DEPARTMENT OF HEALTH. TRANSPARENCY AND QUALITY COMPACT MEASURES (voluntary indicators) GUIDE FOR CARE AND SUPPORT PROVIDERS

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1 TRANSPARENCY AND QUALITY COMPACT MEASURES (voluntary indicators) GUIDE FOR CARE AND SUPPORT PROVIDERS 1

2 Transparency and Quality Compact Measures (voluntary indicators) The Government has worked with care and support providers and their representatives to develop a set of Transparency and Quality Compact measures. Providers can choose to complete these on their online profiles on NHS Choices to tell people more about the quality of care they provide. The list of quality measures is: staff stability staff qualifications resolving complaints medication management (residential and nursing care only) pressure care management (residential and nursing care only) falls management (residential and nursing care only) scheduled homecare visits successfully undertaken (homecare only) scheduled homecare visits taking place on time (homecare only) So far, quality measures have been agreed for residential and homecare services for older people. Work will now take place with providers to develop similar measures for other types of care, such as Shared Lives services or Supported Living. The following pages set out more detail about each of the individual measures, what they aim to demonstrate about the quality of care and how providers calculate their performance against each measure. Frequently asked questions are attached at Annex A. Technical guidance on how providers can add performance against these measures to their online profiles is in the step-by-step user guide at IMPORTANT NOTE Once you publish data for the Transparency and Quality Compact measures on your online profile, it will be publicly available. In addition, from April NHS Choices will give other external organisations the ability to access this data so that they can present it to users in ways that they think will be helpful. This may include generating comparisons between care providers. 2

3 Measure 1: Staff Stability It measures the proportion of permanent and temporary, direct care and ancillary staff you employ who were also in post 12 months ago. Your data will be presented alongside comparison data for England from Skills for Care. Over time, this will become a regional comparison. Continuity of care and being able to see the same care worker(s) each day is important to people who use care services. Clients can build relationships with staff they see regularly so that they understand their individual needs and preferences. Good staff retention generally indicates that the organisation is a good place to work; managers are effective; staff are happy and satisfied at work; and their performance is satisfactory to their employers. However, some factors may affect staff retention which do not necessarily indicate that provider quality is declining. The local labour market may make it difficult to recruit and retain staff. An organisation may also dismiss poorly performing staff to improve the care they offer. If this is true for your organisation, you may want to explain this on your profile. All adult social care providers registered with the Care Quality Commission except Shared Lives providers. The information for this measure will be automatically populated from the Skills for Care National Minimum Data Set for Social Care (NMDS-SC) unless you have told Skills for Care that you do not want this information published. If your data is not up to date, you will need to amend it on the NMDS-SC. This metric is calculated automatically as follows: Numerator: number of staff who were in post in your organisation 12 months ago who are still in post now Denominator: total number of staff who you employ now. The measure is expressed as a percentage. Staff means permanent and temporary workers, both direct care and ancillary staff. Worked example You employ 80 permanent and 20 temporary workers, of whom 90 were in post 12 months ago. You calculate 90/100 giving a result of 90%. How often can I update this? The workforce measures are updated through NMDS-SC and you should update annually at a minimum. You can update your data at any time to reflect your current position on this measure as data transfers from NMDS-SC to NHS Choices will take place every month. 3

4 Measure 2: Staff qualifications It measures the proportion of permanent and temporary direct care staff you employ who hold or are working towards a qualification which is relevant to their work. People who use care and support services expect to have their care, treatment and support needs met by staff who have the right kind of skills and training. Providers have a responsibility to assess the training needs of their workforce alongside the needs of the people using the service and ensure that effective training is in place for their staff. All adult social care providers registered with the Care Quality Commission except Shared Lives providers. The information for this measure will be automatically populated from the Skills for Care National Minimum Data Set for Social Care (NMDS-SC) unless you have told Skills for Care that you do not want this information published. If your data is not up to date, you will need to amend it on the NMDS-SC. This measure is calculated automatically as follows: Numerator: the total number of permanent and temporary direct care staff with or working towards a relevant qualification Denominator: the total number of permanent and temporary direct care staff. This measure is expressed as a percentage. Permanent and temporary direct care staff means staff with a contract of employment with the provider. It does not include volunteers or students. Direct care staff for the purpose of this measure includes care workers; senior care workers; community, support and outreach work; employment support, advice, guidance and advocacy; educational support; counsellor; technician or other job role directly involved in providing care. Nurses within NMDS-SC are captured under professional staff rather than direct care staff (and will by definition be qualified). A relevant qualification is a qualification included in the in the National Minimum Data Set for Social Care (NMDS-SC). The full list is included at Worked example You employ 100 staff of whom 80 are direct care staff. Of these 80 staff, 40 already have a qualification relevant to their work and a further 10 are working towards such a qualification. Your calculation would be 50/80 to give a percentage of 62.5%. How often can I update this? The workforce measures are updated through NMDS-SC and you should update annually at a minimum. You can update your data at any time to reflect your current position on this measure as data transfers from NMDS-SC to NHS Choices will take place every month. 4

