Adult Social Care Annual Provider Survey Results November 2015 1 Adult Social Care Annual Provider Survey Results Introduction How the survey is run Each year, since 2012, during October/November, we run the annual provider survey. This is shared via email with all registered providers and completed online. Survey structure The survey seeks to measure the levels of understanding, knowledge, and opinion of providers in regards to CQC and our approach. This report is broken into three main sections in relation to our overall approach: before (before inspection), during (during inspection), and after (after inspection). Data in this report The data in the graphs shown in this report are for providers who have had a new style, rated, inspection. This is broken down by provider type into the following sectors: all adult social care providers, care homes, domiciliary care agencies. For each bar graph you will also see arrows indicating whether or not the results have gone up, down, or remained the same when compared to last year (see slide 6 for the graph key). 2 Adult Social Care Annual Provider Survey Results Next Steps What happens with these results? We will be taking these results to colleagues in CQC to highlight key issues and discuss what actions may be appropriate - whether that’s further research, reviewing a part of our approach that providers’ have highlighted as problematic, or looking at improving how we engage with you. We will also be talking to providers and stakeholder to get their further views on the results. What else is planned? We will be asking a number of providers from a range of different services to take part in focus groups in June this year, in order to dig deeper into some of the themes we have identified in this survey. When will the next survey run? The next annual survey will run in October/November this year, and be informed by discussion we have had with providers and stakeholders, including the focus groups in June. If you’ve any further questions, please email insight@cqc.org.uk 3 Adult Social Care Annual Provider Survey Results Percentage of provider type who responded to this survey v Total number of providers n = 2764 Sector total % response 4624 12098 8992 N/A 11% 9% 11% Adult Social Care Annual Provider Survey Results Percentage of different ratings received per provider type who responded to this survey 100% 1% 2% 1% 4% 90% 80% Key 70% Outstanding 64% 73% 60% Good 79% 80% Requires Im provem ent Inadequate 50% Total rated respondents = 1535 40% 30% 20% 31% 23% 10% 4% n = 328 2% 15% 16% n = 691 1% n = 443 4% n = 73 5 Adult Social Care Annual Provider Survey Results Summary Each year, across all areas, adult social care providers have reported a greater understanding of how CQC monitors, regulates, and inspects, and higher positivity to our impact and benefits. • Adult social care providers have always reported the highest levels of understanding of our model. In our latest provider engagement strategy, we had anticipated a 2 or 3% rise on last year’s result of 88%, but that 94% of all adult social care providers rate their understanding of our new approach as good or very good indicates that the new model has begun to bed in across the sector. • There were almost three times more positive comments than negative about the inspection team from adult social care providers. Qualitative data from our surveys suggests that more specialised services, such as learning disability or dementia care services, are less positive about their inspection team’s understanding, but in general adult social care providers are very positive about their experience. • Adult social care providers were the most positive towards the benefits of our approach, and how it identifies improvements via the inspection process and inspection reports. With 93% of all adult social care providers saying that our approach was very, fairly or slightly beneficial (and only 10% of that score fell under the ‘slightly’ category). • Across all areas (before, during, and after inspection) care homes without nursing are the most positive about our model and its impact This report breaks adult social care providers into the following categories: all adult social care, care homes with nursing, care homes without nursing, and community services. Throughout the report it is clear to see that care homes without nursing are consistently the most positive. 6 Adult Social Care Annual Provider Survey Results Annual Survey Bar graphs - Key The bar graphs depict data from the latest annual survey (November 2015), and where data is available from last year the arrows indicate movement compared to the previous survey results. Movem ent from last year’s result Overall sam ple size 70% 18% 12% n = 2902 Which sector* * n/b - this report only contains comparisons to last year’s survey where date for all adult social care is displayed, as last year’s survey didn’t distinguish between the further breakdowns. A dotted arrow (where the change is <5%, or if the question or sample has changed significantly from last year) indicates that it is not a significant change. 