The Joint Committee today continued their inquiry into the Government's response to covid-19 and the human rights implications of long lockdown. Dean Russell MP asked Peter Wyman and Kate Terroni, both of the Care Quality Commission, about how data is collected on a visit-by-visit basis in care homes across the country. He also spoke to Helen Whatley MP, Minister for Social Care.
A transcript of Dean's questions can be found below and the full details of the event can be found on the UK Parliament's Committee website here.
{First Part}
Dean Russell
I will wrap my questions all into one, because I know that many of my colleagues would like to come in. Forgive the length of the question, but please do answer all the parts of it.
My questions relate to the role of monitoring and compliance. We as a committee are incredibly keen to understand whether care homes are implementing government guidance on visiting care homes. We have had many witnesses and read many reports. We wrote to the CQC expecting that you would be able to tell us, but you said as the CQC that you did not collect this information.
First, why do you not monitor adherence with visiting guidelines? If you do, can you please clarify that? Last week, the chief executive of Care England told us that the fact that you were not able to supply this information suggested a more fundamental problem with data collection within the CQC. I would like to know whether you agree with that. Thirdly, I would like to get a really clear idea from you whether you see the visiting guidance as advice or as guidance that must be followed.
Peter Wyman
Thank you, Mr Russell. I apologise if my letter to the Chair was not sufficiently clear and caused some misunderstanding. We absolutely collect data all the time. Our data starts with our understanding of a home when it first registers with us. That data is constantly updated by information that we collect, information that comes in from members of the public and so on. It is a very live set of data, which is why we were not able to say, “At a particular moment in time, we can tell you precisely how many homes have what visiting rights”. It constantly changes.
Chair
Forgive me, but you could have then said, “This is a snapshot”. There was nothing unclear about your letter. You said that you could not give us the information. We hear, as Dean said, that loads of people cannot get the visits which the guidance says they should have. We wanted to get a sense from you as the regulator, the monitor, and the inspector, what percentage of care homes are complying with the guidance at any one time. You could not give us that information.
Peter Wyman
As I said, I am sorry if my letter was not clear. I can tell you that, at this moment, we are not aware of any home that is not providing appropriate visiting rights. As I said a minute ago, where we have been contacted by relatives who have said they do not have the visiting rights, we have pursued that. We have satisfied ourselves that either the visiting rights had always been there and there had been a communication failure, or the home has changed and the visiting rights are now there.
I can absolutely say that, as of today, as of this moment, we are not aware of any home that is not making appropriate visiting rights in accordance with government guidance. To your point, Mr Russell, we regard the government advice as something we expect homes to follow. Kate was very clear right at the start, and has been clear in communication to care home providers over the past 12 months, that we expect government guidance to be adhered to.
Dean Russell
Sorry to interrupt, but can I just ask a very specific question? On the data collection, you mentioned that you were tracking how many homes, and you can assure us at the moment that no homes are stopping visitations and so on. Do you have a dataset that says, over the past 12 months, how many visits have happened across each home? If not, how can you be assured that the volume of visits has been accurate compared to the number that should have been able to visit?
Peter Wyman
We certainly do not have that particular data.
Dean Russell
In that case, have you been able to monitor over the past 12 months whether that has been implemented? Forgive me, but I do not quite understand how you can be assured of any figures if you do not have the figures, and how you be assured that things have been followed if you do not know what has been followed or not.
Peter Wyman
We regulate well over 20,000 care homes and 25,000 adult social services. We are constantly monitoring those providers. We are getting information from the providers, the relatives and what our inspectors are seeing. We have carried out inspections and monitoring calls during this period.
Dean Russell
Sorry to interrupt again, but is that qualitative data or quantitative data? Can you say as a snapshot at any point in time that X thousand people have had visits at a certain care home? Is it more a qualitative thing that they have been able to have visits, and it would therefore be up to the family to then say that that has not been the case?
