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