5 Measure 3: Resolving Complaints It measures the proportion of complaints you have received over the past 12 months which were resolved within 28 days. Good quality care providers are responsive to feedback about their services and act quickly when a complaint is made. Providers should reassure complainants that their concerns have been addressed, and that action has been taken to improve the service in the future. All adult social care providers registered with the Care Quality Commission except Shared Lives providers. You should calculate this using the last 12 months of recorded complaints: Numerator: total number of complaints which you have resolved within 28 days of initially being notified of the complaint Denominator: total number of complaints you have received in the last 12 months of recorded complaints. You should express the result as a percentage. The definition of a complaint is any adverse comment by the person using the service (or by someone acting on their behalf) that has resulted in a written record of the complaint by the provider under its complaints procedure. Complaints may have been made in person, by telephone, or writing to the provider or their staff. Previous 12 months is defined as meaning a 12 month period ending 28 days before the date you calculate the measure. For example if the calculation is made on 1 st April 2013, it should include all complaints made between 4 th March 2012 and 3 rd March This is necessary to exclude complaints raised within 28 days of the date of calculation, which may not have been resolved within the timescale measured. Worked example You have received 20 complaints in the last 12 months and resolved 19 of these complaints within 28 days of being notified of the complaint. You would divide 19/20 to give a percentage of 95%. How often can I update this? You should update this measure on an annual basis using the previous 12 months data. If you wish, you can update it more frequently. 5

6 Measure 4: Medicines Management It measures the percentage of residents you have cared for who have had their medicines administered safely in the last twelve months because their medicines were administered without causing a moderate, severe or fatal harm. People want to be reassured that medicine administration is safe. Most medicines will be administered in a safe manner. However, the very large number of medicines administered over time will mean that a provider cannot only rely on the competence of its staff to ensure that accuracy. Systems must be in place to identify and fix errors or gaps in medication information. Providers should review their systems and the information available to create a culture of learning from past events. All adult social care providers registered with the Care Quality Commission to provide nursing or residential care. It does not apply to registered residential or nursing home providers which provide supported live in accommodation where the individual is responsible for their own medicines management. You should calculate this as follows using the previous 12 months data: Numerator: the number of users whose medicines were administered without causing a moderate, severe or fatal harm Denominator: the total number of users receiving medicines. You should express the measure as a percentage. The definition of a medication incident, taken from the National Patient Safety Agency, is any incident which actually caused harm or had the potential to cause harm involving an error in the process of prescribing, dispensing, preparing, administering, monitoring or providing medicines advice. The definition of moderate or severe harm or death is taken from the National Patient Safety Agency s definition of harm using the terms fatal meaning death as a direct result of the harm; severe meaning permanent harm; and moderate meaning required hospital treatment or admission to hospital. Worked examples Your 40 bedded care home has administered medicines to 50 users over the last 12 months. One user has experienced a moderate harm. One user has experienced a severe harm. You would calculate 48/50 giving you a percentage of 96%. How often can I update this? You should update this measure on annual basis using the previous 12 months data. You can update it more frequently if you wish. 6

7 Measure 5: Pressure Care Management It measures the percentage of residents your organisation has cared for who have received appropriate pressure care in the previous 12 months because they did not develop a pressure ulcer at stage 3 and above whilst in your care. Each resident should receive appropriate assessment and subsequent care to maintain appropriate skin condition. This will include regular risk assessments of the individual, taking appropriate measures to prevent pressure ulcers developing. Providers caring for people at the end of life and with certain conditions may have a higher incidence of pressure ulcers because it is not always possible to maintain skin condition. You should explain this on your online quality profile if it is relevant for you. All adult social care providers registered with the Care Quality Commission to provide nursing or residential care. You should calculate this as follows using the past 12 months of data: Numerator: the number of residents you have cared for over the past 12 months who have received appropriate pressure care because they have not developed a pressure ulcer at stage 3 and above Denominator: total number of people you have cared for in the last 12 months. You should express this measure as a percentage. This measure is based on the number of residents you have cared for not the number of beds you have. Appropriate pressure area care is defined as meaning that the person has not developing a pressure ulcer at stage 3 and above. Pressure ulcers that developed in other care settings are excluded. Worked example For example, if you ran a 33 bedded care home which had cared for 40 residents in the previous 12 months with 2 residents who developed stage 3 pressure ulcers, you would calculate 38/40 giving you a measure of 95% How often can I update this? You should update this measure on annual basis using the previous 12 months data. You can update it more frequently if you wish. 7