Peter Wyman
Thank you. You have put that very well. We are very interested in qualitative data that we can verify. This is not just asking for data from the homes that may or may not give you a complete picture. We are very much taking a qualitative view of whether what the home is providing at any point in time is appropriate to the circumstances of that home at that moment. This is constantly changing.
Dean Russell
No, I understand that, I really do. The bit I do not understand is that there would surely be a register of visitations in each home that would have a numerical value to it, whether it was 10 visits or 1,000 visits. Given the number of homes that you oversee, surely there must be a way for you to be able to track how many visitations have happened. That should be recorded somewhere so that, when you are reviewing that, you can see that there has been a massive drop-off in certain care homes or a trend. Surely, if it is based only on qualitative data, you are only then getting a snapshot at the point that you are doing the review, not a regular flow of data to see where the patterns of flow are happening, if that makes sense.
Peter Wyman
Yes, it makes sense, but what I was trying to say in my letter to the Chair, and what I obviously have not expressed very well, is that we have not collected that data, formed a register and added it up on a daily basis across all those homes that we regulate. We are much more interested in being sure that there are appropriate visitation rights—“appropriate” is obviously the key word—at a point in time. When we do an inspection, we will obviously look at wider data. If we are following up and we are concerned that there may not have been appropriate visiting because a resident’s family may have told us that, we can absolutely seek the data that you have suggested.
Dean Russell
Thank you. I should go to Kate, if I may. I am conscious of time. Kate, I will ask the same questions to you. Can you shed any light on whether there is a process to gather that data across all those care homes? It just feels to me that the idea of live data means that you have a regular track of analytics. It sounds to me like you have more of a snapshot of instances in which you have inquired, or a family has raised a concern. If an inquiry next week said, “How many care home visits took place over the past year?” would that be available? How long it would take to do?
Kate Terroni
We do not have that as we speak. Our focus is whether people are getting high-quality, person-centred care, and we have a number ofways of establishing that. We put out our messaging and have kept putting out messaging over the last year to say that we expect providers to follow government guidelines and listen to local advice. We want to see person-centred care plans to make visiting happen. We have been really clear in our expectation of providers.
We meet weekly with local authorities and clinical commissioning groups to find out what they are hearing on the ground when it comes to visiting. We have also met regularly with large care home providers to establish what are they doing at a corporate level to make visiting happen. They might share with us their visiting policies. We would also ask them for what they are doing to assure themselves that, maybe across their 100 care homes, they are all taking a person-centred approach to make visiting happen. In addition to that, we send out our inspectors to corroborate that information. It is not a day-to-day “On Monday, how many care homes are making visiting happen?” because it is so complex. If an outbreak in a home happened on a Monday, they would take certain action.
We have had examples in the last couple of weeks of concerns about blanket approaches to visiting. We have intervened and met with the registered manager or the regional manager. As a result of that, families have been able to see loved ones, and that organisation has changed its approach. I have letters in front of me.
Dean Russell
Sorry to interrupt you again. The bit I really do not understand, and I appreciate that the horse has bolted in some ways in this aspect, is that I could look at a dashboard now and get a sense of how many vaccinations have happened over the past week and how many hospital beds are full. Lots of different data on hospitals, for example, is stored and has to be verified. I just would have assumed that the CQC would have a similar thing for care homes, because it cannot be that hard to set up a registration system to just track numbers of visitations. Surely, you would then have been able to see patterns of behaviour. If there had been a lot of visitations, perhaps that might have caused an outbreak, or perhaps not. It just feels like you have to work a little bit blind. Am I totally misunderstanding the data you have?
Peter Wyman
Sorry. Kate may want to come in, but we are certainly not working blind. It is quite the opposite. We are working constantly with the sector to understand what it is doing on a day-to-day basis. You are right, Mr Russell, that we have not thought it a good use of our resource to compile the sort of register that you are suggesting. I understand where you are coming from, obviously, but it is just not the approach that we have adopted, so we cannot supply that data in that format.
