Evidence used in this report

This report sets out the Care Quality Commission’s (CQC’s) assessment of the state of care in England in 2019/20.

We use data from our inspections and ratings, along with other information, including that from people who use services, their families and carers, to inform our judgements of the quality of care.

Most of the analysis in this report is generated by CQC, specifically:

• Quantitative analysis of our inspection ratings of more than 31,000 services and providers, drawing on other monitoring information including surveys to engage staff and the public including using CQC’s online participation platform. In previous years, we have used ratings as at 31 July to enable as contemporaneous a view as possible. Because we suspended our routine inspections and ratings in March 2020 as a result of the coronavirus pandemic, the ratings in this report are as at 31 March 2020 and all comparisons with the previous year are with ratings as at 31 July 2019.
• A programme of primary qualitative data collection and analysis to gather evidence to inform the messages of this report. Through this work, we have heard from 153 people through focus groups or interviews with CQC inspection colleagues and external stakeholders. All interviews and focus groups took place between February and April 2020. Due to the timing of the data collection, these evidence sources represent a pre-pandemic view. We adopted the following methods and objectives for this work:
  • Thematic analysis of 22 focus groups, four interviews and five written responses. These were conducted with CQC inspection colleagues and representatives from local Healthwatch and supplemented by a small number of interviews with other external stakeholders. Focus groups with inspection colleagues operating in each of the seven NHS England/Improvement regions aimed to gather insight about cross-sector working and successes and challenges at a regional level. In addition, interviews and focus groups with external stakeholders in each of the regions aimed to explore what stakeholders understood to be the primary successes and challenges for their local health and social care systems. The discussion focused on pre-defined themes: access, local communities and innovation. Analysis identified high-level findings related to these three themes.
  • Thematic analysis of two focus groups with a total of 19 CQC inspection colleagues, including mental health and adult social care inspectors and Mental Health Act reviewers with a particular knowledge and interest in Deprivation of Liberty Safeguards (DoLS). Acute hospital inspectors were unable to take part due to operational pressures relating to COVID-19. The work aimed to provide insight into CQC’s knowledge about the operation of the DoLS system this year. We also carried out secondary qualitative analysis of 100 care home and 40 hospital inspection reports to understand what good, poor and improvement in DoLS practice looked like.
• Mixed-method analysis of comments submitted to CQC in 2019 through our online feedback service (Give Feedback on Care or Share Your Experience), as well as complaints made to our National Customer Service Centre. The online form can be used by people using a service, family members and/or carers, and the public as well as healthcare professionals. Our colleagues in data science produced a national topic model, covering all NHS England/Improvement regions, that grouped just under 60,000 comments into 15 distinct topics. The 20 highest weighted comments within each topic were qualitatively analysed.
• Infection prevention and control (IPC) – we analysed the outcomes of 138 Emergency Support Framework calls between our inspectors and all acute and specialist trusts. These calls discussed each trust’s ‘Board Assurance Framework’ to identify how the trust was assuring itself of good IPC across 11 key areas. During August 2020, we carried out a special programme of IPC inspections in 301 care homes selected as potential examples of where IPC was being done well, and also reviewed IPC in 139 care home inspections that we carried out in high-risk services. During these inspections, we reviewed how well staff and people living in care homes were protected by IPC measures, looking at assurance overall and across eight key areas. There were 43 calls with GP practices to discuss their IPC measures in response to the pandemic, to understand what they had done, and hear about good practice they wanted to share and challenges they had faced.
• As the scope and focus of this year’s report shifted with the emergence of the pandemic, additional work was carried out to understand the impact of COVID-19. In July and August 2020, we rapidly mobilised teams to carry out provider collaboration reviews, to find out how care providers have worked together in response to the pandemic to improve care for older people, who are most at risk of COVID-19. We analysed data from 224 interviews as part of the evidence collected for the first phase of this programme. The interviews were conducted with a range of external participants from 11 sustainability transformation partnerships or integrated care systems across England.
  
  The speed of this project meant we had to focus on a sample of interviews from each area. Inspectors presented their findings to the area at the end of each review. We reviewed all these presentations to see if any key findings were missed because of analysing a sample of interviews.
• We also carried out a survey focusing on the experiences of patients who were admitted to hospital during the peak of the pandemic. More than 10,000 people across the country told us about the care they had received while in hospital, whether they were diagnosed with COVID or admitted for other reasons. The survey used many questions from CQC’s annual adult inpatient survey, with new questions specific to the patients’ experiences at that time.
• We also analysed enquiries from staff, people who use services and their relatives and carers, and members of the public, including Give Feedback on Care web submissions, received between March and July 2020. Enquiries relating to COVID-19 were tagged to high level topics.

Evidence in this report, alongside our Annual Report and Accounts, enables us to fulfil our legal duties to report on equality issues. In particular, this is in sections 1.9, 2.4 and 4.1 of this report. Similarly, we report annually on the operation of the DoLS through this report, in accordance with the DoLS code of practice. This is in sections 1.8, 2.5 and 4.6.

Analytical findings have been corroborated, and in some cases supplemented, with expert input from our chief inspectors, deputy chief inspectors, specialist advisers, analysts and subject matter experts to ensure that the report represents what we are seeing in our regulatory activity. Where we have used other data, we reference this in the report.