Me Learning - Prepare for GDPR

Evaluation article: What is an effective service?

Published: Wednesday, 10 June 2015

Tim Dallinger looks at CQC’s expectations of an effective service, and how to demonstrate to CQC that your service is effective.

Summary

  • ‘Effective’ is one of the underpinning concepts of a good care service, and means that people’s care and support achieve good outcomes.
  • Staff should support people to live their lives in the way they choose, and experience the best possible health and quality of life outcomes.
  • Providers should design their service so that its effectiveness can be measured and demonstrated to the Care Quality Commission (CQC).
  • Providers should invest money in their service, as good staff help make a service effective and well-maintained premises and décor make a good impression on inspectors.

What does CQC expect?

CQC defines ‘effective’ as: ‘people’s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence’. In adult social care, this means people are supported to live their lives in the way they choose and experience the best possible health and quality of life outcomes.

CQC further defines this in the key lines of enquiry (KLOEs) as follows:

Community adult social care – home care

  • How are people’s needs, preferences and choices for care, treatment and support met?
  • How do people know they receive effective care from staff who have the knowledge and skills necessary to carry out their roles and responsibilities?
  • How are people supported to maintain good health, have access to healthcare services and receive ongoing healthcare support?
  • How are people protected from the risks associated with nutrition and hydration?

Adult residential care – care homes

  • How are people’s needs, preferences and choices for care, treatment and support met?
  • How do people know they receive effective care from staff who have the knowledge and skills necessary to carry out their roles and responsibilities?
  • How are people supported to maintain good health, have access to healthcare services and receive ongoing healthcare support?
  • How are people’s individual needs met and their privacy and dignity enhanced by the adaptation, design and decoration of the home?
  • How are people protected from the risks associated with nutrition and hydration?

As you can see, four of the above five KLOEs are common to home care and care homes; the additional one is for adult residential care which relates to the design of the care home.

In order to demonstrate that the service is effective, care providers must be able to evidence that the requirements of each of the above KLOEs and the associated prompts has been met for all aspects of the service.

How does this link to the fundamental standards?

As with the other four key questions, ‘effective’ is one of the underpinning concepts of a good care service. As CQC says, an effective service is one that achieves the best outcome for the service user. In other words, the service user is at the centre of their care provision. The fundamental standard and associated regulations set out the requirements providers must meet. KLOEs are the way CQC will inspect services, and providers should use them to demonstrate that their service meets the KLOE prompts and thus the fundamental standards.

What are the pitfalls of ‘effective’?

Some of the key mistakes care providers make that will lead to a poor rating for effective are when they:

  • fail to design the service so that its effectiveness can be measured
  • do not invest in staff
  • do not invest in the premises.

Fail to design the service so its effectiveness can be measured

How can you demonstrate that your service is effective if you have not defined the key performance indicators (KPIs) of an effective service? These are the standards you are required to meet to ensure legislative, contractual and ethical compliance. Once you decide upon key performance indicators, you can then go about designing a service to meet these, building in systems to measure standards of performance against the KPIs. For example, a KPI for care planning could be ‘we will review all service users’ care plans, either whenever their needs change in such a way that we have to change the service we provide, or every three months, whichever is sooner’. This is defined and then systems can be put in place to deliver this.

Of course it would be folly to set a KPI that was unachievable. One care home signed up to a contract with a local authority to review care plans for 77 service users on a monthly basis, then gave the task to one person who had to manage the home as well. With each review taking half a day at least, this meant that at most 10 care plan reviews could be done each week, thus it would take nearly eight weeks (two working months) to do each monthly review.

Do not invest in staff

Like it or not, our staff are the major resource we possess: with a great staff team we can provide a great service; the converse is also true. The average care provider will spend 55–65% of their expenditure on staff costs, yet many scrimp on the investment in maintaining their most vital resource to ensure they deliver an effective service. This investment will be in both staff morale and staff development, thus ensuring people have the skills and knowledge to meet the needs of people in their care and actually want to achieve the best outcome for those people.

Do not invest in the premises

This applies to both care homes and home care, although there is only a KLOE for care homes. First impressions count, and a scruffy, hectic, untidy home care office creates the impression of a service that is run on the cheap. Similarly, a neglected care home, with peeling paint, soiled furnishings and that familiar odour, leaves a lasting impression on all who experience it. Recent CQC inspection reports have used the word ‘tired’ to describe decor and furnishing. Providers should consider their refurbishment budget and measure if it is sufficient to create that fantastic first impression.

How to demonstrate that your service is effective

In this section we will illustrate one way that care services can demonstrate that their service meets each of the KLOEs for ‘effective’. There are many other ways that these KLOEs can be evidenced and providers should use a range of methods and evidence to demonstrate compliance.

Needs, preferences and choices for care, treatment and support

Key to meeting needs and preferences is to involve the person. Many people are not even aware that their care is being planned or reviewed, let alone invited to attend the review. Unless there are compelling reasons (documented and evidenced), service users should be invited to all aspects of the care planning process.

Effective care from staff who have the knowledge and skills necessary to carry out their roles and responsibilities

Staff development is more than so-called ‘mandatory’ training. This is an outdated concept, and is evidence of a lack of awareness of current requirements and hence an ineffective service. Staff development should concentrate on providing a range of development opportunities and training based on meeting three requirements. These are: to ensure legal compliance (e.g. first aid), to meet service users’ needs (e.g. dementia training) and to meet staff needs (e.g. literacy).

Good health, access to healthcare services and ongoing healthcare support

Key to this is a proactive approach to good health. A proactive approach uses knowledge of the service user, service user group, health conditions and health system to anticipate health needs. A proactive approach then takes the necessary action to ensure that these needs are met as far as possible. The opposite of this is the reactive approach where the service is ignorant of the typical health needs of the service user group, fails to recognise symptoms and then panics when the service user gets really poorly. This is not an effective service.

Adaptation, design and decoration of the home

Think about your home. Most probably it is laid out and furnished in the way you and your family like it, and this makes you feel comfortable and safe. Now think about a care home: is it set out to meet the needs of service users or the needs of the service and the staff who work there? An effective service consults service users about the environment they would like to live in, takes heed of best practice and designs a living environment to meet service users’ needs, and to make them feel at home and safe.

Nutrition and hydration

There is no health without effective nutrition and hydration. This sounds so simple yet in practice there are a multitude of challenges faced by care providers. Often the nutritional needs of service users are known but not met. The main reasons for this are a lack of awareness or knowledge by key staff. An example is catering staff in care homes who design menus based on the available budget, their likes and what they have always done rather than on meeting individual and collective needs of service users. In home care, staff are often faced with the choice of offering a selection of frozen ready meals as that is all that has been provided by the service user’s family. A little engagement and education will go a long way to providing an effective service.

Conclusion

An effective service is a person-centred service: one that is designed around the person, measures its performance continually and makes changes in response to changes in the person’s needs and preferences. This type of service will achieve the best possible outcomes for service users and a good or outstanding rating for the service provider when CQC inspects the service.

About the author

Tim Dallinger provides training and consultancy services to care homes, care agencies and local authorities with an emphasis on practical techniques that work in the real world. You can contact Tim via email This email address is being protected from spambots. You need JavaScript enabled to view it..

Most frequently read