to happen. How do we expect a group of services to suddenly click into a new mindset? So we're just trying to kind of create that bridge between the old Chloe prompts and the new quality statements and just help services to move their thinking along again. It's kind of stuff we do with our training as well.

It's about helping people. Move and shift their thinking. I mean, CQC started releasing a lot of this way back in kind of April 22. But everyone's busy. But because of what we do, we spent a lot of time looking at the thrilling CQC webinars, looking at all the various outputs, changes to the website, so on and so forth.

So we've kind of been In this mindset for about a year and a half now, it feels kind of like well worn in shoes for us, but we're aware that when we speak to services, it's just, it's, it's only just starting to come into view with, you know, the news of the November launch for the South. So we're just trying to share what we've seen, having kind of tracked this and kind of kept a close eye on it over the year and a half, and just trying to create resources that are helpful as we manage the transition period.

And the way I described it recently was. You remember when you're at school and there's someone that tries to grow their hair long and there's that really awkward bit where their hair isn't short and their hair isn't long. That is where the care sector is as we're kind of going between these services.

And we're just trying to accelerate that and help people through that tricky stage so they feel a bit more comfortable, um, as we move through to the new system.

I think that's quite a nice analogy, actually, because usually that's the point where people just go and get it cut again.

Well, exactly. And unfortunately, there is no chance of it getting cut again.

This change is happening. And so it's about making it as smooth a transition as possible. And you know, I'll hold my hand up. I quite like the framework. I don't think it's perfect. I think there's going to be challenges and CQC knows that. What I think there is a gap with at the moment is that support and that comes to help services transition over.

Um, there's been a lot of work with pilot. services, which is great. But 99. 9 percent of services that exist are not part of those pilots. So we're just trying to help with some of the comms and resources and training and stuff that we do just to help that transition feel a little bit smoother and a little bit less sudden and chaotic.

That makes so much sense though, as well, because People don't like change, you know, you get an update on your phone and everyone's like, Oh my gosh, where's this? I hate this. You know, it's, you know, people don't like that instant change. So when there's a, when there is a change that's happening, that is actually a really important one, but to make that easier and simpler for, for people to get to grips with it.

It's really important. I think the other thing we have to bear in mind is we have to think of, we think of the care sector, we think of care services, really you've got three or four layers of people, all with different experiences, all with different levels of responsibility, and possibly, obviously it will change on the individual, different levels of comfort.

You know, there'll be people who've just started work in a care service, they've heard these whispers that the framework is changing, and they'll suddenly think, oh my goodness, is this, It's not the job for me. Is this, is it all going to change? Um, it's about helping services think through how do we pass, how do we cascade this change so that we don't lose staff. We don't have burnt out people. We don't have stress. We don't have whispers from residents, family members, people we support who are hearing that there's big changes. The reality is good quality care is good quality care. Um, they've not kind of completely changed the game in that. Space. What they've done is they've changed the way that that's going to be collected, the way it's going to be evidenced, and the way that they are framing all of that.

I described it recently, it's like, imagine you've got a puzzle with 100 pieces. All of those 100 pieces are still there, but now the puzzle is being reorganised to make a different picture. So there's not a lot of brand new, Oh my goodness, we've never done that before, stuff within the framework. You look through the quality statements and you go, Oh yeah, we do 99.9 percent of that. There's a few interesting new ones, which we can talk about a bit later. But fundamentally this is about how the CQC now inspect, support, gather evidence, and frame and communicate all of those points to care services, which is just helping people move with the shift and make it a slightly more comfortable experience.

That's a really key message that as well. I think that actually it's not all of a sudden all of this new stuff. And I think that's the bit that scares people is we don't know how to do anything, but actually. Everyone knows how to do it, they're doing it, but it is that shift in how to change it.

There are a couple of new ones that I thought were really interesting.

When I was doing some training yesterday, um, the service pointed out that that feels new, but also makes sense. One of them was around workforce well being, enabling, which is now its own area within the caring key questions. So the idea that being a caring service, not just caring for the families, the people you support It's also now directly the well being of your staff. That's something that a lot of services will have been very aware of, but now it's very much enshrined in this framework as something you will be scored on and you will be assessed. So that feels like a bit of a change. And also right at the very end, right at the end of Well Led, I think, not that I want to over interpret, but there's certainly something about the fact that it's the very last quality statement.

There's a quality statement around environment and sustainability. So looking at the environmental impacts and the processes around sustainability in homes, that's kind of a newer experience. But overall, you know, things like assessing needs, medications, optimizations, kind, compassionate, safe, effective stuff.

These are all things that services do, and it's just Reconnecting this new framework with how people carry out their day to day care and how they now evidence that in the new framework as well so they can prove that is what is often about. How do I prove that what I'm doing is what I should be doing? Yeah.

And, and yeah, that's, that's, that's the challenge that we're trying to support people through.

You briefly touched on in, when we were just chatting there about the Excel sheet that Oh, yes. that Care Research have developed. So this is to help services score their evidence and automatically generate the quality statement, key questions and service ratings.
Um, I know there's obviously work to be done on this. Yeah, But, um, do you want to just tell us a little bit about what What that is.

