Care Choices

The request was partially successful.

Dear Care Quality Commission,

I would like CQC to supply as few authoritative emails, minutes, reports etc as necessary which tell how individuals care choices work with a top-down process sending people into care homes etc direct, or after hospital discharge, or restricted admission to hospital, with the aims of easing pressure on hospitals and keeping care homes viable, during and after the pandemic.
Also clear instructions on how to quickly access and compare all the information we now know is important, such as location and size, visiting, ownership, infection rates*, bank staff, CQC reports etc.
Explanation.
This is a follow-up to your FOI response 20210427 CQC IAT 2021 0970 FOIA response.pdf While we seemed to be at cross-purposes; i think you were withholding information i did not ask for and you said less than has already been made public by the media, ONS and Vivaldi, you have kindly supplied two new items of information.
1 CQC do not wish to make location-specific care home death data public yet but are keeping this under review.
2 However, CQC expressly endorsed the joint NCF/ R& R Assn statement which includes the following.:
"This includes updates on whether COVID-19 has been suspected or detected amongst staff or residents"
and
"Whilst this statement is primarily aimed at providers of residential care in response to concerns about the COVID-19 status of homes, we hope it will also be helpful across other care settings, including domiciliary care."
*Obviously information on infections in care etc homes may have informed initial decisions on home/ domiciliary care without first involving any specific care home.
Opting for supported home/ domiciliary care, choosing or if necessary officially shifting to a care home with certain characteristics or to avoid institutional restrictions or loss of autonomy is rational and patient -centred.
i am trying to piece together how informed decisions by individuals, families and representatives fit into the disjointed and organisation-centred form of integrated care as we emerge [hopefully] from the pandemic and its rules. CQC oversee separate elements, the NHS, Care etc Homes and relevant activities of local authorities I am. Decisions on home/ domiciliary care and home support usually come before care homes I noted that in 2020 the government provided an extra £588 million for support in the home.
Please say if you do not understand the request. To be clear, I am not pre-empting an inquiry, nor prematurely seeking location -specific data on care home deaths or care home finances, though somehow self-payers should know if they are subsidising LA funded residents..

Yours faithfully,

Dick Fowler

Information Access, Care Quality Commission

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Information Access, Care Quality Commission

Dear Mr Fowler

 

I acknowledge receipt of your correspondence dated 8 May 2021, in which
you made a request for information

 

Your request is as follows:

 

“I would like CQC to supply as few authoritative emails, minutes, reports
etc as necessary which tell how individuals care choices work with  a
top-down process sending people into care homes etc direct, or after
hospital  discharge, or restricted admission to hospital, with the aims of
easing pressure on hospitals and  keeping care homes viable, during and
after the pandemic.

 

Also clear instructions on how to quickly access and compare all the
information we now know is important, such as location and size, visiting,
ownership, infection rates*, bank staff, CQC reports etc.”

 

CQC will consider your request in accordance with the Freedom of
Information Act 2000 (FOIA).

 

Our statutory deadline for response is 7 June 2021, but we will in any
event endeavour to respond as soon as possible.

 

We will write to you if we are unable to meet this deadline.

 

Please be aware that there may be a delay in providing a response to your
request for information. The Information Access team are experiencing a
higher than usual workload at present due to the pandemic situation. Where
possible, please request specific information. We are currently working
through a backlog of work and will respond to each request as soon as
possible. We thank you for your patience.

 

The information you have requested may be subject to an exemption from the
right to know. Should this occur, we will explain the reasons why when we
respond.

 

Regards

 

On behalf of:

Information Access Team

Regulatory Customer & Corporate Operations 

 

Care Quality Commission

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Information Access, Care Quality Commission

Dear Mr Fowler

Having further reviewed your correspondence of 8 May 2021, the Care Quality Commission (CQC) is unclear as to the information that you are seeking. We are therefore asking you to clarify your request.

Policy on the discharge of people from hospitals into care homes during the pandemic was set by the Department of Health and Social Care (DHSC). You can find the latest guidance on admission and care of residents in care homes during COVID-19 at https://www.gov.uk/government/publicatio....

If you are seeking clarification of these policies, or other information relating to them, we would advise you to contact DHSC directly with your requests. You can find contact details at https://www.gov.uk/government/organisati....

CQC's role as the regulator is to make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve. As part of this role, we inspect these services and publish reports of our findings to help people to make informed choices. You can access our inspection reports and latest ratings for care providers on our website at www.cqc.org.uk. There is also information on our website about how the way we work has changed in response to the pandemic.

