Inspection commenced on 09 06 2014 of the Avon and Wiltshire Mental Health Partnership NHS Trust

Steven King made this Freedom of Information request to Care Quality Commission

This request has been closed to new correspondence from the public body. Contact us if you think it ought be re-opened.

Response to this request is long overdue. By law, under all circumstances, Care Quality Commission should have responded by now (details). You can complain by requesting an internal review.

Dear FOI Team, Care Quality Commission,

I understand the CQC has a process of inviting individual service users and carers, in this case of Avon and Wiltshire Mental Health Partnership , by way of using an independent organisation to widely publicise and advertise in the weeks leading up to this major inspection , involving some 70 staff and inspectors working for CQC, that a major inspection is about to take place and offering them the chance to feedback their experiences either to the independent organisation or by meeting with CQC staff ?

I understand AWP also puts forward a number of patients and carers they have carefully selected !

In the case of the above mentioned inspection,I understand AWP became aware of the ' independent organisation ' you use, maybe due to the fact a number of AWP and other Wiltshire NHS staff have been working inside and with the CQC over a period of months leading up to this inspection.

I further understand that AWP instructed this so called ' independent organisation ' to carry out some work for AWP itself prior to the CQC instructing this ' independent organisation ' to act ' independently ' on behalf of the CQC ?

It is my understanding that about a week or ten days before the inspection was due to start - and long after all the publicity, adverts, invites and feedback was due to be collected, someone alerted the CQC of a clear ' conflict of interests ' here, hence shortly before the inspection - and without carrying out its work - the so called ' independent organisation ' was de instructed , and hurried limited arrangements were made for another body to carry out the works in the 7-10 days leading up to this major inspection, which would have usually taken place over say a 2 month period by your usual ' independent body ' ?

Clearly the usual processes of gaining information and feedback from patients and carers has been severely restricted and limited in that everything was so ' last minute ' that VERY MANY PEOPLE have been denied the opportunity of feeding back their experiences - except of course those put forward by AWP itself ?

The CQC is VERY AWARE of my own MULTIPLE ATTEMPTS to have my own voice heard, and I know of many others who have not been invited or allowed to give their own feedback.

Clearly questions need to be asked of AWP as to why they chose to instruct and pay money to the ' independent organisation ' they knew - or should have checked - you use yourselves when carrying out these inspections , and I hope you are able to get honest answers from them that are believable ?

This leads to my request : I wish to see the instructions and agreements you had with your' usual '- ' independent organisation '
I refer to that handles the work I have described, to include all data and records of contacts with them from start to finish of these matters please and I ask you to leave all dates on the information you provide please.

Would you also be kind enough to let me have a copy of any document you hold in relation to the matters ive raised that will show me how the ' independent organisation ' you instructed must act when a conflict of interests exists ?

Please supply me also with all the documents you hold in respect of CQC instructing the ' replacement independent organisation ' , and the ongoing data and records you hold following your initial contacts with them please ?

Also , in light of the fact it appears this inspection has been carried out in a way that is unfair to AWP patients like myself and carers who really wanted to give their feedback but were PREVENTED from doing so, what plans are CQC putting into place to ensure ALL of those who wish to input their experiences to the AWP inspectors are now given the opportunity to do so - in a way that allows their experiences to be fully and ACCURATELY recorded ?

You will be aware I have been reporting abuse, neglect, ( under NO SECRETS and Adult Safeguarding procedures) to the CQC falsification of records, removal of complaints and correspondence etc etc over a number of years, and I trust CQC will not now be producing another worthless report that covers up the truth and again denies patients of their chance to preferably replace, or at least temporarily improve this long failing organisation ?

Maybe from now on, you will start giving me ALL the information I ask for at the first attempt and in as short a time as possible - certainly within the maximum 20 working days allowed PLEASE ???

Yours faithfully,

Steven King

Information Access, Care Quality Commission

Dear Mr King

 

We write to acknowledge receipt of your correspondence dated 22 June 2014,
in which you made a request for information, which CQC received on 23 June
2014.

 

Your request was:

 

“I wish to see the instructions and agreements you had with your' usual '-
' independent organisation '

I refer to that handles the work I have described, to include all data and
records of contacts with them from start to finish of these matters please
and I ask you to leave all dates on the information you provide please.

 

Would you also be kind enough to let me have a copy of any document you
hold in relation to the matters ive raised that will show me how the '
independent organisation ' you instructed must act when a conflict of
interests exists ?

 

Please supply me also with all the documents you hold in respect of CQC
instructing the ' replacement independent organisation ' , and the ongoing
data and records you hold following your initial contacts with them please
?”

 

We can confirm that your request is now being processed in accordance with
the Freedom of Information Act 2000 (FOIA).

 

CQC will respond to your request as soon as possible, but in any event,
within 20 working days following the date of receipt of your request as
outlined by FOIA.

 

You can therefore expect a response by close of business 21 July 2014,
subject to the information not being exempt from disclosure or containing
reference to third party individuals. Should this occur, you will be
notified accordingly when we write to you next.

 

In certain circumstances CQC may be unable to provide the information by
the statutory deadline. We will write to you before the deadline for
response if we are unable to meet it.

 

If you have any queries please do not hesitate to contact the team, on the
telephone number provided, quoting our reference number.