Yeah. So I think one thing I need to do very quickly, um, is just explain what scoring is. Some of some of the listeners will have been going to the webinars and reading up and we'll know this, you know, to the T. Others won't. Long story short, you've basically got what we have at the moment is someone comes in, they do an assessment and they go right for safe. We're giving you good for well led. We're giving you. Requires improvement and then you have kind of three pages of text to read through and that's it and it's kind of up to you to kind of unpick that and interpret whether you feel that was an accurate description.

They're now putting in um, evidence categories and more importantly a scoring system so they're going to score evidence. You've got your six evidence categories and they're going to score your evidence against each category. Those scores will aggregate. to a score at the end, which will be a quality statement score.

Those quality statement scores then aggregate again to create your key question score. So safe, effective, caring, responsive, well led. And then those Um, scores and aggregate to your final score. As you can see with your eyes kind of looking up there, this of seeing, which is why we created, um, an Excel sheet that will enable services to start scoring individual bits of evidence and watch what happens to their quality statement scores, watch what then happens to their key question scores, and then as a result, watch what happens to their final service rating.

So it's really, it's a, it's a tool to play around with, it's a tool to help you kind of experience the new ratings. And scoring system. It's also a tool for you to monitor your own evidence. And go, okay, um, We think we're doing this well in this area, but not so well in this area. And to kind of have a bird's eye view of, okay, our score in this area is bringing everything down.

For example, because there's lots of other, there's a couple of extra rules around how if you get RIs or you get inadequates, they have an impact on. What your score can be. So there's some interesting limiters that we might discuss a little bit later. The Excel sheet is just a way for services to play around with that, experience it, get their heads around it, but also potentially use it as an internal audit tool to just kind of keep a track on, okay, if we're asked to send this evidence, we believe it's a three.

So that means that our quality statement score goes to this, which means our key question score goes to this, which means our service rating goes to this. Um, as I say it out loud, it sounds very tricky and complicated. It isn't as hard as it sounds. Um, I would recommend cqc. co. uk forward slash assessment.

It is a great site. You know, they have done credit where credit's due. They've done some good work on putting some of the core information. So, again, to kind of look through that and see that to understand the scoring. Yeah, our Excel sheet, which hopefully we're waiting CQC, particularly around how they round numbers up and down.

Because if an average is 3. 2, are they going to call that 3? Are they going to call that? So we're just waiting on a little bit of extra work so that we have confidence that we are exactly matching the scoring process. Um, and once we do, we'll let you know and you can communicate that.

That sounds really exciting though, because again, I can imagine, you know, like you said, those scoring mechanisms and things like that, they're not the easiest to sort of understand how stuff impacts everything else.

So to be able for a service to be able to sort of pinpoint, actually, that's the area we really need to fix. Yeah. Because. That is impacting this, this, and this. Yes. Is quite a big thing.

It is. I think one of the things that we've found really interesting is When we were talking to services about this, first as initial, oh my goodness, this sounds intense and horrendous.

And then when you explain, do you know what this does mean though? This means that when you get your report, you know exactly why they've given you the rating. Which means two things. Number one, you can more directly combat it if you feel it's fair. Number two, through the development of things like the online portal to upload evidence, you can fight back and go, okay, you gave us a two gave us an R.I. In this particular people's experience evidence, for example, or this particular process evidence we've done. We've done things. We've changed it. We want to re upload it so you can review that and change our rating. So it means that there's a lot more opportunities for services to have a much clearer view of why they're getting the rating.

That's that's um, that's the problem that has kind of played services. You know, there's a service down the road that's got a good. You feel you're doing exactly the same and you're getting an R. I. You know, was it that the inspector just got out the wrong side of the bed? Is it that they didn't like or didn't understand the forms we were showing them?

This enables you, instead of having to kind of go through the whole document and try and with a highlighter find what you might need to challenge, this helps you really clearly see. This is why we got. this mark in this area. This is our final grade because of that mark. And you can start to develop appeals processes.

You can start to resubmit evidence on that specific thing. Enable services to kind of be involved and challenge more clearly, um, what, what CQC has said about their service because it's so much clearer now. Um,

Definitely. I mean that, um, we're going to chat a little bit about feedback. I mean, feedback is something you're very passionate about.

It's my daily bread. Yeah, I think a lot of people feel the same. Um, and it's obviously going to form quite a big part of, of this new, new framework. Yes. Um, So how can providers basically make sure they ensure that the information is captured continuously as well? Um, and without that time burden, I mean, we all know that, you know, the thought of going, actually, how do we, how do we do get this feedback? And the continuously bit I think is the really important bit as well.

Yeah. So I think there's two things. So first of all, because obviously, See, I know people will be in different spaces with the CQC framework. You've got the 34 quality statements, which is what you should be doing. Um, and then you've got the six evidence categories, which is the type of evidence that CQC are going to potentially ask to prove that you're doing the things you're supposed to be doing.

And 50 percent of those. evidence categories are now feedback related. So we've got people's experiences, which are kind of the people you're providing care for and their families. Um, you've got feedback from staff and leaders, so your employees and SMT and so on. And then you've got partnerships experiences, could be GPs, it could be consultants, it could be community groups that you're a part of.

And then you've got processes. Outcomes and observations and what we've seen working with services processes on board. They've been doing processes forever. We're great. We love them. Observations. Observations occur. They do their own internal and external observed audits. Outcomes. I've got a wonderful piece of tech.

They can press a few buttons and outcomes. All of the information around, you know, meds dispensing and all of that. So they're on it. And then you say, yes, but now your rating, because everything's going to be scored, your scores for your feedback could tank all the great stuff you've done in your processes, outcomes, observations.