We have a responsibility to ensure the data we publish is clear and accessible. It is important we explain what the data can and can’t tell us. On its own the number of deaths at a care home does not tell us the whole picture of the quality or safety of that service.

CQC made the decision not to release data on the number of COVID-19 related deaths notified to us by individual care homes. We released this information at national and local level but not broken down to identify individual providers. In making this decision, we were mindful of the potential impact of publishing our data and have had to make a judgement on when it was the right time to do so.

People who use care services and their families have been understandably anxious about the risks of COVID-19 as well as the profound impacts it has had on their rights, freedoms, relationships and well-being. We have stressed the importance of providers being as supportive as possible, communicating clearly and sharing information transparently so people can understand ongoing risks, take necessary precautions and make decisions. However, we were concerned that we were not able to publish the data in a way that would support people to understand how safe and effective those services were and therefore make properly informed choices.

CQC's decision to withhold this data under the Freedom of Information Act 2000 (FOIA) has recently been reviewed by the Information Commissioner's Office (ICO). The ICO concluded that CQC was right to withhold the data at the height of the pandemic due to the risk of publication resulting in serious harm to people who use and work in health and social care services. You can find the ICO decision notice at https://ico.org.uk/media/action-weve-tak...

We are currently working with partner organisations to prepare this data for publication during the coming months, alongside the contextual information required to support people to better understand it. We’ve kept our decision on whether to release this data under review. We already publish data on the total number of deaths in care homes in partnership with the Office for National Statistics (ONS) on a weekly basis, however we’re now working towards sharing further data on this in the coming months and we are in ongoing conversations with ONS about how best to release this.

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Statutory requests for information made under access to information legislation such as the GDPR and the Freedom of Information Act 2000 should be sent to: [CQC request email].

show quoted sections

Dear Information Access,

Dear CQC,
Thank you. You have requested further clarification of my request.

This FOI request is made to get a 'transparent snapshot' of who really makes the key informed decisions about individuals care. Bluntly, are individuals etc treated as ignorant or emotional supplicants?
The timing of the FOI request means that we have hopefully had the worst of the pandemic but we emerge with an obviously threadbare, 'integrated' but disjointed health and care system, and before the promised long term plan for social care and the pandemic inquiry.

i would like to see three things from CQC:
1. Evidence of the weight and priority [or lack of] given by CQC to enabling informed Care Choices [eg Home Care /Care Homes etc /which Care Home/ changing Care Home] by individuals, their families, formal and informal representatives and, in DOLS situations, social workers on one hand, relative to on the other hand the financial and operational interests of those you regulate ie the NHS [eg in discharging patients] ; Individual Care etc Homes [eg occupancy] and the Care Sector as a whole [eg viability, avoiding closures, public image] . Integrated care and Covid seem to have created a process in which the NHS, the Care Sector, ASC and the CQC collectively dominate.

2. Clear instructions on how individuals etc can readily access all the information we now know is important, such as location and size, visiting, ownership, infection rates*, bank staff, CQC reports etc. CQC gave me a link to the 2020 decision to withhold location-specific death data, which amplified the list of information needed to make an informed decision.

3 The CQC email of 1 June 2021 says "We are currently working with partner organisations.....".Are any of these partner organisations ones which CQC regulate?

'2' of this request is not for location-specific care home deaths data which you have already said CQC and ONS are working on. It does however cover all other information required by individuals etc to make informed decisions. Part of that might be location -specific Covid- positive information. As i said previously, CQC have expressly endorsed a statement by the NCF and R & R accepting this:
Quote :
"This includes updates on whether COVID-19 has been suspected or detected amongst staff or residents"
and
"Whilst this statement is primarily aimed at providers of residential care in response to concerns about the COVID-19 status of homes, we hope it will also be helpful across other care settings, including domiciliary care."

Nor is this request seeking financial information other than how self-payers know if they are subsidising LA funded individuals.

And lastly this request is not an invitation to offer patronising or soothing but meaningless words.

Yours sincerely,

Dick Fowler

Information Access, Care Quality Commission

Dear enquirer

 

Thank you for contacting the Information Access Team at the Care Quality
Commission (CQC).

 

Please accept this automated response as acknowledgement that we have
received your e-mail. 

 

What we do

 

We coordinate responses to requests for recorded information made in
accordance with the Freedom of Information Act 2000 (FOIA), the General
Data Protection Regulation (GDPR), Data Protection Act 2018 (DPA) and the
Environmental Information Regulations 2004 (EIR).