 

Regards

 

Sylvia Blakeley

Information Access Officer

 

Care Quality Commission

Citygate

Gallowgate

Newcastle upon Tyne

NE1 4PA

 

Statutory requests for information made under access to information
legislation, such as the Data Protection Act 1998 and the Freedom of
Information Act 2000, should be sent to:  [1][CQC request email]

 

show quoted sections

References

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1. mailto:[CQC request email]

Steven King left an annotation ()

Failing any opportunity being arranged by the CQC before or during the completion of this inspection to give my feedback - I was constantly ignored, I read about a feedback session to the CQC being held many miles away and went to the organisation that had had to press the CQC to allow ' unselected and impartial patients ' of AWP to have their say. The phone conference involved 12 -15 patients with three staff on the phone from CQC - we were told the calls to CQC were free , but my own and other mobile phones quickly used up many pounds of credit within minutes.
However the manager of the South West region for CQC arranged to call me back and did so briefly about 5pm to ask if she could call back Tuesday AM instead .
We spoke for about two hours, and I was able to tell her in great detail about my own horrific experiences of AWP - and of what I had heard at a number of public meetings about AWP from carers, service users and relatives of those who had received a sub standard service and a number of people who's partners or relatives had taken their own lives after experiencing particularly bad levels of service from AWP.
The CQC is formally notified of the information I wished to pass on to them - but will it now appear in their systems, be investigated and reported upon ?
The regional manager TOLD ME, not asked me, she was considering dealing with this request by way of a complaint - although I feel there is no reason not to respond fully to my request here .. along with other similar requests I am now making .. in order to bring about the necessary improvements in the CQC inspection process, handling of patients reports and feedback to CQC and in light of the Savile reports and feedback this week to put a FIRM STOP to CQC and other NHS bodies and local Councils failing to deal with safeguarding alerts and reports of abuse of adults at risk and vulnerable people as appears the ' norm ' in far too many areas of the country.Of course, if the CQC wish to demonstrate to me they are REALLY taking ALL these matters seriously, I would ALSO welcome a full response from them via their complaints process in ADDITION to the FOIA requests I have submitted. Health Secretary Jeremy Hunt said this week " these reports paint a terrible picture, as time and again victims were ignored " although the more up to date statement could be time and time again between 2011 and 2014 victims reports of abuse and neglect to Statutory Agencies are often not investigated and often victims or their families are not even contacted ? How many lives does that ruin - how many deteriorate and die slowly in misery - how many give up and commit suicide when the agencies fail to act ? All seriously damaging to society ! Reading my FOI requests here maybe proves the point at least in my own case ?

Information Access, Care Quality Commission

10 Attachments

21 July 2014

 

Our Refs: CQC IAT CQC IAT 1415 0238, CQC IAT 1415 0239, CQC IAT 1415 0264,
CQC IAT 1415 0265, CQC IAT 1415 0266, CQC IAT 1415 0116

 

Dear Mr King

 

I am the Information Rights Manager for the Care Quality Commission (CQC).

 

Part of my role is to manage the Information Access Team. This team
handles and responds to requests for information made to CQC under the
Freedom of Information Act 2000 (FOIA).

 

You have made a number of FOIA requests to CQC. Some of those have been
answered already, and the remaining ones I will answer in this email. My
hope is that I can tie together all of the various issues and help bring
the concerns that you have expressed about CQC to a resolution.

 

I understand that you have found some of our previous responses unhelpful.
In one email you refer to CQC ‘blinding you with science’.

 

It has not been our intention to be unhelpful. In some cases we simply
have not had the information that you want. For other parts of the
information you have requested there have been other genuine reasons why
we have not been able to fully release the information to you.

 

FOIA places a legal responsibility upon CQC to provide a ‘decision notice’
wherever we refuse to provide requested information. In these decision
notices, we must refer to the relevant exemption under the Act, provide an
explanation of why we consider that it applies and – for most exemptions –
explain what ‘public interest’ issues we took into account in making our
decision.

 

In addition to this, our understanding is that ‘What Do They Know?’ is
only intended for the purpose of making FOIA requests. In order to protect
your privacy, we cannot and will not get into detailed discussions about
your own complaints or treatment on this public website.

 

I’m sorry if this has resulted in some responses that are not as full or
clear as you would want. I will try to be as clear as possible in this
email.

 

I have attached a large number of documents to this email. Some of these,
you have specifically requested. Others are documents which I think may be
of interest to you in understanding our methodologies and processes.
Please do not feel that you have to read them all if you do not want to.

 

I appreciate that you have found your dealings with CQC frustrating.  I am
sorry that this is the case. However, you have used this public website to
accuse my colleague, Russell Wynn, of being ‘inhumane’ and of causing you
suffering by ‘negligence’.

 

I consider this to be deeply unfair. I can assure you that Mr Wynn has
worked hard to ensure that you get proper responses to your FOIA requests.
Where you have raised other matters, he has referred these through to the
appropriate parts of CQC, and he has advised you how to make a complaint
if you are unhappy with CQC’s actions.

 

You have also used this website to make accusations of dishonesty against
Lyn Critchley and Lesley Whittaker. CQC cannot, and will not, use this
website as a forum for considering and responding to complaints of this
type. In this email, I will advise you of how to raise a formal complaint
against employees of CQC if you wish to do so. If you are not happy with
the actions of CQC employees, I would ask you to make those complaints
through a proper process that will allow full consideration and a response
that appropriately respects the confidentiality of yourself and CQC staff.

 

Please consider the guidance for using What Do They Know – in particular
the section on ‘why must I keep my request focussed’ – at
[1]https://www.whatdotheyknow.com/help/requ....

 

In future, I would ask you to restrict your use of this website, when
contacting CQC, to making specific requests for information under FOIA. We
will not answer any other type of correspondence (complaints, allegations,
general correspondence) made through this website, and we may refuse to
respond to future FOIA requests if we consider that they are ‘vexatious’
because they are mixed in with other matters – in particular, personal
comments about CQC employees – and made via a public website.

You should also be aware that any annotations entered on What Do They
Know? are not automatically forwarded to CQC. Therefore we will not answer
any issues or questions raised in annotations on the site.