7 Before inspection During inspection After inspection Adult Social Care Annual Provider Survey Results Before inspection This first section covers activity that happens specifically before an inspection takes place, or outside of the inspection process, i.e. how well do providers understand what we do, and do they think it’s beneficial are two questions which aren’t dependent on having had an inspection from, or contact with, CQC. This includes questions on: • How well do providers understand our model? • How beneficial do providers believe our model to be? • Do our guidance documents and standards help providers improve?* • Does completing the PIR help identify areas for improvement?* • Is the prospect of enforcement action an effective deterrent to encourage compliance?* * These questions are new this year 8 Before inspection During inspection After inspection Adult Social Care Annual Provider Survey Results What Adult Social Care Providers Told Us (Before inspection) The vast majority of adult social care providers reported a good or very good understanding of our approach • 94% said their understanding was very or fairly good This was a 6% rise from last year’s survey Overall, adult social care providers believe that the way we inspect and regulate is beneficial to the quality of care received by people • • 93% said it was very, fairly, or slightly beneficial However, positivity was lower for care homes with nursing, at 89% (a trend throughout subsequent questions) In terms of specific ‘before inspection’ activity, adult social care providers told us it helps them to improve: • 73% of adult social care providers told us that our guidance and standards have helped them to improve • 63% told us that completing the PIR identified areas for improvement • 69% of adult social care providers thought that enforcement action was an effective deterrent 9 Before inspection During inspection After inspection Adult Social Care Annual Provider Survey Results How would you rate your overall understanding of the approach CQC takes to regulation and inspection? Very / fairly good 94% Very / fairly low +6 Don’t know -3 6% n = 1535 94% 6% 93% 6% 1% 92% 6% 2% n = 328 n = 691 n =892 10 Before inspection During inspection After inspection Adult Social Care Annual Provider Survey Results How would you rate your overall understanding of the approach CQC takes to regulation and inspection? 90% 10% 0% 2012 (March) 94% 88% 88% 9% 3% 2012 (October) 5% 1% 2013 8% 4% 2014 94% Very / fairly good 6% Very / fairly low 0% Don’t know 2015 (Results for All Adult Social Care Providers: 2012 – 2015) 11 Before inspection During inspection After inspection Adult Social Care Annual Provider Survey Results To what extent do you believe the way CQC inspects and regulates is beneficial to the quality of care received by people? Very / fairly beneficial 93% n = 1424 Slightly beneficial Don’t know Not beneficial +4 -5 6% (Very – 50% | Fairly – 33%) (Slightly – 10%) 8% 89% (Very – 50% | Fairly – 33%) n = 397 (Slightly – 14%) 6%1% 93% (Very – 52% | Fairly – 32%) n = 865 (Slightly – 9%) 4%2% 94% n = 764 2% (Very – 52% | Fairly – 32%) (Slightly – 10%) What Providers Told Us In Their Own Words (Free Text Comments) Positive Themes There were 117 positive comments, the most common commenting that our new approach drives improvement (56 comments), and encourages adherence to standards (35 comments). Negative Themes Of the 63 negative comments, the most common were about perceived inconsistencies in our approach (23 comments), and that we were too focused on paperwork and bureaucracy (15 comments). 12 Before inspection During inspection After inspection Adult Social Care Annual Provider Survey Results The guidance and standards have helped us to improve quality in our service (We didn’t ask this question last year, so no comparison data is available) Strongly agree / Agree Neither agree nor disagree Disagree / Strongly disagree Don’t know 74% 15% 10%1% n = 1412 71% 15% 13% <1% n = 388 76% 15% 9%<1% n = 803 73% 15% 11% <1% n = 635 13 Before inspection During inspection After inspection Adult Social Care Annual Provider Survey Results Gathering information for the CQC provider information request (PIR) before our inspection helped us to identify areas for improvement (We didn’t ask this question last year, so no comparison data is available) Strongly agree / Agree 63% Neither agree nor disagree Disagree / Strongly disagree 22% Don’t know 13% 2% n = 1309 57% 22% 18% 3% n = 342 65% 21% 12% 2% n = 725 63% 21% 14% 2% n = 606 14 Before inspection During inspection After inspection Adult Social Care Annual Provider Survey Results Do you think the prospect of enforcement action is an effective deterrent to encourage compliance? (We didn’t ask this question last