PIR guidance: People who use your service

This question outlining current dependencies provides context for the following questions.

This information also helps up to look how much capacity/demand there is in each local area.

You should include the number of people who are using your service on the day the PIR is completed.

Find out more about regulated activities.

We will share the responses to this question with DHSC. This will assist them in understanding more about capacity across authorities and regions. For community services, it will help them understand the size and scale of the domiciliary care market and how the market is changing. This information would also be of operational value during times of NHS pressure, such as in winter.

This relates to people who use the service, not staff.

This relates to people who use the service, not staff.

Apart from a change in care needs, what were your reasons for asking people who used your service to leave the service in the past 12 months?

For the bandings that capture people’s needs, select the bandings that apply to the people using your service.

The bandings are the same as those used in applications for registration. They allow inspectors to view the current mix and requirements from people using the service. One person can be counted under more than one dependency.

• Dementia
• People detained under the Mental Health Act
• Mental health needs
• Drug or alcohol misuse
• Eating disorders
• Sensory impairments
• Learning disabilities or autistic spectrum disorder
• Physical disabilities
• None of the above

Give the number of people in each age category. Your responses for all categories should add up to the total number of people who use your service.

• 0 to 17 years
• 18 to 24 years
• 25 to 64 years
• 65 to 74 years
• 75 to 84 years
• 85 to 94 years
• 95 years and over

This question is for residential services only.

This applies to those who are in their bed all the time. To support the understanding of current dependencies and for those that need more support to prevent pressure sores and infection.

For example, they use British Sign Language (BSL) or they need information in large print or another language.

This is a yes or no answer.

We want to know:

• how you identify and record communication needs
• if you seek accessible ways to communicate with people
• how you meet these needs of the individual.

For example, some people with learning disabilities using symbols and pictures developed by the service - and so familiar to them - to communicate.

Give the number of people who use your service and are unable to use speech to communicate.

We want you to tell us how many people are at risk of malnutrition or dehydration. We expect you to know this through the assessment processes you use to identify when a person is at risk.

This question asks about people using your service who may have their freedoms, rights or choices restricted.

Relevant legislation:

• The Mental Capacity Act 2005 explains where a restraint can be used legally. The restraint must be necessary to prevent harm to a person that lacks capacity or to prevent that person causing harm to others. It must also be proportionate in its use to prevent that harm
• Under the Human Rights Act 1998 restraint which amounts to inhuman or degrading treatment is unlawful in all circumstances, for example, using excessive force.

Further information about reducing restraint and the link to human rights can be found in the:

• Restraint Reduction Network tools and resources
• Equality and Human Rights Commission’s Human rights framework for restraint

Restriction

An act that restricts an individual’s movement, liberty and/or freedom to act independently, with a view to taking immediate control of a dangerous situation where there is a real possibility of harm to the person or others if no action is taken. Restriction should end or reduce significantly the danger to the person or others. Restrictions should not limit the person's freedom for any longer than is necessary.

Restraint

The use of force or threat of force to restrict a person's freedom of movement, whether they are resisting or not, or to make someone do something they are resisting (MCA 2005).

Restraint may be physical, prone, chemical or mechanical

Physical Restraint: Any direct physical contact where the intention of the person intervening is to prevent, restrict, or subdue movement of the body, or part of the body of another person. This would include restraint by police officers if this occurred in a care home. Examples:

• A staff member holds Tola’s hands down to stop her punching herself.
• Two staff hold Alex’s arms against his sides to stop him pulling someone’s hair until he calms down.
• Debbie is attacking a visitor. She is not responding to staff trying to stop her, so they restrain her in a chair to allow the visitor to leave the area safely.

Prone Restraint: (A type of physical restraint) holding a person chest down, whether the person placed themselves in this position or not, whether the person resists or not and whether the person is face down or has their face to the side. It includes being placed on a mattress face down and being placed prone onto any surface while being held there.

Chemical Restraint: PRN (as and when needed) medicines to calm or lightly sedate an individual to reduce the risk of harm to self or others and to control extreme agitation and aggression.

Mechanical restraint: The use of a device (such as a safe suit, arm splints or strap) to prevent, restrict or subdue movement of a person’s body, or part of the body, for the primary purpose of behavioural control. Examples:

• Simisola has a history of extreme self-injurious behaviour. Staff follow a positive behaviour support programme with her and have specialist advice, but at times it is agreed she needs to wear arm splints or a cushioned helmet to prevent serious injury.
• Arif becomes physically agitated at the shops, pushing at shelves, waving his arms around and risking pushing items onto himself or others. His behaviour is so dangerous that, despite being able to walk home, staff insist that he sit in a wheelchair and they fasten the strap as it is the only way they can be sure to get him back home safely.
• Ben often wanders and is at risk of falling, so staff encourage him to sit in a chair which he cannot get out of without assistance.

Wheelchair lap belts and bedrails are forms of mechanical restraint. You should include people whose care plans indicate bedrails or a wheelchair lap belt may be used, whether this is due to the person being distressed and potentially causing harm to themselves or others as well as routine and regular use (which is to prevent people from falling out of bed or out of a wheelchair whilst moving).