And that's come as a bit of a surprise, but it's a welcome surprise, because what they're saying, CQC is saying, actually, we recognize that someone driving up the M2 and doing about six hours sitting in your service, looking at things that you printed for us, is not how we tell. the care service is good enough.

Obviously, I know they always will try and speak um, to people and connect externally. I'm, you know, I'm exaggerating. But this idea of feedback from people, feedback from people receiving care, from families, from staff, from partners, is now becoming a central way. In fact, they use the phrase central to our judgment.

They are, um, openly stating that we are using feedback to check whether what What we see is happening is consistently happening. I think that raises a few issues for the care services because different services will be in different places. Some of them will have kind of the word document that they kind of try and hand out and they stick it in a drawer and that's kind of as much as it goes.

That's going to have to change. Feedback is going to have to be something that's built into the culture of your service. I think the three things that make feedback work are anonymity, accessibility, and purpose. The anonymity, people think, oh, well, you know, um, they don't have to write their name, so it's fine. But actually, we all know what certain handwriting looks like, for example.

Or if you've got 20 staff members and only one of them speaks English as an additional language, you may be able to clock who that person is. Or if someone has frequently raised an issue, And they then raise it again in that survey. And again, oh, okay, we know who's, we know who's been saying all this. And without that anonymity, what happens is people don't say what they really think, and what they really feel.

And then when CQC, under this new framework, do Teams chats with your staff, or send them directly a CQC formed fill in, well then the floodgates will open, because they'll finally be able to actually say what they really think. And we've had clients who've said, we never, they've never said. these things before.

I was like, well, you have a question like, what do you feel about the home manager? And then at the bottom of the form it says, hand in your response to the home manager. I'm sorry, I was exaggerating, but we've seen it. Um, and I think it's making sure that anonymity enables people to be truly honest. And with the new CQC approaches, I mean, they're going to be gathering a lot of feedback outside of yourself.

So you need to make sure that the way that you're collecting feedback ensures that people can be honest. So they don't get the first chance when CQC goes. So tell us what you really think. And then they kind of... tell you a whole bunch of stuff they never told you because they didn't feel safe. It's one of the things as Care Research that we offer is that because we are an independent group, people really can be honest because we genuinely don't know who they are.

Um, and we can kind of act as that middle management. I think the other, sorry.

I was just going to say that's the other side of it as well. you know, it's feeling comfortable to do it, but actually it's having the reassurance that you are being anonymous, because even if someone says it is anonymous, sometimes there is that bit of you that's gone, is it though?

And actually, so to have something in place to give one you feel you can speak up enough to, for the reassurance that it actually is, you're not handing it to your manager.

No, of course, of course, you haven't got, I think one of the things that we offer, because as Care Research, we collect. Those surveys, whether that's paper, they can be sent direct to us or online.

The plus of it is that we then don't report it directly. So we don't kind of copy and paste the exact comments, then send it through. We make sure that we can ensure the anonymity of those responding. I think what that does is it helps people feel that I can be truly honest with this. Group, I can raise concerns.

I can raise issues. I can name names if I really have to Um, and i've always said to services services. Oh, yeah, but what if they say really bad stuff? I'm like, well if they don't say it to me And my team they're gonna say it to CQC and their team because CQC Under the new framework, I'm going to be doing a lot more work directly with your staff outside of your bubble.

They're not going to be turning up in your building and asking anymore. They're going to be sending Teams invites. They're going to be sending their own CQC forms. So unless you have another avenue, you may find the first true feedback comes via CQC. And that may not be... A great reflection. I was speaking to an inspector who was very honest.

I said, look, we're not expecting perfect feedback all the time. They said, what concerns us is if someone gives really bad feedback, we relay it to the service and they never knew. That's when we start having concern because it implies they don't really have an accurate knowledge of their service. So I think that anonymity issue is really, really important.

I mean, another one is accessibility. Are you only able to gain, um, views from people that are completely kind of with capacity, competent, able, facilitated? We've been doing a lot of work developing learning disability surveys, Makaton surveys, PECS surveys, video surveys for those who perhaps have vision issues and they can't, um, you know, use writing instruments, online surveys, paper surveys, phone call surveys, calling people and just having a chat and we type in the answers into our systems.

Because at the end of the day... CQC will find a way to get feedback from people, um, and actually as a service, if you're, to be really blunt, if you're taking money from people, you need to also make sure that you're hearing all of those people where at all possible. And so we're really kind of keen on making sure that your surveys, aren't one document.

If you've got one word document and someone, as part of their role, is having to run around talking to each person, um, that's not actually an accessible means. You're trying your best, but that's not actually truly accessible because, for example, if you're an individual with a learning disability and you've got someone sitting next to you who is someone that provides care for you and they're in your home and you know they're about to make you your sandwich or take you out to cinema and they ask you the question, How do you feel about the care you receive?

How on earth is that individual who already has potentially some vulnerabilities built into the situation. Can I then say, Ah, I don't think he always listens to me. And so I think that issue of accessibility is not just about, you know, are we doing it paper, are we doing it online? It's about who is, who am I saying this to?

Um, is this a means that I can do as much on my own as possible? We're really trying to develop this idea that, you know, an individual... whether it be someone with a learning disability or someone has auditory or visual issues, they'll be able to, in some way, open up one of our surveys and they'll be able to do it as individually as possible.