Our role as the Care Quality Commission (CQC) is to ensure that the health
and social care services we register operate legally and deliver safe,
good quality care. To come to a view about the quality of the service, we
use various sources of information to determine how well that service
delivers care. 

 

I would like to confirm that information that you had shared with us
regarding Avon and Wiltshire Mental Health Partnership Trust (AWP) was
taken into account when we visited the service between 10 and 13 June
2014. The inspection report will be published shortly.

 

Furthermore, I would like to assure you that CQC has taken your views
about AWP seriously.  We have added this to the information we already
hold on the service, and have and will take this into account when
evaluating and monitoring the compliance of AWP. This is so that we can
build a picture of how well the service is meeting the needs of people. 

 

However, CQC has no statutory powers to investigate individual complaints
in order to provide remedy or redress. Our inspections are not
investigations into complaints people raise with us. We receive
information from a variety of sources and use the information to check the
compliance of the service - as a whole - with the essential standards of
quality and safety. Our Inspectors make their decisions based on the range
of evidence obtained and corroborated prior to and during inspection.

 

I understand that you want us to help resolve your own complaints with the
Trust. To be clear; we are not able to do this and, in order for this to
happen, it would need a change in the law.  I’m sorry that this may not
meet your expectations and can only acknowledge your frustration in this
regard. This is not to say that your views have been or will be in anyway
dismissed, only that they have been, and will be, placed with all the
information collated in a much broader context to inform our wider
evaluation of the service provider.

 

It may be that our judgments of the Trust do not match your own
experiences or opinions. However, they do take into account the
experiences and views of a wide variety of people who have used the
service, including your own, to reach an overall view on how safe, caring,
responsive and well-led the services provided by the Trust are.

 

I understand that you recently had a two hour discussion with Lyn
Critchley, Inspection Manager, in which you were able to share your
concerns regarding the Trust. Ms Critchley advised you that she would
write to you, but that she would not be able to for several weeks. I can
assure you that Ms Critchley will write to you, privately, when it is
appropriate to do so.

 

In the meantime, in order to answer some of your questions it may be
useful to explain our current inspection methodologies.

 

We are currently going through a period of significant change, so these
processes are changing and developing all the time, but this is basically
how it works.

 

We undertake a programme of scheduled routine inspections of all providers
who are carrying on regulated services. However, we also continuously
collect and monitor information about those services, so that we can
identify whether there is a more urgent need to conduct an inspection.

 

We collect this information from a number of sources.

 

Some of the information is generated by the Trust themselves and fed to
CQC in various ways. For example, there are certain types of incidents
that AWP are required, by law, to notify us of. In other cases,
information that the Trust provide to other organisations - such as the
National Patient Safety Agency - is shared with CQC and feeds into our
monitoring.

 

We also monitor other sources of information, including information
received from people who work at AWP, and a range of information about the
quality, safety and effectiveness of care obtained from a number of
sources.

 

Most importantly, we welcome and collect the views of people who use the
services, their families and carers. Some of these come to us directly by
people phoning, emailing or writing to us, or by filling in the ‘[2]share
your experience’ form on our website
([3]http://www.cqc.org.uk/share-your-experie...).

 

When we are planning an inspection of a service – either as a routine
inspection, or in response to concerns about the quality or safety of care
identified by our monitoring processes – we will consider the information
that we hold about the service, including information of concern that has
been shared with us since the last inspection, and this will help us to
decide how to focus our inspection.

 

We inspect the service for compliance with the Health and Social Care Act
2008 (Regulated Activities) Regulations 2010. We can only make a judgment
on compliance with these regulations based on the evidence at the time –
so a service will be judged compliant if the evidence shows that it was
compliant at that time, even if it might not have been compliant
previously.

 

Where we find that a service is compliant, but have concerns that it may
not be able to maintain this compliance, we would usually consider
carrying out a further inspection within a relatively short period of
time.

 

There is no set rule on how far back we can look in terms of checking
records and speaking with patients and staff but, for the purposes of the
inspection, we will be trying to judge ‘is this service compliant now?’
For this reason, more recent information is normally more useful to us.

 

When we prepare our reports, we cannot (and are not required to) include
details of every complaint, allegation or incident, or of all of the
things that patients and staff tell us. Doing this would create over-long
and unwieldy reports, and would present a risk to the confidentiality and
privacy of people who made complaints or contacted CQC.

 

Instead, we use the report to explain what our overall judgments about the
service are, and we include the evidence that we consider is necessary to
explain those judgments.

 

So, a complaint raised by a patient may not be mentioned in our report,
but this does not mean that it has not been considered, has not helped
guide our inspection process, or has not fed into our overall judgment.

 

Once the report is drafted, it is shared with the service provider – AWP,
in this case. This is not for their ‘approval’, but is an important
process to allow them to challenge any issues of factual accuracy in the
report before it is published. The Trust cannot use this process to
challenge our judgments but, if they think that we have made a factual
error they can provide evidence of this. We have a process to consider any
such challenges. In many cases, these challenges are rejected.

 

As a matter of public law, service providers must have a right to
challenge the evidence that we are publishing about their services. If we
did not offer this opportunity for factual accuracy challenge, their only
option would be to seek a judicial review through the courts. This would
be costly and time-consuming for the service provider, the courts and for
CQC.

 

Following the completion of the factual accuracy process, the report will
be published on our website.

 

As explained above, the views and experiences of patients, their families
and carers are vitally important to our inspection processes.

 

One of the methods we are testing on the new inspections of mental health
services is to encourage local Healthwatch and local mental health groups
to feed evidence about people’s experiences of care into the inspection
team. 

 

In the case of the recent inspection of AWP, we worked nationally through
the mental health strategic partners who are led by the mental health
providers’ forum and include MIND, Rethink and other national mental
health organisations.

 

Information about the planned inspection is shared with local mental
health groups (and HealthWatch) and they are encouraged to let service
users know about the inspection, and to encourage people to provide us
with feedback.