year, so no comparison data is available) Yes Don’t know No 69% 16% 15% 64% 23% 13% 69% 16% 15% 71% 11% n = 1451 n = 310 n = 656 17% n = 426 15 Before inspection During inspection After inspection Adult Social Care Annual Provider Survey Results During inspection This section covers providers’ views during an inspection which includes: • How do providers rate the inspection team on: Their understanding of the care provided Their professionalism* How they interacted with staff*, and How they interacted with users of the service* • How well the inspection team minimised any disruption to care delivery** * These questions were new this year ** This questions was rephrased this year, so the data is not comparable 16 Before inspection During inspection After inspection Adult Social Care Annual Provider Survey Results What Adult Social Care Providers Told Us (During inspection) Providers judged our inspection teams’ professionalism the most positively • Overall 80% of adult social care providers said their inspection team’s professionalism was good or very good, with positive results across the board. Care homes with nursing were the least positive, and community services were also less positive than care homes without nursing • • • 73% and 74% respectively said their inspection team had a good or very good understanding of the care they delivered, compared to 81% for care homes without nursing. 72% and 77% respectively said the team were good or very good in how they interacted with people who use the service, compared to 80% of care homes without nursing. 71% and 68% respectively said disruption to care delivery was managed fairly or very well, compared to 78% reported by care homes without nursing. These results may reflect the nature of how care is delivered in the community, and how the inspection process interacts with this process; we will be further exploring this through engagement and focus groups with providers later this year. 17 Before inspection During inspection After inspection Adult Social Care Annual Provider Survey Results How would you rate the inspection team on their understanding of the care you provide? Very good / Good Satisfactory Don’t know Poor / Very poor 77% 8% 13% 2% n = 1519 73% 14% 11% 2% n = 401 81% 11% 7%1% n = 829 74% 15% 6% 4% n = 655 What Providers Told Us In Their Own Words (Free Text Comments) Positive Themes There were 119 positive comments, the most common commenting that our inspection team was approachable (64 comments), and professional to standards (41 comments). Negative Themes There were 37 negative comments, the most common were that the manner of the inspector(s) was poor (13 comments), and they showed a lack of understanding / knowledge (12 comments). 18 Before inspection During inspection After inspection Adult Social Care Annual Provider Survey Results How would you rate the inspection team on their professionalism? (We didn’t ask this question last year, so no comparison data is available) Very good / Good 80% Satisfactory Don’t know Poor / Very poor 12% 6% 2% n = 1519 75% 14% 9% 2% n = 376 82% 10% 7%1% 80% 12% 4% 4% n = 796 n = 632 19 Before inspection During inspection After inspection Adult Social Care Annual Provider Survey Results How would you rate the inspection team on how they interacted with staff? (We didn’t ask this question last year, so no comparison data is available) 2% Very good / Good 78% Satisfactory Don’t know Poor / Very poor 13% 7% 2% n = 1511 72% 14% 12% 2% n = 394 80% 12% 6%2% n = 827 77% 12% 5% 6% n = 651 20 Before inspection During inspection After inspection Adult Social Care Annual Provider Survey Results How would you rate the inspection team on how they interacted with people that use the service? (We didn’t ask this question last year, so no comparison data is available) Very good / Good Satisfactory Don’t know Poor / Very poor 78% 14% 5% 3% n = 1510 76% 14% 7% 3% n = 396 14% 4%1% 80% n = 831 71% 13% 5% 12% n = 642 21 Before inspection During inspection After inspection Adult Social Care Annual Provider Survey Results How well did the inspection team manage any disruption to care delivery? (The wording of this question was changed this year, so there is no comparable data) Very / Fairly well Neither well nor badly Don’t know Fairly / Very badly 4% 7% 75% 15% 71% 18% 78% 13% 4% 5% n = 1519 7% 4% n = 404 n = 837 68% 15% 3% 14% n = 666 22 Before inspection During inspection After inspection Adult Social Care Annual Provider Survey Results After inspection This section covers providers’ views on the impact of our approach, after inspection which includes: • Were outcomes for people who use the service improved as a result of the inspection?* • Has the process of being inspected helped with the ongoing monitoring of the quality of the service?