8 Measure 6: Falls Management It measures the percentage of residents your organisation has cared for who have received appropriate care in falls management in the previous 12 months. Managing falls means balancing the independence of the person with the possible harm, which may result from a fall. There are many factors which affect that balance including medical history, mobility, medication, impaired sight, footwear, psychological and memory problems as well as the environmental factors Good quality care homes will record all slips, trips and falls whether harm occurs or not and will analyse the causes of such incidents. Appropriate actions should be taken to reduce the frequency of falls whilst ensuring that individuals are continually given the choice to take positive risks so maximising their independence. All adult social care providers registered with the Care Quality Commission to provide nursing or residential care. You should divide the number of residents you have cared for over the last 12 months who did not have a fall which results in moderate or severe harm or death by the total number of residents you have cared for in that period. You should express this measure as a percentage. This measure is based on the number of residents you have cared for not the number of beds you have. Worked example A 40 bedded care home which had cared for 45 residents in the previous twelve months with 3 residents who had had a fall which resulted in moderate or severe harm or death would divide 42 by 45 to generate a result of 93%. The definition of moderate or severe harm or death is taken from the National Patient Safety Agency s definition of harm using the terms fatal meaning death as a direct result of the fall; severe meaning permanent harm; and moderate meaning required hospital treatment or admission to hospital. How often can I update this? You should update this measure on annual basis using the previous 12 months data. You can update it more frequently if you wish. 8

9 Measure 7: Scheduled homecare visits successfully undertaken This measures the proportion of scheduled homecare visits which your organisation has undertaken successfully in the last quarter. People who use homecare services rely on receiving assistance that keeps them comfortable, safe and able to carry out their daily life. A missed visit can be very distressing for the service user and for family carers. However, there may be very exceptional circumstances when a visit may not be completed because of an unexpected situation. This may include sudden illness or injury of the care worker which means it is not possible to replace them. You should explain this on your online quality profile if it is relevant for you. This applies to all domiciliary care agencies registered with the Care Quality Commission, excluding those operating solely as employment agencies. To calculate this: Numerator: number of scheduled homecare visits your organisation carried out over the last quarter Denominator: total number of homecare visits your organisation was scheduled to carry out over the last quarter You should exclude any visits which were cancelled by the user within your agreed timescale. You should express the measure as a percentage. Worked Example Your organisation was scheduled to carry out 100 homecare visits in the last quarter. Of these 5 visits were cancelled by the user within your agreed timescale. Of the remaining 95 visits, 93 were carried out as planned. You calculate 93/95 giving you a measure of 98%. The definition of a scheduled visit means a visit that was agreed in advance to take place on a specific day at a specified time. The agreement may be between the service user and the provider or the provider and the local authority or NHS trust (if care is arranged by them). The definition of provider s agreed timescale is the advance notice period that a provider specifies for cancellation of a visit. If you do not specify a notice period, you should assume 24 hours before the planned start of the visit. How often should I update it? You should update this measure on annual basis using the previous 12 months data. You can update it more frequently if you wish. 9