 

The partners also identify a local mental health service user organisation
to run a focus group to hear experiences from a group of service users. An
inspector attends this focus group.

 

In the case of this inspection, Second Steps (a not for profit local
organisation) were initially approached to see if they could run the focus
group. They indicated that they had been shortlisted to tender for the
contract to provide some of the Trust’s services in future and therefore
declared they had a conflict of interest. They were therefore not used to
run the focus group. Instead the mental health strategic partners
identified the Bristol Survivors Network (a local user group), and they
were able to run the focus group for us, bringing together service users
they work with.

 

You raised a concern that AWP had ‘become aware’ of the support group used
by CQC for the recent inspection. We have no information about whether or
not AWP became aware of the work local mental health groups were doing to
help promote the inspection, to encourage service user feedback, or to
arrange and run the focus group. However, this was not confidential
information as the inspection is announced in advance and CQC had made
clear that it would be working to hear from local service user groups, and
individuals using the service, in advance of the inspection.

 

You claim that AWP instructed this organisation to carry out some work on
their behalf in advance of the CQC inspection. We have no information
about whether AWP instructed any of the local mental health groups to
carry out work before or at the same time that CQC was talking to them –
other than to restate the point above, that we did not commission Second
Steps to undertake a focus group for CQC as they had informed us they were
shortlisted to tender for a contract from AWP.

 

It is important to be clear that we do not have a ‘usual independent body’
that we work with on inspections. We have been testing out the approach of
working with local mental health groups before the inspections that have
taken place since January 2014.

 

We have a contract nationally with the mental health strategic partners
led by the Mental Health Provider Forum and they identify a relevant local
mental health user group who could support focus group work. This is a
different group in each area – depending on their knowledge and experience
of working with people using the trust being inspected.

 

In terms of the timing of activity pre-inspection, we are working to find
the best time before inspections to work with local mental health groups.
We are trying to promote the inspections with the local voluntary and
community sector, and HealthWatch, for several weeks before the inspection
wherever possible. The focus groups we hold currently take place 1-2 weeks
prior to the inspection.

 

The inspections are announced on the CQC website - in addition to the work
we do to reach out to local community groups described above. During the
inspection, the team also leave out comment cards at the service, and
interview individual service users.

 

CQC also encourages the service provider (AWP) to promote the inspection
by telling staff and patients about it. In this case we understand that
the local Clinical Commissioning Group was also encouraging feedback about
the inspection, as it was undertaking its own work to gather user feedback
at the same time. 

 

In addition to this, the inspection team approach service users and carers
on the inspection to talk to them about their experiences of care. The
team is careful to ensure that this is not restricted to people who have
been selected or identified by the trust themselves.

 

We are always keen to develop better ways of hearing about people’s
experiences of care in mental health services and will continue to test
approaches to doing this.

 

You asked some specific questions about this process:

 

“I wish to see the instructions and agreements you had with your' usual '-
' independent organisation ' I refer to that handles the work I have
described, to include all data and records of contacts with them from
start to finish of these matters please and I ask you to leave all dates
on the information you provide please.”

 

We have a contract with the mental health strategic partners to gather the
experiences of people who use services by working with local mental health
groups for the inspections taking place in July-September. This sets out
that they will test out gathering feedback either from individuals or
through a focus group on each inspection on CQC’s behalf. It does not
specify which groups they will work with to do this.

 

I do not believe that this contract is the information that you are asking
for, but please let me know if you wish to receive it.

 

We were informed during a telephone meeting with the mental health
strategic partners, about the AWP inspection, that they had agreed not to
use Second Steps to run the focus group, because of the conflict of
interest identified above. In that telephone meeting, we agreed with the
decision they had taken to approach Bristol Survivors Network instead.

 

As explained above, we have no ‘usual independent organisation’ and we
never entered into an agreement with Second Steps, therefore we do not
hold the information that you are asking for.

 

“Would you also be kind enough to let me have a copy of any document you
hold in relation to the matters I’ve raised that will show me how the
‘independent organisation ' you instructed must act when a conflict of
interests exists ?”

 

There is no document setting this out.  As explained above the mental
health strategic partners are using their experience and networks to
undertake the engagement work and, as part of this, they make judgements
about the most appropriate organisations to work with. Where they identify
any conflict of interest they take this into account.

 

“Please supply me also with all the documents you hold in respect of CQC
instructing the ' replacement independent organisation ', and the ongoing
data and records you hold following your initial contacts with them
please?”

 

There is no documentary evidence of this. The mental health strategic
partners made this decision and discussed it with CQC involvement team on
the phone. We agreed with their approach.

 

“Also, in light of the fact it appears this inspection has been carried
out in a way that is unfair to AWP patients like myself and carers who
really wanted to give their feedback but were PREVENTED from doing so,
what plans are CQC putting into place to ensure ALL of those who wish to
input their experiences to the AWP inspectors are now given the
opportunity to do so - in a way that allows their experiences to be fully
and ACCURATELY recorded ?”

 

We do not accept that we have been unfair in the way that we have carried
out this inspection.

 

Inspectors will speak to people who use services and observe their care on
all inspections, unless there are exceptional circumstances.

 

We cannot guarantee that we will be able to directly speak to every person
who wants to talk about the service. The priority is to speak to, or
observe people, in the most vulnerable circumstances or who find it most
difficult to speak for themselves.

 

In addition, Inspectors will aim to speak to a mix of people using the
service at the time. Wherever possible, inspectors will also speak to
relatives and carers of people using the service. Inspectors can also
track some of the issues raised in a person’s records to further
investigate the things that they tell us about (pathway tracking). 

