Regulating during COVID-19 - why raising concerns about care is more important than ever

While routine inspections have been paused, we have continued to inspect in response to risk and concerns raised, and services have remained subject to close monitoring using a range of intelligence sources. This includes an additional monitoring tool – the Emergency Support Framework (ESF). The ESF helps us better understand the impact of COVID-19 on staff and people using services and identify where we may need to inspect, or escalate concerns to partner organisations.

As the situation evolves and the impact on the health and social care system changes, we’ll be adapting the ESF tool to be used alongside our responsive visits and a managed return to routine inspection of lower risk services in the autumn. Inspectors are now scheduling inspections of higher risk services to take place over the summer.

During the pandemic there has been an increase in calls to CQC’s national contact centre from staff raising concerns about care. We have done some work to analyse this and seen that the biggest increase has come from staff in the adult social care sector; we have received 2,612 calls from adult social care staff raising concerns in the period 2 March 2020 to 31 May 2020, compared to 1,685 for the same period in 2019 – a 55% increase.

Although calls often covered multiple topics, many of the calls (26%) related to lack of PPE or other infection control products. We have escalated these concerns to local authorities to ensure providers get the supplies they need – in some case we have even arranged loans of PPE from another provider to cover immediate need.

Thirty-two percent of calls included concerns about how infection control or social distancing was being practiced at the service they worked in and 4% of calls referred to quality of care being impacted by COVID-19.

In these cases we followed up with the provider directly – usually by phone as we have only carried out a small number of physical inspections since mid-March in order to limit the number of people entering services and risk the further spread of infection. However, of the 17 physical adult social care inspections conducted since 17 March, 11 have been as a result of concerns raised by staff or members of the public – and as we increase physical inspections we will be crossing the threshold more frequently in response to concerns.

The voices of staff are crucial to understanding quality of care on the frontline and listening to them will be key to fighting infection in health and care settings. We have strengthened our processes to help ensure that we can listen and respond as effectively as possible. Our contact centre automatically allocates calls from care workers who have concerns about the safety or quality of care to an inspector or senior member of the team to investigate so these calls are fast-tracked, offering a quicker resolution to the issues raised.

Trade unions have told us that they are getting a high number of enquiries from members employed in social care about how they can raise concerns about the quality and safety of care. In response, unions including UNISON, GMB, Unite and RCN will be promoting our contact centre number to their members, as will ADASS and the NMC. And staff in NHS, independent, primary medical or dental services should also contact us to raise concerns – we are listening, and we will take action to protect people where necessary. We also continue to support the work of Freedom to Speak Up Guardians through the work of the National Guardian’s Office.

There has also been an increase in calls about, or from, people detained under the Mental Health Act – often expressing distress or confusion about why people are more likely to be confined to their rooms rather than being able to move around freely. In response, we have also changed the way we handle calls to help support people who complain to CQC about the Mental Health Act and care or treatment while detained during COVID-19. We now prioritise contacts from, or relating to, people who are detained on inpatient units and allocate them to Mental Health Act Reviewers. Of the eight mental health services we have inspected since pausing routine inspections, five have been as a direct result of concerns raised with us by staff or members of the public.

Kate Terroni, CQC’s Chief Inspector of Adult Social Care, said: "It’s in everyone’s interests that staff are able to speak up freely and are not prevented from raising their concerns about quality and safety – and all providers have a responsibility to support their staff to share concerns safely without fear of reprisal.

"Staff have been going to extraordinary lengths to deliver good, safe care during this global crisis – if they are experiencing barriers to the delivery of that care, we want to hear from them and we are encouraged that so many staff have been brave enough to raise concerns with us."

In Adult Social Care, 17 inspections have been conducted since the cessation of routine inspections on 16 March, of which 11 were as result of concerns raised by staff or members of the public. The remainder were in response to notifications from the provider or information from key stakeholders.

In Hospitals (including mental health and independent services), 12 inspections have been conducted since the cessation of routine inspections on 16 March, of which 7 were as result of concerns raised by staff or members of the public. The remainder were in response to notifications from the provider or information from key stakeholders.

In Primary Medical Services, 3 inspections have been conducted since the cessation of routine inspections on 16 March, all of which were as result of concerns raised by staff of members of the public.

As well as people who work in health and care services, it's also more vital than ever that we hear about people's experiences. We want to hear from people who have used health and care services – as well as their families, carers and loved ones.

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