Please see relevant legislation and guidance (Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 13(4)(b)) for further information around restraints and restrictions.

For this question you should only count incidents of restraint (not restriction).

You should include restraint which is triggered by actions of the person at the time. For example, if they are used when the person is distressed or might cause harm to themselves or others. Do not include routine and regular use of mechanical restraint used to prevent people from having accidents (falling out of bed or out of a wheelchair whilst moving).

Restraint is more likely to be related to the use of medicine or holding methods. It could also include the use of mechanical restraints such as bedrails or wheelchair straps. For example where a person’s condition fluctuates, and these items are used for restraint.

Example:

• Zaida is with family who are celebrating the birth of a cousin’s baby. Zaida is excited and wants to hold the baby and starts trying to grab it. When family try to prevent her taking hold of the child, she becomes agitated and starts pushing people and hitting the wall. To protect Zaida, her family and the baby, her carers must intervene. Her care plan has three options for restraint which her carers can consider (giving Zaida medicine to calm her down, removing her from her family celebration or placing her in a wheelchair with the belt secured).

If you answer ‘yes’, we ask: What are these?

Give clear reasoning for any arrangements over the past 12 months

As a public body, CQC has a statutory duty in the area of diversity to:

• collect information
• advance equality of opportunity
• eliminate unlawful discrimination
• foster good relationships between different groups.

We see this section of the return as one of the main ways we can gather information to help build a national picture of ethnicity and diversity for people using services. We would appreciate your input in this valuable area.

To support you in answering the questions and provide further resources for developing your approach to equality, diversity and human rights, read our human rights approach.

With all the questions, we are looking for how you practically apply equality, diversity and human rights principles to your service and what you have found the impact to be.

Make sure the examples you give are not personally identifiable.

The information you give will provide us with a clearer understanding of the ethnicity and diversity of your service and in the country more widely.

All providers of NHS care and publicly-funded adult social care must follow the Accessible Information Standard (AIS) in full from 1 August 2016 onwards - in line with section 250 of the Health and Social Care Act 2012.

The Accessible Information Standard applies to patients and service users (and where appropriate carers and parents) who have information or communication needs relating to a disability, impairment or sensory loss.

AIS covers the needs of people who are blind, d/Deaf, deafblind or who have a learning disability.

AIS also includes anyone with information or communication needs relating to a disability or sensory loss that affects their ability to communicate. For example people who have aphasia, autism or a mental health condition.

Provide examples of how you have met the Accessible Information Standard - by identifying, recording, flagging, sharing, and meeting the information and communication needs of people who use services, carers/staff and relatives where those needs relate to a disability, impairment or sensory loss.

Include how you know your staff understand it and any procedures you have that help you meet it.

You could answer the questions by ticking if you have carried out any work in relation to areas such as recruitment, staff training, environmental adaptations, care plan amendments or operational changes which promote equality, diversity and human rights.

• Age
• Disability
• Gender
• Gender reassignment
• Race
• Religion and belief
• Sexual orientation
• None of the above

Protected equality characteristics are Age, Disability, Gender, Gender Reassignment, Race, Religion or Belief and Sexual Orientation.

Provide examples for different protected equality characteristics and the impact this has had on their personalised care.

This is about people who use your services only.

This is about your staff only.

Take into consideration all the protected equality characteristics and preferences of those that you care for.

Preferences are what may be detailed in care plan but go beyond dependency assessments.

Detail any tool or recognised approach you use to estimate sufficient staffing levels if you use one.

The Human Rights Act underpins human rights approach. The purpose of this question is to demonstrate how you may have used the principles of human rights to promote human rights in your service delivery and for staff. For example; you may use the FREDA (Fairness, Respect, Equality, Dignity and Autonomy) principles when planning and delivering services as well as looking at workforce related policies.

Services should have this information from the contract and invoicing arrangements put in place.

The NHS tops up funding for people who need nursing care:

NHS-funded nursing care (NHS)

NHS continuing healthcare (AgeUK)

Don’t miss out on funded nursing care (Care To Be Different)

It is a non-means-tested payment of £156 a month that goes directly from the NHS to the nursing home to pay for nursing care. It is provided when a person is assessed as not eligible for CHC funding (the 'entire source of funding' comment) but do still have nursing needs. In many cases, it can change that person’s fee banding. It is, in all cases, a top up towards the full cost that is met by either the person themselves or the LA.

We will share the responses to this question with DHSC. This will assist them with understanding patterns in funding across local authorities and regions as there is limited data within this area.

Your responses to the next two questions should add up to the total number of people who use your service.

We do not ask specialist colleges to answer this question.

Include people here even if they pay user charges towards local authority funded care, pay using a local authority personal budget, or have someone paying a third-party top-up on their behalf.

These people will be self-funded, or charity funded, including those in receipt of NHS Funded Nursing Care, and those paying the full cost through their local authority.