 

Any individual using a service is also able to report their experiences at
any time by using the ‘share your experience’ form on our website
([4]http://www.cqc.org.uk/share-your-experie...)
or by phoning 03000 616161.

 

CQC is committed to gathering the views and experiences of people using
mental health services to inform our inspections. We welcome suggestions
about how we can improve the ways we do this.

 

We are currently considering the feedback from a recent national
consultation which asked about how we could ensure we hear from people
using mental health services as part of our new approach to mental health
inspections.

 

“You will be aware I have been reporting abuse, neglect, (under NO SECRETS
and Adult Safeguarding procedures) to the CQC, falsification of records,
removal of complaints and correspondence etc etc over a number of years,
and I trust CQC will not now be producing another worthless report that
covers up the truth and again denies patients of their chance to
preferably replace, or at least temporarily improve this long failing
organisation ?”

 

It is our view that the report we produce will be balanced, accurate and
robust.

 

We have advised you how the information provided to us is used in
inspection, but that we cannot assist in resolving your own complaint
against AWP.

 

The inspection report will include some information about the engagement
work the inspection team undertook and includes what people using services
told us about the inspection. We are continuing to develop our approach to
writing the reports following inspections. As part of this we have been
getting feedback from some service users about whether they find the
inspection reports useful and balanced.

 

We publish information about our new approach to inspecting services on
our website at [5]http://www.cqc.org.uk/content/our-new-in...

 

This page includes a link to A fresh start for the regulation and
inspection of mental health services. This document sets out the
regulatory approach that we are developing and we are currently piloting,
and sets out the timetable for the implementation of these changes.

 

We are carrying out two initial ‘waves’ of pilot inspections to test our
new approach. The inspection of AWP was part of ‘wave 2’.

 

All members of the CQC Inspection team are qualified to perform their
roles (they have the required skills, experience and qualifications for
their jobs) and received training in their roles upon joining the CQC. Our
new approach to inspecting mental health services is currently being
developed and tested and, as such, we have not yet implemented a specific
training programme for all inspection staff, and there is no examination
for Inspectors in relation to our new processes.

 

Inspectors who act as the team leaders on site have received specific,
additional training for the waves (in addition to their wider training as
inspectors and their own relevant professional backgrounds and
experience). The lead Inspector for the AWP inspection received their
training on 21 January 2014.

 

The inspection team also includes ‘experts by experience’. These are not
CQC employees, but are people who have direct experience in receiving care
in similar services. They receive bespoke and ongoing mental health
training. The team also includes specialist advisors, who are expert
professionals in mental health, and who are there to provide advice and
expertise as required.

 

Specialist advisors and experts by experience work under the direct
supervision of CQC Inspectors.

 

The inspection team were prepared for the inspection by being provided
with a range of guidance documents, through ongoing support from their
line management, and by a pre-inspection briefing that took place on 30
May 2014 and a training session for all members of the inspection team,
which took place on 9 June 2014.

 

For your information, I attach a WinZip file containing the full set of
internal CQC guidance documents for ‘wave 2’ inspections on mental health
services such as AWP. As explained above, wave 2 is a pilot of our new
methodologies, so a number of these documents are draft or working
documents that may change shortly. The document ‘Inspection Framework’ is
the central document that lays out the key principles. The checklist and
some materials for the pre-inspection briefing are also included.

 

These documents, which are specific to mental health provider inspections
sit alongside our range of general policies and guidance.

 

We plan to finish testing and to fully implement our new approach to
inspecting mental health services by October 2014. 

 

With regards to CQC’s documentation on the recording of information, I
attach a number of documents used by our staff:

 

·         ‘Inspection Record Guidance 800326’ (How to complete the
inspection record.)

·         Handling any other information from people who use services
(print out of a page from the CQC intranet).

·         Guidance on recording standards for safeguarding work.

·         A print out of our ‘call log’, for recording details of
telephone calls that our National Customer Service Centre (NCSC) receives
about the services we regulate.

·         SET call recording QA guidance (this is the guidance that we
follow for assessing how well calls to our NCSC are handled, and includes
guidance on assessing the accuracy of information recorded on our
systems).

 

You also asked a number of questions regarding CQC’s responsibilities and
approach to safeguarding issues.

 

Information about this, including our safeguarding protocol, is published
on our website at [6]http://www.cqc.org.uk/content/safeguardi...

 

All providers of care services must have suitable arrangements in place to
ensure that service users are safeguarded against the risk of abuse. We
inspect these arrangements, and publish our findings in our reports.

 

AWP are required by law (regulation 18(2)(e) of the 2010 regulations) to
notify CQC of ‘any abuse or allegation of abuse in relation to a service
user’. As they are also required to notify the National Patient Safety
Agency (NPSA) of these allegations, we have an agreement whereby the
provider only makes a single notification to NPSA, who then forward this
information on to CQC. We ask for these to be provided to us in anonymised
form, and then we can seek further information – including the identity of
the service user and any alleged abusers – if we decide that we require
this information.

 

If we found that a provider did not have adequate processes for protecting
people from abuse (including processes to identify alleged abuse), or that
they had failed to follow the proper process to make a notification about
alleged abuse, we would address this using our various powers.

 

However, CQC are not the lead agency for investigating allegations of
abuse. Safeguarding referrals are made to the local safeguarding board,
which is led by the council.

 

CQC does not routinely attend safeguarding board meetings, but we would
expect to be involved where a person registered by CQC (a registered
provider or registered manager) is directly implicated in alleged abuse,
where urgent or complex regulatory action may be needed, or where
enforcement action is likely which relates to the quality or safety of
care.

 

Where CQC is the first organisation to receive allegations of abuse (or
where we believe that the allegations have not already been referred to
the local safeguarding board) then it is our responsibility to raise a
‘safeguarding alert’. I attach a copy of our process for this.