10 Measure 8: Scheduled homecare visits taking place on time This measures the proportion of scheduled homecare visits that took place within thirty minutes of the agreed start time. Why should I fill this in? People who use homecare services rely on receiving assistance when they are expecting it to keep them comfortable, safe and able to carry out their daily life. If a care worker does not arrive at the time that the service user expects it can be very distressing for the user and for family carers. It can also mean that they cannot carry on with their daily life as they would want. However, there may be very exceptional circumstances when a visit may not happen at the time it is scheduled for because of an unexpected situation. This may include sudden illness or injury of the care worker which means it is not possible to replace them. You should explain this on your online quality profile if it is relevant for you. This applies to all domiciliary care agencies registered with the Care Quality Commission, excluding those operating solely as employment agencies. You should calculate this using data from the last quarter as follows: Numerator: the number of scheduled homecare visits which took place within thirty minutes of the agreed start time in the last quarter Denominator: total number of homecare visits which your organisation was scheduled to carry out over the last quarter You should exclude visits cancelled by the service user with or without prior notice. You should express the measure as a percentage. Worked Example Your organisation was scheduled to carry out 150 homecare visits in the last quarter. Of these, 10 visits were cancelled by the user with or without prior notice. Of the remaining 140 visits, 130 visits took place within 30 minutes of the agreed start time. You calculate 130/140 giving you a measure of 93%. The definition of a scheduled visit means a visit that was agreed in advance to take place on a specific day at a specified time. The agreement may be between the service user and the provider or the provider and the local authority or NHS trust (if care is arranged by them). The definition of agreed start time means the planned arrival time of the careworker at the service user's home which has been agreed either between the service user and the provider or the provider and the local authority or NHS trust (if care is arranged by them). In other words, the time that the person who uses the service expects care to begin. Visits cancelled by the service user with or without prior notice means visits which the user requested not to take place, or situations where the user was not available to receive care (for example by not being at home at the agreed time, or having been admitted to hospital). 10

11 How often should I update it? You should update this measure on annual basis using the previous 12 months data. You can update it more frequently if you wish. 11

12 ANNEX A Frequently Asked Questions Q Who developed the Transparency and Quality Compact measures? In early 2012, the Department of Health and No.10 brought together a range of care providers and representative organisations to explore issues around transparency and quality for the care and support sector. Those organisations include the English Community Care Association, the United Kingdom Home Care Association, the National Care Forum and the Registered Nursing Home Association as well as a range of provider organisations. This group of providers and their representative organisations agreed a set of Transparency and Quality Compact Measures which providers of older people s care can use to report against in homecare and residential care settings (with and without nursing). Providers will have the option to complete this information on their online quality profiles on NHS Choices. Q How will this look on the website The picture below illustrates how the metrics will appear on NHS Choices for each provider s online profile, using illustrative data. Q Our care is Shared Lives/ Supported Living these measures don t all apply. Reporting against all the measures is voluntary. Feedback from some learning disabled providers, supported living providers and their representative bodies suggests most services in these areas could report against the measures around staff stability, staff qualifications and resolving complaints. Where the services provide homecare, the metrics about scheduled homecare visits successfully taking place and scheduled homecare visits taking place on time may also be relevant. Providers can choose to report against some or all of the measures. Overtime we want to work with the sector to see if we can develop additional measures that would work better for services for people with learning disabilities, supported living, shared lives and mental health services. 12

13 Q You say the data for the staffing measures is being pulled in from the Skills for Care National Minimum Dataset for Social Care- how does this work? A care provider who completes NMDS-SC will not need to do anything further unless they opt out of allowing their data on the staff measures to be passed to NHS Choices to appear on the online quality profiles. Opt out boxes are available to providers when they submit their data. No person identifiable data is transferred. The workforce measures are updated through NMDS-SC and providers should update this at least annually, ideally quarterly. However, it can be updated at any time to reflect the current position on this measure as data transfers from NMDS-SC to NHS Choices will take place every month. Q. Can I add my performance on the staff measures directly without going through the NMDS-SC? No. The system is set up in a way that tries as much as possible to minimise the data burden on care providers. As over half of providers already provide this data through NMDS-SC, the decision was taken to use this existing data source and encourage those who do not already supply data to Skills for Care to start to do so. This helps ensure the largest possible dataset is available to enable meaningful comparisons against national (and overtime regional/local) averages. Q How do these measures demonstrate quality? There are three elements to quality - effectiveness, safety and experience. These measures, developed with providers, tell people about a provider s effectiveness and safety. Providers can provide supportive narrative alongside their measures to give context to the numbers they provide. Comments from users and their families and carers left on the online quality profiles will also give people an open and honest indication of the kind of experience others have had. Providers are also looking at other ways of obtaining aggregated comparative information about people s experiences of care. If providers can agree a standard set of user experience measures and methodology for collecting them, these can be added to the online profiles. Q Will the online profiles have their own quality rating? At the Secretary of State for Health s request, the Nuffield Trust is reviewing whether it is possible to develop a composite measure of quality for NHS and social care providers. We expect the Nuffield Trust to report by the end of March. Subject to their recommendations, it is possible that a single quality rating for care providers will be developed. This could then be included on the online profiles. 13

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