In this article, QCS identifies and previews the issues predicted to have the greatest impact on the adult social care sector in 2022. From updated regulatory requirements to ongoing challenges relating to vaccination and workforce shortages, here, QCS shares advice and recommendations to enable providers to put their best foot forwards.
The year just gone was one of the most challenging years the social care sector has ever faced as it lurched from one crisis to another. The ever-evolving COVID-19 landscape, the impact of Brexit’s restriction of free movement, and ongoing issues around funding, recruitment and retention of staff put untold pressure on an already exhausted workforce.
Many were looking to 2022 as the year that COVID-19 was finally tamed, and things could return to some sense of normality. Others were optimistic about the Government white paper, People at the Heart of Care, released at the end of last year, and its ambitious ten-year plan for adult social care reform.
So, what does QCS, a leading provider of content, guidance and standards, predict for the coming year, and what should those in adult social care look out for?
Still challenges ahead
According to Barry Price, a consultant for QCS, the roadmap out of the COVID-19 pandemic will continue to present challenges. ‘The future is still not clear, so we need to expect ever-changing guidance requirements, social distancing measures and care home visiting restrictions in 2022,’ he says.
‘Although Omicron is milder than previous strains for most people, it is highly transmissible and there is always the danger of new more virulent variants appearing too,’ he adds. ‘So, we’re not yet at the point of saying we’re dropping all restrictions, and everything is fine. Managers still need to brace themselves for the year ahead.’
Vaccination policy to cause further staff shortages
As the year began, the Government ‘announced its intention’ to revoke the Vaccination as a Condition of Deployment (VCOD) regulations for both health and social care professionals.
‘I think the key words to note are “announced its intention”. Flicking through the news channels, you could be forgiven for thinking that the government has reversed its VCOD mandate, which states that all frontline CQC-regulated staff (unless exempt) must now be fully vaccinated against COVID-19 by 1st April 2022. It hasn’t. The government has simply announced that although the legal requirement for mandatory jabs will be revoked, the move will be the subject to public consultation and will need parliamentary approval. So, everyone still needs to be prepared.’
So, what can care managers do to get ready? According to Barry, for those care homes that are still insisting on VCOD, the first action point should be to organise a face-to-face discussion with staff who remain unvaccinated. ‘Managers need to be open and honest, and clearly lay out the impact their decision will have on the service, their colleagues and their careers,’ he says. ‘The aim would be to encourage them to take up vaccination.’
Secondly, following these meetings, managers need to review their business plans. ‘Once managers know how many of their staff they will lose, they need to review their recruitment plans and adjust their strategies accordingly. They should also review policies and procedures including admission and Business Continuity Plans,’ he adds.
Finally, in relation to this point, he notes that ‘business planning and service development planning should not be ignored.’ He adds that managers should be asking themselves whether there ‘are options to diversify the business model such as the relocation of office teams, non-front-line staffing to accommodate redeployment?’
Barry believes there may be a change in VCOD policy as April arrives, when it is abundantly clear the devastating effect that these measures have already had on staffing levels across parts of Social Care. ‘April’s VCOD implementation will lead to unsustainable staff shortages that will add to an already chronic recruitment and retention crisis and is in danger of “pushing the sector off the cliff,”’ he says.
Shortage Occupation List changes welcome
Barry is, however, optimistic about the fact that care staff are due to be added to the Shortage Occupation List (SOL) in response to pandemic pressures, following temporary changes to the health and care visa.
‘This is a welcome development, but although very good news it is by no means an overnight fix. It depends on how quickly this is brought in, and the number of additional care workers outside of the UK available for recruitment.’
Care on a cliff edge
Senga Currie, QCS Head of Care Development (Scotland), agrees with Mr. Price when she says that ‘governments of all nations are aware of the cliff-edge faced by care providers and of course the NHS.’
‘It’s the worst it’s ever been,’ she opines. ‘I’ve worked in health and social care since 1980. The sector is really on its knees. Many staff are leaving for better-paid and less stressful jobs in retail and hospitality, and why not when they can earn more working on the checkout in Aldi or Lidl than in care?’
‘It’s not the providers fault,’ she continues. ‘They just don’t have money to pay higher salaries. We need an injection of money into the sector. We’re all hoping that in 2022 there will be a big change with a much-needed boost to health and social care funding.’
Recruitment issues continue
In terms of recruitment, factors such as ‘low pay, lack of benefits such as holiday pay and pensions, as well as long, unsocial hours can be off putting at any time,’ Senga says. ‘However, the added fear of the pandemic has perhaps put off more would-be recruits.’
But, she believes, there is an opportunity to ‘turn perceived negatives into positives’ when it comes to attracting new staff.
‘We need to change our way of thinking and look at the many positive aspects of the health and social care profession,’ she says. ‘Providers can then look at ways to promote care as a career to potential recruits,’ she adds.
A key plus is job satisfaction, says Senga. ‘The privilege of helping people at their hour of need is the most fantastic, satisfying experience. No-one should underestimate the skills carers develop, along with the empathy, kindness and love that they show.’
She also cites shift work as having hidden benefits. ‘We can turn the possibility of shift work into a positive too. When my children were young, I worked nights – when my husband could be responsible for childcare. Otherwise working would have been near impossible for me. I also enjoyed having days off midweek when shopping centres and supermarkets were much quieter. So, I think providers can think out of the box and look for the positives.’
How the Care Quality Commission can help
Ed Watkinson, Residential Care & Inspection Specialist with QCS, believes 2022 is going to be a difficult year for everyone. He says as care providers emerge from the pandemic and are faced with a different landscape, they will ‘continue to struggle to find a way through the endless challenges presented, whether that is recruitment, bed vacancies, funding or morale.’