 

The guidance shows that, where possible, we will inform the people
involved of our intention to raise the alert (page 23), and that we will
raise the alert within 24 hours of recognising the issue as a safeguarding
allegation (page 26).

 

It is important to remember that this is only the case where we believe
that the information in question has not previously been passed to the
safeguarding board.

 

You also asked:

 

“Also as, you have just completed a major inspection of the Avon and
Wiltshire Mental Health Partnership - where a report titled  similar to
Alleged Falsification and or Alteration of Patients Records at Avon and
Wiltshire Mental Health Partnership NHS Trust (after 30 social workers
Whistleblew to Wiltshire Council) I would like to see 1. the information
you looked at regarding this report and its findings and 2. the
information provided to your Inspection Team by the AWP MHP NHS T leading
up to and following on from them reporting themselves to the Information
Commissioner recently.”

 

At the time of our inspection, we decided not to request a copy of this
report as we understand that it relates to the trust prior to 2012 and was
therefore unlikely to be relevant to the question of AWP’s current
compliance with the regulations we enforce.

 

However, we are aware that AWP had commissioned an independent
investigation into these allegations and that this report is now published
by AWP
([7]http://www.awp.nhs.uk/media/508971/249.1...).

 

So far as we are aware, AWP did not inform CQC that they were reporting
themselves to the Information Commissioner. They were not required to do
so.

 

You asked about breaches of the Data Protection Act reported to the
Information Commissioner’s Office (ICO) by CQC during the period 1 April
2013 to 1 April 2014.

 

Under Government rules, NHS organisations and ‘arms-length bodies’ (such
as CQC) are required to assess Information Governance Incidents against a
set of standard criteria.

 

I attach the guidance for making this assessment (‘suichecklist’), that
was in place during the period in question. Under this requirement, if an
incident was assessed as being a ‘Serious Untoward Incident’ (SUI) of a
sufficiently serious nature (‘level 3’), it was required to be reported to
the ICO.

 

During the period 1 April 2013 and 1 April 2014, we did not assess any
incidents as ‘level 3’ – and therefore requiring reporting to the ICO.

 

We did voluntarily report one incident to the ICO, although it was not
assessed as ‘level 3’. This related to a letter containing personal data
being sent to a previous address of the person to whom that information
related, rather than their current address. This was reported to the ICO
on 24 December 2013. The ICO investigated this incident and decided that
it was a result of human error, and did not meet their criteria for
further investigation or action. 

 

The guidance for assessing and reporting incidents has now changed. The
new guidance is published here:
[8]https://www.igt.hscic.gov.uk/KnowledgeBa...

 

I can confirm that we have not made any report to the ICO regarding any
loss of your data. I do not believe that we have lost your personal data.

 

Where you have provided information to CQC about your experiences of
receiving care at AWP, these would not normally be disclosed in full under
FOIA. This is because FOIA disclosures are made into the public domain (in
other words, the information is published to anyone who wants it).

 

We consider that it is vitally important to protect the confidentiality
and privacy of people who raise concerns with CQC, but we also recognise
the need to be open and transparent about our regulation of services.

 

For this reason, when we are asked under FOIA for details of complaints
and concerns we have received about a service, our usual approach is to
provide anonymised summaries of those complaints and concerns, rather than
the full details of the information we hold.

 

If you would like to see the information that we hold which is
specifically about you, you can request this under the Data Protection Act
1998 (DPA). We cannot accept a request for this made using the What Do
They Know? website, but I will include details of how to request this at
the end of this email.

 

A disclosure made to you under the DPA is likely to contain the full
details that we hold about any information you have provided to us. I
apologise if this has not been made clear to you previously.

 

I hope this response explains the position of the Commission and is
helpful to you. 

 

If you are not satisfied that CQC has adequately answered your requests
for information under FOIA, you can ask us to conduct an internal review.

 

An internal review will only be able to consider matters directly relating
to whether or not our responses to you have complied with the requirements
of FOIA.

 

If you wish to request an internal review of our FOIA responses, please
email [9][CQC request email] or follow the instructions for
requesting an internal review via the What Do They Know? website
([10]https://www.whatdotheyknow.com/help/unha...). In requesting an
internal review, please explain what aspects of our FOIA responses you are
unhappy with, and why you consider that they do not comply with FOIA.

 

If you remain unhappy following internal review, you will be able to make
a complaint to the Information Commissioner’s Office (ICO) about our
handling of your FOIA request. The ICO’s contact details and further
information can be found at [11]www.ico.org.uk.

 

If you wish to request information that is about yourself (your own
personal data), you can do so using your rights under section 7 of the
Data Protection Act 1998. To do this, please send a cheque for £10,
payable to the Care Quality Commission, and copies of two items of ID (for
example; photo page from a passport, driving licence, letter from the
council or utility company) to:

 

            Information Access Team

Care Quality Commission

Citygate

Gallowgate

Newcastle upon Tyne

NE1 4PA    

If you wish to make any other complaint about CQC – including a complaint
about how we have inspected AWP, how we have handled or used the
information you provided, or a complaint about any employee of CQC
(including myself) - you can contact our National Contact Centre by phone,
letter or email.

CQC National Customer Service Centre
Citygate
Gallowgate
Newcastle upon Tyne
NE1 4PA
Phone: 03000 616161
Email: [12][email address]

Opening hours: 8.30am – 5:30pm, Monday to Friday.

Further details of our corporate complaints processes are on our website
at [13]http://www.cqc.org.uk/content/complain-a...

As explained above, we will not enter into discussion of a complaint made
using the What Do They Know? website (other than a request for internal
review of an FOIA response). This is for reasons of confidentiality, and
also because the website is not intended for this purpose.

