Policy Updates 23rd October 2022

 

The following policy updates have been curated from the week commencing 23rd October 2022.


Communication to users regarding Security Questions

Have you received either of the communications below regarding your NHSmail account? If you have please don’t ignore it – there is a timeline to respond otherwise your NHSmail account will be disabled. This step is mandatory to protect NHSmail accounts from potential cyber-attacks.


Dear NHSmail user,

We’re contacting you because your account has been identified as having weak security questions and answers configured for your account.

Having security questions and answers that are suitably hard to guess is a basic requirement to protect your NHSmail account and is mandatory when changing your password details. 

We will also be writing to your Local Administrator advising them of this requirement.

Please complete the update of your security questions and answers by no later than Thursday 10 November 2022. 

Failure to do so before the deadline will result in your account being disabled.

Thank you for your continued support to keep the NHSmail Platform secure.

Kind regards

The NHSmail Team

OR

Dear NHSmail user,

We’re contacting you because your account has been identified as not having security questions and answers setup to protect your account. This is a basic requirement to protect your NHSmail account and is mandatory when changing your password details.

We will also be writing to your Local Administrator advising them of this requirement.

Please complete the update of your security questions and answers by no later than Thursday 10 November 2022. 

Failure to do so before the deadline will result in your account being disabled.

Thank you for your continued support to keep the NHSmail Platform secure.

Kind regards

The NHSmail Team

Resignation of Liz Truss

As you will have seen, Liz Truss has announced she will resign as Prime Minister, with a new PM due to be in announced by Friday 28th! Timeline:

  • Candidates will require 100 Conservative MPs to nominate them to make the final ballot (compared to only 20 in the last leadership contest). The purpose of this is to narrow the field down quickly and ensure there is a large base of Parliamentary support behind the new PM. It means that there can only be three candidates in total, with MPs deciding which two candidates should go to the wider members vote.

  • The first round of nominations has now opened and will close on Monday 24th October at 2pm, results of this will be at 6pm.

  • If required this will be followed by a second ballot later that day, results at 9pm. There will be a "behind closed doors" hustings on Monday to MPs if there are more than two candidates.

  • If there is only one candidate who receives the 100 MP nomination threshold, they will become Party Leader immediately and not require ratification from Conservative Party members. We could therefore have a new PM in place by Monday.

  • If there are two candidates after Monday, a membership ballot will take place in an online process with this closing on 11am on Friday 28thOctober, the result would be announced shortly after.

The strongest candidates are currently the following (but there are also others).

  • Rishi Sunak

  • Boris Johnson

  • Penny Mordaunt

Jeremy Hunt is expected to remain as Chancellor - please see our letter to the Chancellor, which was circulated before the PM's resignation. 

Please also note that the Home Secretary, Suella Braverman, also resigned earlier this week and has been replaced by Grant Shapps. 

CQC - The State of Care Report

This morning CQC published its annual State of Health Care and Adult Social Care in England report for 2021/22. The report makes grim reading. It describes a system in gridlock at every point and the impact this is having on people trying to access health and care. Below I have outlined some of the toplines from the report, but you will want to read it yourself. The report does a good job of showing how the failures in different parts of the system are impacting upon one another leading to the deterioration of people’s access to and experience of care – in turn resulting in a deterioration of people’s health and wellbeing. In particular, according to the report, ‘many of the challenges services are now facing are linked to historical underinvestment and lack of sustained recognition and reward for the social care workforce’. You can read our response here. We also address the current political instability and the need for urgent action and honouring of commitments by the government. 

Gridlock

  • Proportion of people satisfied with the NHS overall dropping from 53% to 36%

  • More people (41%) were dissatisfied with the NHS than satisfied.

  • Proportion of people who reported a good overall experience of their GP practice went down from 83% to 72%.

  • Many people are unable to access primary care services.

  • Only 2 in 5 people are able to leave hospital when they are ready to so.

  • Around 500,000 people are waiting for an ASC assessment, for care or a direct payment to begin, or for a review of their care.

  • In the first 3 months of 2022, 2.2m hours of homecare could not be delivered because of insufficient workforce capacity, leading to unmet need and under-met needs.

  • CQC commissioned a survey of more than 4000 people aged 65 and over who had used health or social care services in previous 6 months:

    • Over 1 in 5 people (22%) said they were currently on a waiting list for healthcare services.

    • 37% on a health waiting list did not feel well supported by health and care services

    • 41% said their ability to carry out day-to-day activities had got worse while waiting

    • Of those waiting for a care needs assessment, 57% said they felt very or fairly well supported while waiting but 36% said they felt they were not very well or not at all supported.

    • 40% of those waiting for a care needs assessment said that their ability to carry out day-to-day activities was now worse than when the assessment was required, while 15% said it was better.