They'll press the play button and hear the question. They'll click perhaps a logo or an image rather than writing an answer. Instead of writing answers, they can press a video button and they can video record how they feel rather than scribe or type or write anything. If you don't get feedback from everyone, then you don't really have feedback.

You can't build a service on the views of 10 percent of the people you care for. If, if, in any other sector, in any other industry, in any other business, if we said, Oh, we've, we've, uh, we're only going to speak to maybe 10 or 12 of the 80 employees that we have. You, you instantly would have a problem with the validity of that information.

We think about, you know, you see things that, you know, 70 percent of people said this or whatever it is, you know, like on beauty products or whatever. Yeah, of course. And you always, I always look at the bottom text in the corner. Of course. If it's something like, you know, actually 70% of 30 people, yeah, I don't really trust that.

So it's exactly the same kind of perception, isn't it? Actually, you want that and you want that feedback from everyone. And actually, realistically, everyone's giving you feedback constantly because people have conversations, but it's capturing. That feedback isn't it?

And this is a big thing that, you know, we've been talking about.

So obviously, survey stuff that we do is part of that model. And, you know, what we do really helps services do that kind of formal survey stuff. Benchmarking, getting a whole service view. But we also need to recognize that that kind of idea of Constant feedback involves really thinking through the processes of how you collect information.

We had a really interesting one recently that was suggested by someone on one of our training days. They said, you know, everyone's going on that check in, check out system when they walk to the door. What if when they check out, it just comes up with a simple question. Um, tell us about something that went well today or tell us about something that You can improve or even just take a smiley face or unhappy face and how you feel really easy way to suddenly get hundreds of points of information over the course of several months.

It's all about having your armoury. CQC, you're going to go out and get lots of information about you. You need to make sure that that's not the only information out there because you want to be able to say, okay. This issue was raised by a staff member. We take that really seriously. Thank you, CQC.

We'd also like to point out that, you know, we had an independent group, for example, that did surveys with all of our staff. And actually, they've rated us as a three in this particular issue. It's about making sure that you avoid the open goal where CQC go, we found this and you go, Oh, uh, right. That's what you want to avoid.

You want to avoid the, uh, moment.

Well, it's going back to as well. You mentioned earlier about, you know, what if someone gives bad feedback? That's realistic. It’ s expected. Nobody's perfect. There's not a single business, let alone a, you know, care home or care provider that is 100 percent perfect. So if all of a sudden you are getting... All this perfect feedback that does raise a red flag.

Yeah Um, I was chatting to someone a few weeks ago about audits and they were basically saying that actually The red flags come for them when their care homes are saying their audits are 100 percent and going, well, actually, we know this is, this needs some work, but we're working on it because we're doing X, Y, Z.

Yeah. They're, they're sort of hiding that and going, well, actually, is it perfect? And it's the same kind of thing, isn't it? No service is perfect. So if all of a sudden that actually the realistic thing is that you're going to get some potentially negative feedback. But as long as you're. you can capture that and then you can look at it and go, well, actually, we can put this in place and that will fix that.

And

it's about improvement. I think perfect isn't what we're aiming for. Um, we're aiming for continuous improvement. We're aiming for, um, people led services, do that person centered care. That's, you know, what care should look like. But if we think about it as a service, why we want people led services. So getting those views from people, from everyone, making it accessible, making it anonymous.

So you really do get their view, not the view they're comfortable telling you. That's the way that you have kind of people led services. And that means your quality continues to improve. We're not saying that everything gets. Better and better and better all the time forever. But it's those little wins like, ah, you know, I remember a service that one of the surveys said that, um, there was some rubble in the garden and there was a bit of an access issue that meant that their relative was unable to go in to the garden.

So they got the caretaker to spend half a day. They rented a skip for a few hundred pounds. And suddenly that whole garden area is transformed. And the feedback the next time around, a few months later, was all about, oh, we've been really enjoying going out in the garden. We've loved having barbecued. And you just sit there and think.

This is something that wouldn't really have come through because no one might have had the confidence to raise it or say it. Um, I remember another one. Sometimes we think we're doing really well and we just haven't quite thought it through. I remember, you know, services that are really proud of the wide range of food options they give, which is great.

You know, it's good to have huge options of food. But what came through in a survey was that some residents were saying the menu's just a bit confusing. I'm finding, I've got like nine mains, nine desserts. And nine possible snacks. And it was kind of, typically, but not exclusively, relatives kind of saying, you know, I think, you know, my father finds it a bit tricky to know what to go for.

Almost a bit overwhelming. Yeah, and it didn't mean they suddenly went, Right, we're going to bin all of this. But it did mean they had to think carefully about, Oh, maybe we need to diversify the menus. Offer smaller menus, but more targeted. So we know that this person's a vegetarian. Let's make sure we're only giving them a Instead of highlighting those that are vegetarian.

Let's just give them a paired down menu that just has vegetarian options. Okay, we know these individuals You know are vegan or we know these individuals have particular food Right, so rather than having a massive menu with everything they offer and then a little symbols next to everything it was just tweaking the menu content and it's those little wins that are really valuable and that enable you as a service to prove that you're listening.

And that's what CQC are looking for. They're not looking for you to create the perfect service. They're looking for you to demonstrate that you are a listening service that has people at the centre.