As previously explained, we cannot help you resolve any complaints about
AWP. You may already be aware that the Parliamentary and Health Service
Ombudsman does have the legal powers to investigate complaints about NHS
Services. The Ombudsman is an independent service that considers cases of
alleged mal-administration.  The contact details are:

 

The Parliamentary and Health Service Ombudsman

Millbank Tower

Millbank

London

SW1P 4QP

 

Telephone: 0345 015 4033

Website: [14]www.ombudsman.org.uk

 

I have also attached a leaflet which provides details of other
organisations that may be able to assist you, in addition to a leaflet
explaining the Commission’s complaints procedure which I hope you find
helpful.

 

Yours sincerely

 

Simon

 

Simon Richardson

Information Rights Manager

Legal Services & Information Rights

Care Quality Commission

 

0191 233 3599

 

Annual Leave: 21 July, 24 July – 1 August, 6 August, 13 August – 15 August

The Care Quality Commission is the independent regulator of all health and
adult social care in England. [15]www.cqc.org.uk. For general enquiries,
telephone the National Contact Centre: 03000 616161.

Statutory requests for information made pursuant to access to information
legislation, such as the Data Protection Act 1998 and the Freedom of
Information Act 2000, should be sent to: [16][CQC request email]

 

 

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1. https://www.whatdotheyknow.com/help/requ...
2. http://www.cqc.org.uk/share-your-experie...
3. http://www.cqc.org.uk/share-your-experie...
4. http://www.cqc.org.uk/share-your-experie...
5. http://www.cqc.org.uk/content/our-new-in...
6. http://www.cqc.org.uk/content/safeguardi...
7. http://www.awp.nhs.uk/media/508971/249.1...
8. https://www.igt.hscic.gov.uk/KnowledgeBa...
9. mailto:[CQC request email]
10. https://www.whatdotheyknow.com/help/unha...
11. http://www.ico.org.uk/
12. mailto:[email address]
13. http://www.cqc.org.uk/content/complain-a...
14. http://www.ombudsman.org.uk/
15. http://www.cqc.org.uk/
http://www.cqc.org.uk/
16. blocked::mailto:[CQC request email]
file:///tmp/

Steven King left an annotation ()

Having read this response, I would welcome and invite annotations and or advice please on how to proceed with these requests in light of the responses given ?

Information Access, Care Quality Commission

Dear Mr King

 

Further to my email of yesterday:

 

If there is further information that you require from CQC (whether or not
this is information that you have already asked us for) it may be useful
for us to have a discussion. This will help me to fully understand what
information you want, and I can advise you what we may be able to give
you.

 

If you would like to talk, I am available for most of today or tomorrow
and will then be off work until 4 August. Please let me know if you would
like to talk and I will make arrangements to call you at a convenient
time.

 

Yours sincerely

 

Simon

 

Simon Richardson

Information Rights Manager

Legal Services & Information Rights

Care Quality Commission

 

Annual Leave: 21 July, 24 July – 1 August, 6 August, 13 August – 15 August

The Care Quality Commission is the independent regulator of all health and
adult social care in England. [1]www.cqc.org.uk. For general enquiries,
telephone the National Contact Centre: 03000 616161.

Statutory requests for information made pursuant to access to information
legislation, such as the Data Protection Act 1998 and the Freedom of
Information Act 2000, should be sent to: [2][CQC request email]

 

 

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http://www.cqc.org.uk/
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D. Speers left an annotation ()

Your tenaciousness deserves a completely open, honest response Steven.....and I hope you will find what you are looking for .
I note AWP are offering to contact you and may I suggest a minuted meeting /phone call may prove helpful. Onus, of course .will be on AWP to provide a transcript!

Dear Simon Richardson,Information Rights Manager, Legal Services and Information Rights, Information Access,
Care Quality Commission,
Thank you for your emails here, and I am sorry I have not been well enough to come back to you earlier.
You are aware I am an elderly, disabled man with a diagnosed brain injury PTSD - that remains untreated for 14 years now !
It has caused me upset and distress that where you have not provided clear individual responses to each of the FOIA requests i have submitted, I am unable to understand which piece of information relates to which request or to see and understand the responses you have given to each request.
My injury causes me considerable problems, I see it as a disability, and I am sure it is recognised as a long term disability, and therefore ask you to make a reasonable adjustment and respond individually to each of the requests I have submitted,as clearly and completely as you possibly can, ensuring all the matters I have asked about have the information supplied, so I may hopefully have a better understanding of the information you have given me.
I genuinely am suffering, and ask the CQC for proper help and assistance in the manner I have requested.
I have no doubt with the technology you use, it will not be an arduous task to place the correct paragraphs and information under each of the requests I made please.
If only you had asked me if the method of response you used was acceptable to me , in light of my ill health I would have felt much better if you had cared to ask .
Thank you for your anticipated assistance, and I will telephone you after receiving your responses in a format that I might better understand if presented in the usual acceptable format, at present I am unable to link any of the responses and information you have given me to any particular request due to my mental health problems.
I wish to be able to read each of my requests, then below each request easily read the responses you have given individually to each request please.
I find it difficult, but trust I have explained my needs and requirements adequately ?

Yours sincerely,

Steven King

Steven King left an annotation ()

Dee Speers, FINALLY feeling well enough for a few days to deal with a number of outstanding matters here.
Thank you for you annotation of 24 07 14, I agree and hope for the same !
Re AWP, what they say and what they actually do are two very different things !
I had thought on several occasions when ive met with their senior staff ACCURATE minutes would be provided - but that has repeatedly failed to happen - they are altered, watered down and spun to cover up what happened to me and caused my illness.
Members of their Board know about whats going on, I had a private meeting with two of them last month.
They have even twice audio recorded what ive said at my request, only to delay for months in providing a copy which is then heavily edited - again covering up what happened to me and others. Its VERY SERIOUS stuff - and the local agencies have been covering up the whole truth for many years - thats a fact but I must say in my opinion !