Inequalities 

  • CQC commissioned a survey of more than 4000 people aged 65 and over who had used health or social care services in previous 6 months:

    • Those living in the most deprived areas were more likely to report that they had a long-term condition, disability or illness, compared with those living in less deprived areas. They also tended to use fewer health services than average, although they did use them more frequently.

    • Disabled people were less likely than nondisabled people to describe the care and support they received for their health and wellbeing over the previous 6 months as good.

    • Satisfaction with being able to access services when needed was lower among disabled people (61% satisfied compared with 68% for non-disabled people).

    • Similarly, 60% of disabled people were satisfied with being able to access services in a way that suits them, compared with 70% of non-disabled people, and the same with the process of making appointments (48% compared with 58%)

  • Care for people with a learning disability and autistic people is not good enough. CQC’s review of the care in hospital for people with a LD and autistic people will be published shortly and reinforce this point.

  • CQC reiterates its ‘Right support, right care, right culture’ guidance and highlighted the practice of requests for large-scale services, rather than small-scale ordinary housing in the supported living space as being one example the sector needs to improve.

  • A shortage of LD Nurses was highlighted by CQC as being a particular problem in all settings.

  • CQC emphasised the legal requirement for all CQC registered providers to ensure their staff receive training in how to interact with people with a learning disability and autistic people.

  • Ongoing problems with DoLs process means that people are at risk of being unlawfully deprived of their liberty.

  • CQC also criticised the way in which demographic data was recorded in relation to inequalities.

  • CQC plugged its Supported Living Improvement Coalition as a way to embed the improvements that are needed by listening to relatives and their representatives.

Workforce 

  • The report recognises the heroic efforts that the care workforce is making to support people in very difficult circumstances. It also recognises the challenges managers are facing and the overall pressure that gridlock is having on wellbeing

  • Providers are losing the battle to retain and recruit staff due to other industries paying better and being less stressful

  • Shortages in social care worse than NHS.

  • More than 9 in 10 NHS leaders have warned of a social care workforce crisis in their area which they expect to get worse this winter.

  • Almost three-quarters of healthcare leaders (73%) said a lack of adequate social care capacity is having a significant or very significant impact on their ability to tackle the elective care backlog. Over 80% said it is driving the demand for urgent care.

  • Care homes have found it very difficult to attract and retain registered nurses. Nurses moving to jobs with better pay and conditions in the NHS, and care homes that have had to stop providing nursing care

  • 36% of care home providers and 41% of homecare providers said that workforce challenges have had a negative impact on the service they deliver

  • Of the providers who reported workforce pressures having a negative impact, 87% of care home providers and 88% of homecare providers told us they were experiencing recruitment challenges. 48% of care homes and 41% of home care providers said they were experiencing retention issues.

  • Vacancy rates in both care homes and homecare is over 10% and staff turnover rates in excess of 30%.

  • Over a quarter of care homes that reported workforce pressures told us they were actively not admitting new residents

  • Care home profit margins are at their lowest level since their Market Oversight scheme in 2015.

  • CQC has highlighted concerns about the increase in the delegation of specialist medicines administration to care staff. This can work well but the variation in the availability of training, supervision and access to support can mean that people don’t get their medicines correctly.

  • CQC has highlighted the increased use of electronic medicines administration records and the benefits it brings but highlighted that they have seen poor training, implementation and IT literacy amongst staff, alongside variable quality of equipment and software, meaning that people don’t have their medicines administered as prescribed.

Capacity and Stability of Providers

  • There has been an increase in demand for home care services following pandemic.

  • This has led to large waiting lists and delayed discharges from hospital as the workforce is stretched.

  • Some areas have seen homecare providers handing back care packages to the LA as they can’t fulfil obligations.

  • LAs continuing to commission homecare in 15-minute blocks but more and more providers are refusing such contracts.

  • Occupancy in care homes is increasing – was 82.5% in August 2022 but this is still below pre-pandemic level of 84.7%.

  • Between March 2021 and August 2022 there was a 2.4% reduction in the number of care homes.

  • By end of March 2022, agency staff costs made up 13.2% of total staff costs for non-specialist care homes in the Market Oversight scheme. Reduced profit for organisations.

  • In non-specialist homecare providers, similar story – profit margins decreasing.

  • Challenges for homecare in relation to petrol costs.

Ratings 

  • 83% of adult social care providers were rated as good or outstanding. This masks a small increase in the number of ratings of requires improvement and inadequate across residential homes, nursing homes and home care.

  • CQC has identified problems mainly related to leadership, management and oversight, driven by staffing challenges.

  • These challenges include the availability of experienced managers, staffing levels and staff burnout.

  • This resulted in poor person-centred care and not meeting basic care needs.

Integrated Care

  • CQC identified ICSs as a mechanism to resolve many of the issues highlighted in the report and they point to some pockets of innovation where healthcare leaders have recognised this and are taking action to jointly invest in and commission social care services.

  • They call for leadership that ensures that system-level planning includes all health and care services to address population needs and health and care inequalities, and do their best to keep people well

 
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