And that, those examples you've just mentioned about being able to go out in the garden and the menus, that improves the quality of life of those residents.

Hugely. Which is ultimately what everybody wants to do.

We want to have a great time in our space. Um, you know, it's, it's, it's really important that that feedback enables, not just quality of care and compliance, it's about just having a good time. You know, that's really at the day. You know, when I think about myself when I'm retired in several decades, um, I, my hope is that I enjoy it, whether I'm in a home, whether I'm receiving home care, whether I'm in some other form of facility.

Um, and so making, I think it all boils down to this. Are you happy? Is there anything that can make you happier that's within our, our capacity to do it? And that's what feedback's about. It's about what's, what's making you happy, what's not making you happy. Obviously, it's more complicated than that. But that's the fundamental question.

Are people having a good time?

You mentioned, um, one of the other key points in that participation. So obviously getting, getting people to, because it's, we want to capture all this feedback. How do people encourage people to participate in, in feedback?
So I think there's a couple of things. One of the big things I've talked about in the past is the idea of purpose. What we often see, and we've been guilty in the early days when we were first starting, we would put these on our surveys. They would say things like, um, so and so service is really passionate about high quality care. Um, this survey will enable us. To improve our care. And you kind of sit there and think, I don't really care about how this affects your life.

It's like, you know, a few days ago I stayed at a kind of one of those nice little cheap hotel room. And of course I received an email saying, Hi to us, and I didn't bother doing this at all because their opening spiel was this helps us improve our quality. Well actually if the purpose is that I'm telling you stuff so that you can do your job better then I can't be bothered.

What's a more valuable statement is, um, you know, this survey is there for, you know, to improve our care. We will share the results with everyone in a month's time, and we will have one to one catch ups with anyone that raises negative feedback that wants to talk with us. Obviously, that would involve them if they wished leaving their name, if they wanted to.

Um, but obviously, as an independent, we can pass on that information, you know, um, sensitively. It's about making sure that services, um, are framing it in a way that this is for you. to communicate with us rather than this is for us to prove or demonstrate. our own quality. That's how you're going to use it.

Of course, you're going to use it as evidence. You're going to use it potentially even as marketing collateral, but that's not how you frame the thing to the people that are giving you their time. I think another reason, another way to kind of boost up the sign up is, you know, using online tools is really helpful, particularly for staff, um, and especially for, for younger staff or staff that kind of very tech savvy, a three minute questionnaire.

On an iphone on their ipad is much more appealing than a paper version. I'll say I remember one client And I'm not exaggerating here. They asked us to create a questionnaire that had 57 questions. Wow. Now, they were all very important questions. They were all very good questions. And I got their logic from a quality perspective.

We need to know all this information. But, um, When you then get three responses that are complete versus, say, 112 that have the first four questions, you sit there and think, wouldn't it be more useful to have done a 10 question questionnaire that 112 people complete than a 57 question questionnaire that three people complete?

So I think you've got to bear in mind that what you do... Um is not actually that Important to the people that you are asking questions for they care about their own lives their own sphere of influence So staff don't want to ask answer 40 questions about how well led You think you are. They'll happily answer two or three about their experience working for you, but they're not going to answer 40 questions about, you know, the governance structures and those sorts of things.

It's about thinking, could I be bothered to complete this? Because if you can't be bothered to complete this, and you're the one that's running the thing, of course your staff team, families, um, people that you're running, care for are not going to feel bothered. So I think it's pitching it right as well.

So again, we do a lot of work with our services. You know, we don't just kind of create them on our own. We work with you. We go, here's our recommended questions. They come back, maybe offer some more. And we sometimes have to remind people, look, I know you want to know all of this, but let's do two or three over a year rather than doing one absolute.

I think, you can use this as my soundbar, I think the annual survey is dead. The annual survey is dead for three reasons. Number one, CQC wants continuous feedback. So the feedback you got in January 2024 is not relevant, you know, six, seven, eight months. Secondly, I think the amount of stuff that feedback is required for, you got 34 quality statements.

Some of those quality statements have two or three areas built into them. Unless you are going to create a 60, 75 question questionnaire, you're not going to cover everything. In that questionnaire. I think the third reason, I think people have less and less time. I

was going to say, time's a massive one, especially for staff.

Totally. So, you know, one of the things that, you know, we've, we've been kings of the annual survey for many. One of the reasons why we kind of got so involved in the CQ C world is we sat there and thought, oh my goodness. Our business model is is annihilated because my goodness, feedback on the one hand is going right up in importance, but continuous feedback and the way that they want to see that feedback means we have to totally change our processes and that's exactly what we've done.

And so we now kind of do two, three, sometimes even quarterly surveys because it's better to do several short things across the year. than, you know, the annual survey, which isn't going to work from evidence point of view, from a CQC point of view, or from a volume point of view in terms of the amount of information you collect.

Well, I think that works as well, because like you said, they want continuous feedback, right? You can ask people quick, short, sharp questions. Totally. Something we do at, um, at Radar Healthcare is, so when we're getting feedback just from around the businesses, we do our quarterly, sort of. Maybe 10 questions, but every month we have what we call a pulse survey.

So we go into our system and it'll pop up and it is three questions and it is literally a, like almost a yes or no type of thing. Um, and it takes 30 seconds. So the involvement of you sort of logging in and going, rather than going, Oh, I've got to fill that in. You just go. All right, okay, I did it. Done.
Yeah, totally. And it's a totally different perception of what you're doing.

