CQC Diabetes Review

Review methods
CQC carried out fieldwork for the review between January and March 2016 including East Lancashire, Liverpool and North East Lincolnshire in the North. The review looked at 4 key aspects of care for people with diabetes, including:
•        Identification and diagnosis
•        Structured education and support for self-management
•        Care pathway
•        Person-centred care coordination

The review included interviews with GPs, clinicians and commissioners; multi-professional / multi agency focus groups with staff; focus groups, 1 to 1 interviews, and case tracking of people with diabetes. The review looked at existing evidence from CQC’s comprehensive inspections, information provided by Healthwatch, CCGs and other data sources. The review also used an online web form, limited to the areas covered by the fieldwork, to gather the experiences, opinions and insights of people about their diabetes care.

Review conclusions

The review discovered that people at high risk of developing Type 2 diabetes were not always identified and supported to become healthier. Some people felt they were not receiving enough emotional support – providing this support at diagnosis and beyond can contribute to more effective self-management and increase engagement with services and attendance at structured education programmes.

 

CQC saw many examples that others can learn from, including local commissioners and providers proactively engaging with individuals and communities, and innovative methods to increase people’s ability to self-manage. The review also highlighted that people who had attended structured education courses felt it improved their ability and confidence to manage their diabetes. Where these courses were less likely to be accessed, for example by people from black and minority ethnic (BME) groups, some local services were able to show how they were providing culturally relevant information, support and training to people in their local community.

Better Care in my Hands: Care Quality Commission’s Report into People’s Involvement in their Care

The Care Quality Commission (CQC) is the independent regulator of health and social care services in England. We make sure that hospitals, care homes, dental and GP surgeries and other care services in England provide people with safe, effective, compassionate and high-quality care, and we encourage them to make improvements.

CQC is publishing a report into the extent and quality of people’s involvement in their health and social care, based on new analysis of CQC’s national reports and inspection findings and on national patient surveys.

People’s right to being involved in their own care is enshrined in law in the fundamental standards of care. It is an essential part of person-centred care and leads to better and often more cost effective outcomes. This is particularly true for those with long term conditions or people who need to use services more intensively. The NHS Five Year Forward View and the Care Act place renewed focus on improving this area of care and CQC can take enforcement action against providers of care services that fail to meet this standard. This report is timely because as health and social care services reconfigure to adapt to the changing needs of their populations there is an opportunity to make sure person centred care becomes a reality for more people. The report identifies what enables people’s involvement in their own care and provides examples of good practice identified by CQC inspectors. CQC will use the findings from this report to strengthen our regulation and reporting of people’s involvement in their care.

Our key findings are:

Recent national patient survey data shows that just over half of those surveyed report feeling definitely involved in decisions about their health care and treatment, and this includes people’s responses for care in hospitals and in the community.

Women who use maternity services are particularly positive about how well they are involved in decisions about their care.We found examples of good practice of people’s involvement in their care in our inspections over the last year. However, there has been little change in people’s perceptions of how well they are involved in their health or social care over the last five years. A significant minority of people have consistently reported only feeling involved in their care to some extent or not at all over this period.

CQC’s national reports and thematic reviews from the last five years consistently show that some groups of people are less involved in their care than others. This is confirmed by new analysis of patient surveys. They are:

– Adults and young people with long term physical and mental health conditions.
– People with a learning disability.
– People over 75 years old.

We have also reported a lack of progress over the last six years in involving people in their care when they are detained under the Mental Health Act. Poor involvement in care is the biggest issue we found in monitoring the use of the Mental Health Act in 2014/15.

There are common problems in health and social care services, which can create a vicious circle of poor involvement particularly for those using different services or using services over a long period of time. These include:

– Failure to assess and monitor people’s capacity to make decisions about their care and to provide advocacy support
– Limited understanding , recording and monitoring of people’s wishes and preferences
– Inadequate family and carer involvement
– Lack of information and explanation of care and support options