* • Did the inspection help to identify areas for improvement? • Did the inspection report provide information that will help us improve our service? • Are CQC reports and ratings useful for your service? n/b – comparisons to last year’s survey for the first two questions are shown as dotted arrows as last year only “non-compliant” providers were asked this question, and this year all providers were asked, so the sample type and size is significantly different 23 Before inspection During inspection After inspection Adult Social Care Annual Provider Survey Results What Adult Social Care Providers Told Us (After inspection) Providers were generally positive about the impact of our inspections • However, 72% of all adult social care providers said the inspection had a positive impact whereas 93% answered positively to the previous question on whether our approach was beneficial (see slide 10) • Care homes without nursing were more positive than care homes with nursing and community services, about the impact on their monitoring of quality As a whole, adult social care providers thought the inspection process was more helpful in identifying improvement than the inspection reports were • Domiciliary care providers were slightly more positive than care homes in both areas However, inspection reports were seen as more useful to services than ratings • Community services were most positive about inspection reports Guidance and standards were again mentioned as a key factor to encouraging improvement • This was the most cited factor in the free text responses when providers were asked what else CQC could do to them improve • Promoting good practice was the second most common theme 24 Before inspection During inspection After inspection Adult Social Care Annual Provider Survey Results To what extent do you feel that outcomes for the people who use your service have been (or will be) improved as a result of CQC’s inspection?* Very / fairly / slightly improved 72% n = 1443 -1 26% (Very – 24% | Fairly – 28%) (Slightly – 20%) 28% 68% (Very – 24% | Fairly – 27%) n = 379 24% (Very – 22% | Fairly – 30%) 28% (Very – 23% | Fairly – 27%) 2% 4% 4% (Slightly – 20%) 69% n = 610 +1 (Slightly – 17%) 72% n = 788 Don’t know Not changed 3% (Slightly – 19%) What Providers Told Us In Their Own Words (Free Text Comments) Positive Themes There were 105 positive comments, the most common commenting that the inspection helped with unspecified improvements, or provided helpful guidance (39 comments). Negative Themes Of the 30 negative comments, the most common were concerned with too much focus on documentation (18 comments), and general disagreement with inspector comments (8 comments). 25 Before inspection During inspection After inspection Adult Social Care Annual Provider Survey Results Has the process of being inspected helped with your ongoing monitoring of the quality of your service? Very / fairly / slightly helpful 84% n = 1443 Don’t know No +4 -5 (Very – 43% | Fairly – 28%) 18% (Very – 35% | Fairly – 31%) 13% 1% (Very – 45% | Fairly – 27%) (Slightly – 14%) 14% 82% n = 610 2% (Slightly – 14%) 86% n = 788 1% (Slightly – 13%) 80% n = 379 15% (Very – 41% | Fairly – 28%) 4% (Slightly – 13%) What Providers Told Us In Their Own Words (Free Text Comments) Positive Themes There were 142 positive comments, the most common commenting that the inspection helped provide focus (77 comments), and that it was a helpful or good prompt (72 comments). Negative Themes Of the 32 negative verbatim comments, the most common themes were that providers already had systems in place (19 comments), and that our approach to inspection was inaccurate or inconsistent (6 comments). 26 Before inspection During inspection After inspection Adult Social Care Annual Provider Survey Results The inspection helped to identify areas for improvement Strongly agree / Agree 72% Neither agree nor disagree Disagree / Strongly disagree -5 Don’t know +4 17% 10% 1% n = 1383 65% 21% 14% <1% n = 362 74% 15% 10%<1% n = 755 74% 15% 9% 1% n = 565 What Providers Told Us In Their Own Words (Free Text Comments on ‘What can CQC do to help you improve?’) There were 125 comments with suggestions; the most common themes were around: • • • Improving guidance and templates (25 comments) Promoting good practice (16 comments), and Using more experienced inspectors (13 comments). 27 Before inspection During inspection After inspection Adult Social Care Annual Provider Survey Results The inspection report provided information that will help us improve our service Strongly agree / Agree 68% -5 Neither agree nor disagree Disagree / Strongly disagree Don’t know +4 19% 12%>1% n = 1392 63% 18% 16% 3% n = 352 68% 19% 11% 2% 70% 18% 10% 2% n = 739 n = 539 28 Before inspection During inspection After inspection Adult Social Care Annual Provider Survey Results Are CQC reports and ratings useful for your service? Yes Don’t know No Reports 87% Adult Social Care Ratings 9% 4% n = 1424 85% Care Homes with Nursing 11% 4% n = 304 Adult Social Care 15% 6% 73% Care Homes with Nursing 79% Care Homes without Nursing 83% Community Services 