Totally. I mean, we've got this idea, we're kind of piloting and working on the idea of like the flash survey, which is the idea of, again, two or three questions that we do regularly. We're thinking particularly one of the evidence categories is feedback from partners.

And we know that, you know, GPs are really busy. They might have a hundred homes that they're providing medications for. Why would they complete a 20 question survey about... You, one of the many services that they work with. So we've been kind of thinking about, you know, are there one or two or three question surveys that can be continuously open, um, that mean that, you know, it's always the same link, it's always the same questions, and maybe every quarter we just check in and see what responses have been left.

Because it's better to have the core points. consistently available, then again, sending out a 20 question survey to someone who isn't really invested in, in giving you that amount of time and feedback. And I think certainly with partners, there's going to be a bit of that.

Yeah. I love the idea of, of having something on the, like you said, as they check out as well as, that is, it might just encourage it.

And it's working out, different feedback will come from different places in different ways. Whilst I think the idea of the annual survey, um, is tricky, I think the idea of kind of a more formal done, perhaps twice a year, three times a year, maybe even quarterly, has its place because I think we need that, we need that framework in which we can go, okay, across our services, everyone is saying, So we need that, but we need to also work out what are these quick wins?

What are these quick ways of collecting information? And digital is so important, because when we're uploading evidence to an online portal, a paper document that someone has written on, you're going to have to get that onto an online portal. So whether, you know, someone's going to be up till 2am scanning all these in, um, there needs to be some thinking around capturing things digitally as quickly and effectively as possible.

Yeah, definitely. Um, I'm going to touch a little bit on the priority quality statements. So, we, obviously this, at the time we're recording this, um, in September, they're still to be released. Yes. I just want to get your thoughts on what, you know, what's been said so far and what you think.

So, firstly, I just want to say, I do quite like CQC.I think they're, despite what I might be saying in a moment, I do like them, I get their model and I'd actually, I like 99. 9 percent of the new framework. What I said earlier is that communications has been challenging and that's to be expected. We're talking about a national overhaul of a framework system that is being applied to all healthcare.

That's why it's the new single assessment framework. So it's the same framework with your dentists and ambulance care. So. All of that aside, one of the challenges is that we've kind of been drip fed information, um, and one of the bits we were kind of surprised drip fed was during one of the webinars. If you go onto the CQC YouTube channel, I think it's about 57 minutes long, it was done mid August, you can watch it for yourself.

One of the questions that everyone has raised is you've got these 34 quality statements, you've got evidence categories and scoring, those scores get you final grade. How on earth are you going to launch this because Are you going to assess all 34 quality statements against all six categories for all homes like in a week so that you can give everyone their full rating?

Um, is it going to be drip fed? And if it is drip fed, is it going to be random? How do we move? Um, and, and the point that was raised is the idea that they're going to develop priority quality statements. So essentially what they stated was these are going to be, of those 34 quality statements, we're going to identify a subset that are going to be used as kind of our first Benchmarking exercise.

We're going to be looking at services, um, against these specific quality statements. The two things that we're waiting for, bless them, are those priority quality statements. And, and credit where credit's due, there's a lot of thinking, a lot of planning that has to go in. I do understand. So there's, we want to know what those priority quality statements are.

The second thing that we're also waiting from CQC is, uh, from is which evidence categories Go with which priority quality statements and and the quality statements in general Some of those are easy to note. So one of the quality statements workforce well being enablement, of course feedback from staff and leaders It's gonna be one of them is processes Is outcomes?

We don't, we don't know. Um, are things like medications optimization definitely processes and outcomes? Will feedback from staff and leaders be part of that? Will people's experience? Are we going to expect, um, individuals receiving care to, to raise their voice about their experience of receiving meds? Or is that?

Not really where they want to go with the meds. They want to focus predominantly on the processes, outcomes, observations. So there's, there's, um, there's two missing bodies of knowledge. What these first quality statements, priority quality statements going to be that we know certainly for services in the South, for whom at present, we're told that the framework will be in place from the 1st of November.

And then secondly. What's the pairing behind the evidence categories and the quality statement? So we know what to collect to evidence for each quality statement. There was a really good question someone asked, which is, you know, what's happened to the Chloe prompts? As I said earlier, the Chloe prompts have gone in the bin.

Um, and when you look at the quality statements, I remember I was with a client this week, and I was showing them the quality statements and... They looked at me and said, is that it? I mean? He said, so you're saying for medications optimisation it's that sentence? I'm like, yeah, I mean the quality statement is exactly what it says what's in.

It is a statement, it is at best two or three sentences. Um, and I think there's, what CQC were asked is, what do we do with these very broad sentences? And they responded very openly and said, the way that we will differentiate between services and what services need is which evidence categories will be needed for which quality statement and that will change based on your service. So a domiciliary service is not going to have the same evidence requirements for a particular quality statement as a residential service or an ambulance or a hospital ward or a mental health unit. So that's a big. big, big missing piece of the puzzle.

What evidence categories are going to be in place for what quality statements? Because that dictates what feedback we get from whom about what. It dictates what processes are being kind of front line versus what processes perhaps are not as priority. And then obviously with the priority quality statements, what are they going to look at first so that we know.