On a more positive note, he says that, by being aware of regulatory changes and developing evidence of good practice, professionals in the care sector can ‘make the Care Quality Commission
(CQC) an ally and work with them to improve outcomes for everyone.’
‘To find the time to do this is not easy,’ he adds, ‘but the alternative is to continually firefight, feel swamped and then have the added pressure of having to retrospectively meet CQC requirements.’
CQC new strategy means change
Ed cites the fact that CQC released its new strategy in 2021, which will inform its regulatory approach across all sectors this coming year. The strategy’s four main themes focused on people and communities, smarter regulation, safety through learning and accelerating improvement. But what will this mean for adult social care services and their relationship with CQC?
According to Ed, the way the commission gets information about services will change in that it will be from more varied sources – people that use services, commissioners, the public, local health services and other stakeholders. Providers will therefore need to ensure that they have good relationships with stakeholders and seek feedback and evidence that show the quality of the service being provided.
‘Providers should involve people using their service as much as possible in decisions made, seek their views on a range of subjects and evidence that changes have been made as a result of listening and acting on their views,’ he advises. ‘(The) CQC as an organisation value co-production, and if providers can evidence that they are doing this, they will be in a strong position.’
Advent of remote inspections and digitalisation
The CQC will also undertake more remote inspections, Ed says, using the evidence provided by others to come to a judgement. ‘The commission will possibly start to rate services without stepping over the threshold. Providers will therefore need to be consistently developing, reviewing and sharing action plans to improve the quality of their provision, and not just prepare for an on-site inspection event. It is felt that inspection will become more of a continuous process as opposed to a cyclical event.’
There is no getting away from the fact that the digitalisation of social care is happening extremely quickly and has been enhanced by the pandemic. Ed adds, ‘The CQC will be looking closely at how electronic, online systems are being used and the benefits for people using services. This can be seen as a real opportunity for services to demonstrate innovation and lead the agenda.’
Criteria changes and their impact
In addition, the CQC is going to be changing its judgement criteria and the Key Lines of Enquiry (KLOE) that directly relate to the five key questions asked of all services – are they safe, effective, caring, responsive and well-led?
These are going to be replaced by ‘Quality Statements’, which will encourage services to demonstrate and evidence how they are focused on improving the lives of people using services.
‘All the evidence indicates that the Quality Statements are going to be similar to the existing KLOEs,’ says Ed, ‘but there is going to be an increased focus on partnership working, promoting independence, leadership, quality monitoring, infection control and how the service ensures that equality is hardwired in all aspects of care.’
He advises providers to be ‘prepared and lead the conversations with the CQC rather than waiting for its views, comments and judgements and rectifying the issues that they have identified. After all, a key objective of the CQC is to work with providers, and to provide advice, guidance and to share best practice.’
Ed believes that changes in the ways in which inspections are done is going to be evolution rather than revolution. ‘It will be based upon the learning from the pandemic and the need to focus more on outcomes for people rather than processes,’ he concludes.
Deprivation of Liberty Safeguards to be replaced
Another key change scheduled for 2022 was the abolishment of the Deprivation of Liberty Safeguards (DoLS), and their replacement with a new system, the Liberty Protection Safeguards (LPS) – both are applicable to England and Wales only.
The Government has now cancelled two implementation dates, most recently for April 2022. There is currently no implementation date set, but a consultation process is due in early 2022.
Rachel Griffiths, Human Rights and Mental Capacity Consultant to QCS, says, ‘Many found DoLS bureaucratic and difficult to work with. Also, they miss out many of the people who would definitely benefit from their protection. This is because DoLS can only be used in registered care homes and hospitals, and only for people who are aged 18 and over.’
LPS will be more flexible and easier to understand, she says, and will protect far more people using services. The LPS will apply to anyone from 16 who lacks mental capacity, and who is deprived of their liberty so that they can have the care they need, wherever they are receiving care services – including their own homes, shared lives and supported living.
So, what can providers do now to get ready for LPS? According to Rachel, providers need to make sure they are working within the Mental Capacity Act, especially the five statutory principles. Firstly, they must assume adults have capacity to make their own decisions unless they can establish that they don’t. Secondly, they mustn’t treat someone as unable to make a specific decision unless all practicable steps have been taken to help them do so, without success.
Thirdly, they must never treat someone as unable to make a decision just because others think their decision is unwise. Fourthly, anything they do, or decide, on behalf of someone who lacks capacity must be in that person’s best interests. And finally, before they act, they should see if there’s any way to meet the person’s need that is less restrictive of their rights or freedom of action.
Rachel advises providers to always think about any possible restriction or restraint, however minor, in a human rights-based way. ‘In particular, providers should ask themselves how necessary and proportionate it is, and whether they can find a less restrictive way to meet the person’s needs for care or treatment. Clearly any restrictions on someone’s freedom in a health or care setting can only be when there isn’t any alternative, and when it’s the only way to keep them safe and well.’
Will reforms be enough?
Looking across the social care landscape for 2022, then, there are some encouraging signs that some much-needed funding and sector reform is on its way. But it’s impossible to ignore that short-term actions to reduce workforce shortages, along with longer-term measures to get the sector out of its current crisis, are lacking and it looks like the sector is set to face another challenging year.
QCS policies on the Mental Capacity Act, including restraint and deprivation of liberty, can be found at www.qcs.co.uk/the-road-to-liberty-protection-safeguards-lps
Quality Compliance Systems (QCS), a leading provider of content, guidelines and standards for the social care sector is supporting over 140,000 users across 5,000-plus organisations, including residential care, supported living, domiciliary care, clinics and care services in the UK. Across the social care sector, QCS is a widely trusted and respected brand specifically designed to conform to the CQC Fundamental Standards.