Information Access, Care Quality Commission

Dear Mr King

I am sorry if the way in which we have answered your Freedom of Information requests has caused you difficulty or distress. This was not my intention.

I had hoped that providing a single response that covered all of the issues you raised in your multiple FOIA requests would be the clearest way to assist you.

We consider that we have responded to your Freedom of Information requests in accordance with the requirements of the Act, but we will provide further assistance by responding separately to your multiple requests. I anticipate that we will be able to send these responses within the next 2 weeks.

Yours sincerely

Simon

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

0191 233 3599

The Care Quality Commission is the independent regulator of all health and adult social care in England. www.cqc.org.uk. For general enquiries, telephone the National Contact Centre: 03000 616161.
Statutory requests for information made pursuant to access to information legislation, such as the Data Protection Act 1998 and the Freedom of Information Act 2000, should be sent to: [CQC request email]

show quoted sections

Dear Simon Richardson, Information Rights Manager,
Legal Services and Information Rights, CQC,

Thank you for your assistance with these matters,

Yours sincerely,

Steven King

Steven King left an annotation ()

You will see above, following correspondence between myself and the Care Quality Commission, they have now agreed to provide a proper individual response to this request later this month.

Information Access, Care Quality Commission

Dear Mr King

 

I have been asked to issue a response to your individual requests on
behalf of Simon Richardson, Information Rights Manager. As we originally
provided one single response to all of your requests, you have asked if we
can separate each response to make it clear which of our responses relate
to which request. Here is the response to request CQC IAT 1415 0238.

 

You asked the following and our responses are provided below:

 

I wish to see the instructions and agreements you had with your' usual '-
' independent organisation ' I refer to that handles the work I have
described, to include all data and records of contacts with them from
start to finish of these matters please and I ask you to leave all dates
on the information you provide please.

 

We have a contract with the mental health strategic partners to gather the
experiences of people who use services by working with local mental health
groups for the inspections taking place in July-September. This sets out
that they will test out gathering feedback either from individuals or
through a focus group on each inspection on CQC’s behalf. It does not
specify which groups they will work with to do this.

I do not believe that this contract is the information that you are asking
for, but please let me know if you wish to receive it.

We were informed during a telephone meeting with the mental health
strategic partners, about the AWP inspection, that they had agreed not to
use Second Steps to run the focus group, because of the conflict of
interest identified above. In that telephone meeting, we agreed with the
decision they had taken to approach Bristol Survivors Network instead.

As explained above, we have no ‘usual independent organisation’ and we
never entered into an agreement with Second Steps, therefore we do not
hold the information that you are asking for.

 

Would you also be kind enough to let me have a copy of any document you
hold in relation to the matters I’ve raised that will show me how the '
independent organisation ' you instructed must act when a conflict of
interests exists?

 

There is no document setting this out.  As explained above the mental
health strategic partners are using their experience and networks to
undertake the engagement work and, as part of this, they make judgments
about the most appropriate organisations to work with.

 

Where they identify any conflict of interest they take this into account.

 

Please supply me also with all the documents you hold in respect of CQC
instructing the ' replacement independent organisation ', and the ongoing
data and records you hold following your initial contacts with them
please?

 

There is no documentary evidence of this. The mental health strategic
partners made this decision and discussed it with CQC involvement team on
the phone. We agreed with their approach.

 

Also, in light of the fact it appears this inspection has been carried out
in a way that is unfair to AWP patients like myself and carers who really
wanted to give their feedback but were PREVENTED from doing so, what plans
are CQC putting into place to ensure ALL of those who wish to input their
experiences to the AWP inspectors are now given the opportunity to do so -
in a way that allows their experiences to be fully and ACCURATELY
recorded?

 

We do not accept that we have been unfair in the way that we have carried
out this inspection.

Inspectors will speak to people who use services and observe their care on
all inspections, unless there are exceptional circumstances.

We cannot guarantee that we will be able to directly speak to every person
who wants to talk about the service. The priority is to speak to, or
observe people, in the most vulnerable circumstances or who find it most
difficult to speak for themselves.

In addition, Inspectors will aim to speak to a mix of people using the
service at the time. Wherever possible, inspectors will also speak to
relatives and carers of people using the service. Inspectors can also
track some of the issues raised in a person’s records to further
investigate the things that they tell us about (pathway tracking). 

Any individual using a service is also able to report their experiences at
any time by using the ‘share your experience’ form on our website
([4][1]http://www.cqc.org.uk/share-your-experie...) or by phoning 03000
616161.

CQC is committed to gathering the views and experiences of people using
mental health services to inform our inspections. We welcome suggestions
about how we can improve the ways we do this.

We are currently considering the feedback from a recent national
consultation which asked about how we could ensure we hear from people
using mental health services as part of our new approach to mental health
inspections

 

This concludes our response to request CQC IAT 1415 0238

 

If you have any queries please do not hesitate to contact the team, on the
telephone number provided, quoting our reference number.

 

Kind Regards

 

Information Access Team

Legal Services & Information Rights

Care Quality Commission

Citygate
Gallowgate
Newcastle Upon Tyne, NE1 4PA

 

Telephone: 03000 616161

Fax: 03000 200 240

The Care Quality Commission is the independent regulator of all health and
adult social care in England. [2]www.cqc.org.uk. For general
enquiries, call the National Customer Service Centre (NCSC) on 03000
616161 or email [3][email address].
 
Statutory requests for information made under access to information
legislation such as the Data Protection Act 1998 and the Freedom of
Information Act 2000 should be sent to: [4][CQC request email].

 

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References

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1. http://www.cqc.org.uk/share-your-experie...
2. http://www.cqc.org.uk/
3. mailto:[email address]
4. mailto:[CQC request email]

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