Now there's a bit of a bit of interpretation. There's this idea that They're going to try and look at a number of services early against just these priority quality statements. In theory, that could be in a month and a bit's time in November. Um, so yeah, I think there's some question marks around what the quality statements are and how the evidence categories relate to each quality statement.

Well, hopefully by the time this goes out, then we'll have some more information on these. But yeah, it is an important thing because people want, it's very difficult for people to start planning. what they need to do, in terms of, you know, different things they may need to implement. Obviously, we've just chatted a lot about feedback and if you don't know what's going to link to what, it makes that a little bit more difficult, doesn't it, at this stage?

Yeah, I mean, one of the things, I've seen both sides of the argument, because when, um, there was a webinar that was cancelled and there was a bit of an uproar, and I'll be honest, I kind of post about it to let people that I'm connected with on LinkedIn to know this webinar because I've done a lot of work to promote it.

Everyone watch this webinar. It's going to be really important. And there were, you know, there was some that kind of, you know, CQC bashing is a very real thing. You know, everyone likes to rail against what they perceive as an authority. But they're also, um, you know, I remember one of my contacts in LinkedIn made a really, really challenging and thoughtful post around, actually, this is a huge shift, um, a national program that is being shifted and developed. We've got to allow them to do it well. But on the flip side, there is this concern for providers, like, what do we do? And I think one of the reasons why... I kind of got a bit of attention, but why people started to tune into our webinars and download our Chloe prompt document is because I was willing to put my head above the parapet a bit.

I was always very open and say, look, this is just based on what we know. This could all be wrong in six month time when they tell us more, but at least. There were some people that were saying, okay, this is where it's heading. And I think there are two ways to think about CQC. One is that we want to get it in.

We want to kind of work with them and get everything as, as the information is being drip fed so that we're ready. And there are some servers that I know that like, I'm just ignoring it until it fully lands. Because until I know exactly what I'm dealing with, I'm not going to trouble myself with it. And I think both modes make sense.

The only criticism I have of that second one is there is so much changing. That it might be too late if you wait for it to be in place, because there's a whole lot you'll have to go back and catch up on. And that's why we've been trying to kind of bring people along the journey, even though things have changed.

What they defined as observation change. They used to describe it as one thing. Now the observation evidence category is a different thing. But that's fine. It's better to be a part of the process than wait until it's landed and possibly have a huge amount. to catch up on. Yeah.

What would you say your, so obviously we've chatted a lot today, we're waiting for a lot of information obviously still from CQC, and we know that that is coming.

But we know we are waiting for it. But for sort of care providers that are listening to this, what would your, maybe your top three, four tips that they can start and maybe look at what they need to do.
Very first thing is go to the CQC website, cqc. org. uk forward slash assessment. Everything that we know.

So you can start to spend a bit more time thinking about evidence categories, what the quality statements, what the evidence categories, how's the scoring work, just so you've got that foundation. Those really are the three main things to get your head around. What are the quality statements? What are the evidence categories? How is the scoring work? Once you've got that, then you're kind of 80 percent of the way. I think the next thing is to have a really serious look at your feedback processes. Um, what we've seen when we've worked with services and audited services evidence is processes, great, outcomes, great, observations, great.

Because that's what the old framework was. It was almost exclusively, or it felt almost exclusively like that. There were other things CQC were doing to gain feedback, but it didn't have the same prominence. It certainly wasn't equally weighted. And so I think a lot of services have recognized, ah. We need to review our feedback processes.

Um, it may be that you partner with an organization like ourselves. It might be that you kind of work with your quality team to develop something, but your feedback processes have to be better than they currently are. And I can say that because no matter what service you are running or how well you're doing your feedback.

It will not be at the level that CQC is now expecting. Um, and I think the third thing really is to start to share information sensibly with your staff. I think what I've found is that a lot of our webinars, a lot of the downloads of our ChloePrompt doc, a lot of our training days have been full of SMT and leadership.

which is great, that's important, that's crucial, that's vital, general managers and so on. But fundamentally, this focus on feedback from staff and leaders and this move to quality statements is also about empowering care staff to be more involved. You know, we want to move away from the general manager at 3am, panically downloading everything for the inspection tomorrow.

That's one of the things they're trying to avoid. They want continuous feedback that's more collaborative, that is developed and collected. So there's, there's a piece of work to be done around. Effectively communicating these changes to staff. Um, and we have some, we have some work, and we have part of our training day we talk about how to put this over to staff without terrifying them.

There's a very real sense that if people feel that the change is too big, they'll leave and they'll go to a sector where change doesn't really happen. They'll go and, you know, work in a supermarket, which is nothing wrong with that whatsoever. But there's lots of great people in care that just need that little bit of extra support so that this shift doesn't become, um, a worry or a concern or a place of anxiety.

Yeah. And it's, I think they're great tips as well. And, you know, ultimately this change is happening to improve things, to make sure that the, you know, the quality of care everyone's getting is the best it can possibly be. And ultimately that is what people going to care to do as well. Definitely. It is so important.

I mean, one of the things that I found really encouraging, um, when I was kind of, talking this through with certain, you know, various organizations, a lot of people get it. They go, actually, this makes sense. Like, you know, my, my father's 76. Um, you know, he's, he's well and he's fine.