I am very confident, as I said earlier, that we have good visibility of what care homes are doing on a day-to-day basis. If the visitation rights are not appropriate, we are taking the action to get that changed. We are doing what you as a committee would want us to do in the sense of making sure that people can visit their loved ones safely as appropriate. We are just not perhaps doing it in the way that you had envisaged.
{Second Part}
Dean Russell
Thank you, Minister, for joining us today. The Government issued new guidance on care homes visiting, effective from 8 March 2021,and again earlier this month, effective from 12 April. Can you share what evidence you have that care homes are facilitating more visits as a consequence of the guidance, please? If I may add an additional question to that, have you found any discernible difference between the way the guidance has been implemented in the more expensive care homes and the more publicly funded provision?
Helen Whately
Thank you for the questions. I also heard your question to the CQC about monitoring. As somebody who is keen on data myself, I understand where this is coming from. Since, and even before, the guidance that you refer to, we have introduced ways of understanding the level of visiting going on.
We have two main ways of getting a sense of the situation. One is through the work that the CQC does. You heard from the CQC. We spoke with the CQC some time ago about making sure that it specifically looked at visiting as part of its inspections and had a question that would ask about whether the care homes were following the government guidance.
One route is the CQC. The other is the data collection system that we have established during the pandemic called the capacity tracker, which is filled in by social care providers. It up to them to do it. We strongly encourage it, I should say, and a significant proportion of care providers do fill it in frequently. That gives us a sense of the extent that visiting is going on. For instance, I have been looking at that since the latest guidance has been published and have been seeing a steady increase in the number of care homes that say that they are supporting visiting, including supporting indoor visiting. That is one form of evidence that we have.
Dean Russell
Sorry to interrupt. Following on from my questions earlier, would you agree that it would make sense to have a very simple measure of the number of visitations for each care home so that there is a macro view of trends generally, whether there is a pandemic or not, and an ability to monitor and track that activity?
Helen Whately
I would also like that, but I am aware of needing to be conscious of the sector that we are talking about here. We have around 15,000 care homes, some of which may have 100 or so residents and administrative staff and IT. They may be well set up to be able to report a substantial amount of data. Other care homes will only have a handful. They might be converted houses with five or six people living in them. Some will not even have a computer. The department is doing a separate piece of work to improve the IT infrastructure and skills of the social care sector.
Another thing that we have heard during the pandemic is quite a lot of resistance on the administrative and reporting requirements which the department has made of care homes. For instance, we are asking care homes that, when their staff are tested, they should upload the test information. When they are testing visitors, they should also upload the result of that visiting testing. That is very time consuming. We are providing funding to support the extra cost of doing that. I give that context because asking for what seems like a straightforward piece of data can involve a substantial amount of work for care providers who are already really stretched. It would mean doing things that took extra time when they were working with PPE and supporting visiting in the very careful way that visiting is happening.
I am trying to be proportionate in what we ask of care homes, but this capacity tracker gives us a certain amount of evidence. We have created a regional assurance team, which is a small team based in the department of individuals who have experience in the social care sector. They are following up. Where it looks like visiting is not happening as you would expect, they are working with local authorities to ask what is going on and why visiting is not happening. So far, I have been hearing back that they are hearing of only small handfuls of care homes that are not supporting visiting. The most usual reason for that at the moment is because there is a current outbreak. Therefore, visiting is not advised except for the end-of-life exception.
Dean Russell
Thank you. May I just come back to the question about whether there is a discernible difference between the more expensive versus the publicly funded provision if you have that information?
Helen Whately
Yes. My apologies for not picking that up. I have not seen anything to suggest that. It is clear that there are some slightly different approaches. Some care providers have invested more in visiting pods and set-ups like that and have been keener to continue using those until their residents have had their second dose of the vaccination. I have not seen any evidence that shows me that there is a particular split along the divide that you suggest.