 

If you are making a request for information which falls under these Acts and
regulations

 

We aim to respond to you within three working days with a formal
acknowledgement of your request including a unique reference number and
deadline for our response.

 

Please be as specific as possible in describing the information you want
to request.

 

We have published information on our website explaining [1]how to ask for
official information held by CQC and [2]how to ask for information about
yourself or other people.

 

If you are seeking an update on an existing request

 

The Information Access team is experiencing a higher than usual workload
at present.

 

We are currently working through a backlog of work and will respond to
each request as soon as possible. Thank you for your patience. 

 

Information relating to medical records

 

If you want to request your medical records please contact your GP
surgery, or the organisation that provided your care. CQC does not
routinely hold patient medical records.

 

General enquiries about CQC

 

CQC is the independent regulator of health and adult social care services
in England.

 

There is information about our role published on our website,
[3]www.cqc.org.uk

 

If you have any questions about any aspect of CQC’s work, you can contact
our National Customer Service Centre (NCSC). Please e-mail
[4][email address] or call 03000 616161.

 

Statutory requests for information made under access to information
legislation such as the Data Protection Act 2018, GDPR and the Freedom of
Information Act 2000 should be sent to: [5][CQC request email]

 

How CQC handles and protects your personal data

 

Personal data is processed in accordance with the General Data Protection
Regulation (GDPR) and relevant data protection law. Information on the
processing of personal data by CQC can be found at
[6]www.cqc.org.uk/about-us/our-policies/privacy-statement

 

 

Kind regards

 

The Information Access Team 

 

 

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Dick Fowler left an annotation ()

I have replied to CQCs request for clarification

Dear Care Quality Commission,
I clarified my request as you required on 2 June and CQC sent an automated acknowledgement on the same day.

i would appreciate a reply

Yours faithfully,

Dick Fowler

Information Access, Care Quality Commission

Dear Mr Fowler

Please accept my sincere apologies for the delay in acknowledging your clarification email of 2 June, and in responding to your request.

The statutory deadline for responding to a Freedom of Information Access request is twenty working days from the date when CQC received clarification of your request therefore you should have received a response no later than close of business 30 June 2021. CQC recognises that failure to respond by that date is a breach of the FOIA.

The Information Access Team are a small team and during the past year we experienced a higher than usual workload of complex and large requests for information. The team have been working remotely during the pandemic which has posed challenges. In addition to this, our team has been short-staffed. All of these factors have contributed to a backlog of requests which we are working hard to clear. Unfortunately, your request is part of that backlog.

We are prioritising your request and will endeavour to provide you with a full response as soon as possible. However, we can advise the following information today which will address part of the second limb of your request:

I can advise you that we have now confirmed a date for publication of data showing notifications received from individual care homes relating to deaths of people with COVID-19 between 10 April 2020 and 31 March 2021. This is in addition to the data we already publish on a weekly basis with ONS on the total number of care home residents who have died with COVID-19.

We made a commitment to publish data on location level death notifications as soon as we were able to do so accurately and safely. We can now confirm that we are working towards bringing this data to our Public Board meeting on 21 July 2021, with publication on the CQC website later the same day. You can find out more on our website:

https://www.cqc.org.uk/news/stories/data...

Thank you for your patience.

Kind regards

The Information Access Team
Governance and Legal Services
Customer & Corporate Services Directorate
Care Quality Commission

Email: [CQC request email]

show quoted sections

Dear Information Access,
Thank you for your holding reply. I note that you are about to publish location specific death data but this was not the focus of my request.
I look forward to seeing how patients and their families will be enabled to make the key informed decisions on care settings.

It would be helpful to see how that will work with the proposal in the Health and Care Bill 2021 which the National Pensioners Convention summarised as follows:
Vulnerable patients being put at risk – the Bill removes the requirement for social care needs assessments to be carried out by the relevant local authority BEFORE a patient is discharged from hospital [5]; this will leave families to pick up the pieces, and those without family at risk of isolation and lack of care.

We are not yet post-pandemic but this does pre-empt the long term plan for care.

Yours sincerely,

Dick Fowler

Information Access, Care Quality Commission

Dear Mr Fowler

In your email of 2 June 2021, you asked for three things from CQC.