He's doing fine. But were there ever a time where we had to look at any kind of care, whether it was care within the home, whether it was care, um, in a residential setting, I know as someone that's worked in the sector. What the current CQC reports are really saying most people don't so actually to be able to click on a report Hopefully in the two three four five years time and see number scores against safe effective caring responsive Well led and then to see deeper each of the quality statements kindness compassion dignity. They've got three. They're good. Okay Well being staff well being enablement. They're two. All right. Okay, they're not doing so well there that kind of quick Kind of one visual gulp to be able to see actually this is all the nitty gritty details of where this home is at That's so much more valuable and so much more useful to me as someone searching for a service Um to know what's going on and also to see that this report wasn't written four years ago This has been updated as recently as three months ago, and actually that quality statement was updated three weeks ago.

That quality statement is four months old, but they haven't had any complaints, which is why they haven't reinvestigated it. So I think for people choosing services, this clarity, the use of the scoring system, is going to be really helpful. Um, but for services, There's a few kind of mind shifts that have to happen for them to be able to put it in place and work with it.

Yeah. And what about you? What about care research? What's, what's next? Obviously, there's a lot going on, but what, what, what's in the pipeline or what, how do you see like the future of care?

Yeah. So I think right now, so between now and March, we're doing a lot of work on creating documentation, creating information, creating webinars to help people ease through this process.

We're doing a lot of training days. Um, so we're trying to do full day trainings in care services just to help them feel ready. So that's a big piece of work we're kind of doing at the moment, um, over the next six months. But alongside that, we're really spearheading our survey service. We're making sure that care services know that there's a way to get feedback from clients, feedback from staff, feedback from families, feedback professionals, and have it all done end to end by an independent body and have documentation that really hits.

It's directly mapped to new frameworks. We really kind of grow that and kind of push that more. And kind of as a sub side of that, we're doing a lot of work developing, learning disability surveys. We want to be, we want to enable everyone's voice. And we know that the paper survey and even like the free online survey month survey, that's not going to do it anymore.

And the new framework has kind of put into focus what we all really knew, which was that. Does a CQC report really say what people feel like at the moment? No, it doesn't. So a lot of our work is developing those, those surveys so they're the best that they can be, and kind of working with, with more groups and kind of helping them get their feedback on point and make sure it fits the new framework.

Um, alongside that, Um, I'm also kind of, uh, a partner in the development of a program called Care Tech Guide, which is launching October, um, which is kind of a tech marketplace, which is an exciting kind of little, um, project that I'm involved, I have some involvement with. Um, but yeah, with care research, it's mainly about getting people trained so they feel equipped for the new framework, and making surveys, um, as best as, as we can, and enabling people with learning disabilities to finally be independently heard. Um, as part of feedback collection,

I love that. Um, what you've just said about, you know, enabling everyone's voice. Cause I think that's so important. It's, you know, a massive thing. Um, and maybe we'll have to get you back on next year to talk about care tech. Yeah, yeah.

Maybe so. Yeah. I'm more than happy to.Yeah, yeah, yeah.

Um, so. At the end of every episode, we ask everybody what their What the Health Tech moment is. So this started when we first started the podcast. Um, we've heard some weird stories, we've heard some wonderful stories, we've had some emotional stories. So Louis, what's your What the Health Tech moment that you'd like to share?

So I spent a long time thinking about what is my What the Health Tech moment. I think I even sent you an email going, I don't know if I have one. And one struck me a few days ago. I realized what my first ever. experience of health tech was and it was my great grandmother who's no longer with us. Um, it was her 95th birthday.

Um, and I would have been about six or seven and my mother, bless her, who is lovely and is a living legend. But in this moment, she made a misstep and decided to put 95 individual candles on a cake. So she didn’t get a nine and a five. She got 95 individual single candles. She set fire to them and of course all the wax melted, the cake and then the table caught on flames.

And then my great Nan, so we're talking, what, 1994 maybe? She had one of those little red buttons. And I distinctly remember my grandmother, not framing it, my great grandmother, not framing it very well and going, Help. My granddaughter has tried to set the house on fire, which clearly is not what was happening. She was trying to celebrate her birthday. Um, but yeah, so my first ever experience of health tech was thinking at the time, the power rangers was a big thing. I was like, my great nan has like this power ranger button, like she presses it and she can like speak to people which is amazing.

So, you know, that was my first ever, um, introduction to health tech. It was also the first time I ever nearly got burnt alive. Hopefully the last. Um, yeah, hopefully the last. Touch wood. so that's my health tech moment, my great Nana on her 95th birthday, um, using her little red button to call for help.

I love that. Not that they nearly burnt the house down, but there's just that moment of actually like, you know, tech has been around for a while and to think that actually, you know, it was. It's improving the life of, you know, your great nana in the 90s, and look at where it is now.

Oh, totally. I mean, now she'd probably have an app that would warn her that her house is about to catch on fire. Probably, yeah. Um, but yeah, no, it's a great, it's, it's a weird memory, but it's, it's one of my earliest.

Yeah. I love it. I think that's a, a great, a great memory to end the podcast on. So Louie, thank you so much for joining us this week. It's, You know, I know our listeners are going to find all the information that you've, you've given us so, so helpful. So thank you. Um, and we'll share obviously the links with, for Care Research and the documents and things like that, um, in the, in the podcast notes as well.

So thank you very much. Thank you for having me.

Um, and thank you everybody for listening. Join us, um, in a couple of weeks for another brand new episode. Uh, don't forget to rate and subscribe. And if you've got any questions for us, um, or Louie, then please email whatthehealthtech@radarhealthcare. com.