How will the CQC’s new framework impact learning disability providers?

The Care Quality Commission (CQC) have developed their new Single Assessment Framework, following nine months of engagement and interactions with providers, people who use their services, and other stakeholders.  

Having just 34 topic areas across five key questions means that learning disability providers will be much clearer about what the CQC are looking for in their assessments.  

In this blog post, I explore how the new framework will impact learning disability providers in four ways, with tips on how to prepare and stay one step ahead.  

1. Increased emphasis on person-centred care  

The recent framework emphasises the importance of person-centred care. It promotes choice, dignity, and involvement in decision making.  

For many learning disability providers, this won’t be a significant change. However, for those that may fall under the old healthcare guidance, like long stay services, this is going to be a drastic change.  

The roll out of person-centred care will see a huge focus on family and loved ones being involved. With the consent of the individual, we know involving family members and support networks in decision making processes can contribute to a more holistic and effective approach to care. ‍

Tips to improve person-centred care for learning disability providers

• Implement relative meetings
• Establish clear communication channels which can be captured as evidence
• Review all care plans and ensure that they are comprehensive and individualised, detailing the person's needs, abilities and preferences
• Ensure information is provided in accessible and understandable ways for service users to understand
• Encourage activities that promote independence and enhance the service user’s ability to participate in daily life and evidence positive risk taking.  

2. Simplified quality statements

The key questions (Safe, Effective, Well-Led, Caring and Responsive) are not changing, which means there will be some stability for learning disability providers.  

Instead of the 330 Key Lines of Enquiries, these are being replaced with 34 quality statements. Having 296 less things to focus on will help improve overall understanding and quality, and the CQC hope it gives providers a clear definition of what good care looks like and what their expectations are.  

How learning disability providers can apply the simplified quality statements

• Prepare a record of incidents or significant events from the last 12 months, including investigations, actions taken, and how you implemented the learning from the event
• Prepare a record of complaints received in the last 12 months, including lessons learnt and actions taken
• Review and update your business continuity plan
• Ensure you are undertaking regular staff, relative, professional and next of kin surveys, and evidence lessons learnt, and actions taken
• Read up on the quality statements, involve your team and begin pulling evidence to meet each one.

3. Quality of life framework

We know that the CQC drafted their quality of life framework. The primary purpose of the quality of life tool is to improve the CQC's ability to consistently identify and take appropriate regulatory action in services that fail or are failing to meet the needs, aspirations and skills development of people with a learning disability and/or autistic people. This framework looks at 4 sections:  

1. Is there a planned programme for each person that focuses on their quality of life?

2. Are the planned programmes relevant to each person's needs?

3. Is each person's support programme being delivered at the right level of intensity?

4. Is there a balance of the programmes and support plans for each individual, with coherence across settings and over time?

We know the CQC embedded this toolkit into their old inspection framework in some regions, although there have been Registered Managers who have stated this has not always been the case. I can speak first hand that during my last inspection at the LD home I managed, this did not come up.  

Whilst we do not yet know if this will be fully embedded in the new framework, it is still a great tool for providers to have up their sleeves as it helps push the quality of care. It will be interesting to see if this becomes embedded in the new Single Assessment Framework over time.  

Tips to improve quality of care with the quality of life framework

• Read and understand the toolkit
• Take the 17 questions in the toolkit, embed them into your own audit, and benchmark your service against them
• Ensure actions taken off the back of your new audit are documented and evidenced.  

4. Staff training and development  

Despite it being 2023, the CQC has neglected to include training from their framework and lacks regulation on what is taught to our teams and how often. However, we shouldn't ignore this issue. It's important to ensure staff receive proper training and support, and how we document this for inspections is vital. In my experience managing learning disability services, training is often inadequate, but it's not always shouted about or captured.

Tips to improve staff training in learning disability care services

• Collate all the training you currently offer onto a training matrix
• Ensure there is a training guide that captures the frequency of training
• Document and capture role-specific and person-specific training that helps meet the needs of the people you support  
• Capture evidence where training has reduced the use of medication or restrictive practices, such as positive behaviour support and de-escalation training
• Seek support from external specialists – document and evidence
• Ensure all staff have CPD (continuous professional development) plans in place
• Staff should be competent in working collaboratively with colleagues, families, and other professionals – ensure they have the skills and confidence to do so, and document and capture where this is happening and the impact it is having on those you support.  

Conclusion

I hope this helps you form some actions and thoughts on how to get ahead of the new framework. However, it is important to also stay up to date, and I would strongly recommend you keep checking out the CQC website for their latest updates.

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