20% 6% n = 304 89% Care Homes without Nursing 8% 3% n = 648 15% 6% n = 648 89% n = 393 79% n = 1424 Community Services 8% 3% 10% 6% n = 393 29 Before inspection During inspection After inspection Adult Social Care Annual Provider Survey Results Please tell us whether your judgement/rating had the following impacts Confirmation of our performance Identified priorities for action Motiv ated Staff Prov ided impetus for action Demotiv ated staff Loss of business Prompted interv entions Adv erse effect on for others (e.g. regulators) care deliv ery 30 Before inspection During inspection After inspection Adult Social Care Annual Provider Survey Results CQC’s Independent Voice What Adult Social Care Providers Told Us • Awareness and interest in CQC’s major publications was high • With the Deprivation of Liberty Safeguards (DoLS) Report being cited most frequently in terms of providers being aware of it • The DoLS report was also cited most frequently as being of interest to providers • Complaints Matter was cited second most often as being of interest, and third was State of Care (2014/15) • The Deprivation of Liberty Safeguards Report was cited by the most providers as having lead to action after being read • Celebrating good care, championing outstanding care and Complaints Matter were the second and third most common to have lead to action • Overall, if a provider took action after reading one of CQC’s major publications, almost 70% of adult social care providers said that the change led to improvements 31 Adult Social Care Annual Provider Survey Results Were the following CQC reports of interest to your organisation? (all adult social care) Aware of the report, and it was of interest to our organisation Complaints Matter (n = 1729) Not aware of the report, but it would have been of interest Aware of the report, but not relevant to our organisation DoLS Celebrating good care, Right here, right State of (13/14) now: mental health Care championing crisis care review 2013/2014 outstanding care (n = 1753) (n = 1746) (n = 1739) (n = 1706) Not aware, and not relevant to our organisation State of Care 2014/2015 Cracks in the pathway (n = 1717) (n = 1731) Mental Health Act annual report 2013/14 (n = 1716) 32 Adult Social Care Annual Provider Survey Results Report Name Complaints Matter Did your organisation take any action to make changes as a result of reading the report? (% of Yes answers) 43% As a result of the changes you made, have there been improvements in care? n = 644 63% DoLS (13/14) n = 1004 Celebrating good care, championing outstanding care Right here, right now: mental health crisis care review State of Care 2013/2014 45% n = 654 22% n = 274 28% n = 409 State of Care 2014/2015 34% n = 515 Cracks in the pathway 28% n = 338 Mental Health Act annual report 2013/14 n = 1541 30% n = 386 33 Appendix A – Questions broken down by rating The following three slides break down questions detailed earlier in this report per rating the organisation received. The slides are ordered to reflect experience: • Before inspection, • During inspection, • And after an inspection As would be expected, Good and Outstanding rated providers tend to be much more positive, but there are a few exceptions in the following questions: • To what extent do you feel that outcomes for the people who use your service have been (or will be) improved as a result of CQC’s inspection? • Has the process of being inspected helped with your ongoing monitoring of the quality of your service? N/B - The % results shown in the tables are for positive answers only. 34 Questions by Provider Rating - All Adult Social Care providers Before inspection % of positive responses for impact Qs Outstanding Good n = 38 Requires Improvement n = 1118 Inadequate n = 343 Providers’ overall understanding 95% 96% 87% Beneficial to the quality of care received 88% 96% 86% N/A n = 36 78% 70% n = 451 91% 92% The guidance and standards* have helped us to improve 71% 81% Gathering info for the PIR helped us to identify areas for improvement 77% 74% 55% 46% 62% Enforcement action is a deterrent 74% 72% 60% 50% 74% 60% 65% 74% 35 Questions by Provider Rating - All Adult Social Care providers During inspection % of positive responses for impact Qs Inspection team's understanding Outstanding Good n = 38 Requires Improvement n = 1118 Inadequate n = 343 n = 451 n = 36 83% 85% 58% 44% Management of disruption 71% 81% 56% 39% Areas for improvement identified 77% 74% 68% N/A 58% 79% 69% 72% 36 Questions by Provider Rating - All Adult Social Care providers After inspection % of positive responses Outstanding Good n = 38 Requires Improvement n = 1118 Inadequate n = 343 n = 36 Were outcomes improved? 71% 72% 72% 84% Ongoing monitoring of the quality of your service 85% 86% 77% 81% The inspection report will help us improve 77% 70% Inspection reports are useful 88% 92% Ratings are useful 91% 86% 61% 74% 57% N/A 57% 70% 53% n = 451 63% 83% 64% 87% 75% 37