A quality and audit lead at a hospice tells Jon Stone about jumping through CQC hoops, and the joys of unfunded central policies.
“I’m a quality and audit lead at a hospice for adults. We’re a charity, but we receive about 20% of our revenue by selling services to the NHS. We have about 20 inpatient beds, and a similar number of day patients daily – about average for a hospice. I’ve worked here since 2010, and in the sector for 13 years.
I work with the clinical and medical teams and managers to make sure we meet essential safety and care standards. I also make sure we have documented evidence that we meet those standards, so we can show the Care Quality Commission when they inspect us, and also the Clinical Commissioning Groups who buy our services. The former could close us down; the latter could go elsewhere for end of life care.
Our relationship with the CCGs is good. We’ve always worked closely with local GPs, as a lot of our patients are referred to us via them. So when the GP-led CCGs replaced primary care trusts, we had quite a smooth transition compared to other service providers. On top of that, a lot of people who were working in the PCTs were made redundant and have reappeared working for the CCGs. In that sense, the NHS reforms haven’t had a huge effect on us.
The CQC assesses us every year, and I think their inspections are pretty helpful. Recently they seem to have become more thorough, after all the criticism of bad care in some NHS trusts and care homes.
Their approach seems to involve changing their tactics at each inspection, and asking for different information; this has advantages and disadvantages. On the one hand, it keeps us on our toes and stops us from getting too clever: we have to be good all-rounders, instead of concentrating on what we know they’ll assess. More negatively, it takes us time to get our heads around what they’re asking for, and it can be a bit of a time-sink – even though they’re basically asking for the same thing as last time in a different way.
On the plus side, the process seems to have become less bureaucratic. As well as submitting lengthy reports, we used to have to complete ‘provider compliance assessment tools’ – the latter requiring both written answers, and documentary evidence. They seem to have done away with the latter.
Sometimes, inspection pressures can distract us from what we think is a priority locally. The CQC does tend to focus on what’s been in the news and on the hot political issues: currently, that’s the training of the staff, infection control, nutrition, and how patients are cared for. That’s not necessary a bad thing, because if something is wrong in one part of the healthcare system it’s certainly worth checking it across the piece – but sometimes we find ourselves diverting resources from local priorities to deliver on the objectives we think they are likely to ask for.
I worked in a larger, NHS-run hospital before I was here, and I would say it’s harder to comply with the CQC’s standards in a smaller organisation. We don’t have the same resources as a large hospital, but we still have to meet all the same standards, and have the same policies and safeguards. There are certain economies of scale that we miss out on. We do manage, but it’s harder.
The central government policy on end of life care is contradictory: they say they want to give people the choice of where they are cared for when all treatment options have been exhausted – for example, at home, or in a hospice where they specialise in end of life care – but it’s not being funded. In 2012-13, there was a one-off £60m capital grant scheme announced in England for hospices– it was awarded to some 150 hospices.
That’s all very well: capital investment in the patient environment is very important, and one-off grants may help us to expand our services and facilities for a limited period. But we have to be able to plan ahead, and ensure that we have enough funding to cover the cost of staff too. If the government wants to increase hospice care, there should be a ring-fenced, yearly hospices budget allocation.
Working for a charity, sometimes you get the feeling the government thinks: ‘Oh, most hospices are charities. They raise their own money – let them keep raising it’. But the recession affects us as well: less spare money in people’s pockets makes it harder to fund-raise. We’re feeling the pressure here as well.
Money may be tight, but that doesn’t mean we can let standards slip for our patients.”