1. Evidence of the weight and priority [or lack of] given by CQC to enabling informed Care Choices [eg Home Care /Care Homes etc /which Care Home/ changing Care Home] by individuals, their families, formal and informal representatives and, in DOLS situations, social workers on one hand, relative to on the other hand the financial and operational interests of those you regulate ie the NHS [eg in discharging patients] ; Individual Care etc Homes [eg occupancy] and the Care Sector as a whole [eg viability, avoiding closures, public image] . Integrated care and Covid seem to have created a process in which the NHS, the Care Sector, ASC and the CQC collectively dominate.

CQC does not hold the requested information as we do not hold recorded information which specifically weighs and prioritises care choices against the financial and operational interests of registered providers of care.

However, I can direct you to CQC's published guidance for providers on Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

https://www.cqc.org.uk/guidance-provider...

Regulation 9(1)(c) places a requirement on registered providers that the care and treatment of service users must reflect their preferences.

Regulation 9(3) sets out things which a provider must do to comply with this requirement, including:

9(3)(d) - enabling and supporting relevant persons to make, or participate in making, decisions relating to the service user's care or treatment to the maximum extent possible.

These are things that providers must do.

We publish our Key Lines of Enquiry (KLOEs) which set out what we look for when we inspect a service. These include our KLOE on involving people in decisions about their care:

https://www.cqc.org.uk/guidance-provider...

Further to this, I would add that section 3(1) of the Health and Social Care Act 2008 requires that:

The main objective of the Commission in performing its functions is to protect and promote the health, safety and welfare of people who use health and social care services.

And section 3(2)(b) requires that CQC must perform its functions for the general purpose of encouraging the provision of health and social care services in a way that focuses on the needs and experiences of people who use those services.

To the extent that CQC has regard to the financial and operational interests of providers, it is for the overall purpose of protecting and promoting the vital interests of people who use those services.

2. Clear instructions on how individuals etc can readily access all the information we now know is important, such as location and size, visiting, ownership, infection rates*, bank staff, CQC reports etc. CQC gave me a link to the 2020 decision to withhold location-specific death data, which amplified the list of information needed to make an informed decision.

This is not a valid FOIA request as CQC does not hold recorded information setting out 'clear instructions' for accessing all such information. Nor do we know the full list of information that you would consider to be important.

In the 2020 decision to withhold location-specific data on deaths in care homes notified to CQC as being related to COVID19, we provided a range of factors that may influence the number of deaths in any given home. This was not intended as an exhaustive list, but was instead an indicative example of the wide and complex set of circumstances that may influence the number of deaths experienced by any home at any individual time.

CQC made the decision not to release this data under FOIA in the exceptional circumstances of the height of the pandemic due to very serious concerns about the risk of harm to people who use and work in registered services. This was a decision that the ICO agreed was right at the time (https://ico.org.uk/media/action-weve-tak...). CQC is now preparing to publish this data.

CQC publishes information about care services that we regulate on our website at www.cqc.org.uk. This includes information on the persons registered to carry on regulated activities there, location, inspection reports, and information about regulatory action taken by CQC.

3 The CQC email of 1 June 2021 says "We are currently working with partner organisations.....".Are any of these partner organisations ones which CQC regulate?

CQC has been in discussion with a range of partner organisations to prepare the location-level notification data. This has included the Department of Health and Social Care and the Office of National Statistics. We have notified registered care providers of our intention to publish the data and listened to their views expressed through trade associations but the decisions to publish the data, on when to publish the data and on how to present the data have been made by CQC.

Yours sincerely

Simon

Simon Richardson
Information Rights Manager
Governance & Legal Services
Care Quality Commission

The Care Quality Commission is the independent regulator of all health and adult social care in England. www.cqc.org.uk. For general enquiries, call the National Customer Service Centre (NCSC) on 03000 616161 or email [email address].

Personal data is processed in accordance with the General Data Protection Regulation (GDPR) and relevant data protection law. Information on the processing of personal data by CQC can be found at: http://www.cqc.org.uk/about-us/our-polic...

Statutory requests for information made under access to information legislation such as the GDPR and the Freedom of Information Act 2000 should be sent to: [CQC request email].

-------------- The contents of this email and any attachments are confidential to the intended recipient. They may not be disclosed to or used by or copied in any way by anyone other than the intended recipient. If this email is received in error, please notify us immediately by clicking "Reply" and delete the email. Please note that neither the Care Quality Commission nor the sender accepts any responsibility for viruses and it is your responsibility to scan or otherwise check this email and any attachments. Any views expressed in this message are those of the individual sender, except where the sender specifically states them to be the views of the Care Quality Commission. Information on how the Care Quality Commission processes personal data is available here http://www.cqc.org.uk/about-us/our-polic...