See also Local Forms, Leaflets, Letters for relevant forms.
Quality means different things to different people. Therefore, the Hull City Council Adult Services Quality Assurance (QA) Framework will look at quality from many different points of view. It will incorporate wherever possible work already done to achieve or demonstrate quality outcomes and will provide a toolkit to help managers evidence quality and address issues in a consistent way, while enabling the flexibility needed to engage with and respond to stakeholders in the way which best meets their needs.
In any social care service, there are three main groups of stakeholders and each tells us different things about quality:
- Service users and carers give us a wealth of information at reviews, through comments, compliments and complaints and through consultation;
- People in the workforce tell us about quality, either directly through supervision and Personal Performance and Development or through the work they do. This can be measured by looking at the records they make about the outcomes of their work or by the workload they undertake. It can be tempting to allocate more work to higher performing individuals because of a belief that the work will be done and done well. But this is a trap for the unwary because if someone is overloaded, the quality of the outcomes suffers. For this reason, a caseload analysis tool is included in the toolkit;
- Our ‘governors’ – Care Quality Commission, the Department of Health and Social Care and the City Council also gather information and judge us on the outcomes we achieve.
2. The QA File
Using this QA framework should not entail doing lots of additional work to show the quality of what you do, but rather should make the best use of the information you already gather and the information people already give about what they think about your service. The framework hinges on collating copies of all the feedback you receive and checking it periodically so that you can see if there are any trends emerging which you may need to respond to. This will also give you a clear, concise audit trail of what people have said and how you have responded, which you can use with managers, regulators, users, carers or staff.
The QA file can be a file, a box or an electronic file. It should be whatever works best for your team but it should be able to contain all the relevant information and should be accessible whenever you or your manager wants to access it. Details of the sort of information it should contain are set out below. It’s not an exhaustive list however, and if you have feedback or gather relevant information which is not listed below, you should include it.
2.1 Service user and carer feedback
2.1.1 Comments, compliments, complaints
Unsolicited comments, whether positive or negative set out what people feel strongly enough about to come and tell us. Please include copies of comments together with any action taken as a result. This could be your response to a complaint or, if as a result of a compliment, you decided to do more of something. Please also include an analysis of comments, so that if the same thing is coming up repeatedly, you can show how you’ve responded.
Please include a copy of any formal consultation you’ve undertaken, together with the feedback and a summary of how practice has changed as a result of something you were told through consultation. How you consult with people, act on what they say and feedback is up to you and will reflect the needs of your particular service.
2.1.3 Review feedback
During a review of a person’s service, they or their carers often tell us how they feel about the service they’ve received, how satisfied they are and whether it fully meets their needs. Please include an anonymised summary of review feedback together with any trend data (for example 90% of people expressed a high level of satisfaction with the service or 40% expressed dissatisfaction with call times) together with any action taken as a result of feedback.
2.2 Information for and feedback from regulators
2.2.1 CQC reports
Please include your latest Care Quality Commission report, or a summary of it together with any actions taken as a result.
2.2.2 Health and safety monitoring information
The information you gather to monitor compliance with health and safety regulations can say a great deal about the quality of the environment within which the service is delivered. Please include a summary of your findings together with any action taken as a result.
2.2.3 Performance monitoring reports
The Department of Health and Social Care gather a wealth of information on services at a Local Authority level, but all of the outcomes are delivered at a team level. The Adult Social Care Outcomes Framework (ASCOF) asks for information on performance in relation to four key outcomes:
- Enhancing quality of life for people with adult social care needs;
- Delaying and reducing the need for care and support;
- Ensuring people have a positive experience of care and support;
- Safeguarding adults whose circumstances make them vulnerable and protecting them from avoidable harm.
Please include a copy or a summary of information you or your Assistant Head of Service prepares for the ASCOF.
2.2.4 Contract compliance monitoring reports
Externally commissioned services are subject to and have support from Contract Compliance Officers who check and give feedback on how well a service is meeting the outcomes specified in the contract it holds, which in turn gives a clear indication of the standard of quality within the service. Please include a summary of feedback given together with any action taken as a result of feedback.
2.3 Staff information and feedback
Well supported staff are vital to achieving a high quality service and the feedback they give provides well informed insight into what’s working well within the service, what needs to be improved and very often, how to improve it. The key phrase here is ‘well supported.’ People who are not well supported may lose motivation or make decisions in isolation, leading to mistakes and a poor quality service. This section gives guidance on the levels of support required by Hull City Council and how to reflect this in your QA file.
It also addresses case file audit, as the quality and comprehensiveness of the records made by staff is the main way their work and its outcomes are reflected, and it addresses caseload analysis because if a particularly skilled and able member of the team becomes overloaded, it becomes impossible for them to maintain the standard of quality they would like to provide and which people using the service expect.
Supervision, often called 1-1 time is the best opportunity to discuss the nature and quality of the work undertaken by the staff member. It should be protected time, free from interruptions and should be an open, two way discussion. Both people should have the opportunity to agenda items and raise issues and the supervision record should contain details of both the items discussed and the action which is agreed as a result. Further guidance on how to structure supervision is given in the supervision policy and procedure, but a record should be kept in the QA file of the frequency and duration of the meetings. Records of the meetings themselves and the issues discussed should not be included as these are highly confidential and sensitive documents which are protected by the Data Protection Act and should never form part of a public document or file.
2.3.2 Personal Performance and Development
Hull City Council requires that all staff have regular Personal Performance and Development (PPD) interviews as it recognises that people are at the heart of quality and that regular discussions about current performance and future development are the most effective way of making sure that everyone has the opportunity to develop. Guidance on how to structure these meetings and the areas to be covered is given in the PPD policy and guidelines, but a record should be kept in the QA file to reflect that these meetings took place. For the same reasons given above, records of the meetings themselves should never be included.
2.3.3 Team meetings
Regular team meetings give the opportunity for open discussion of shared concerns, for managers to brief the team on local, departmental or corporate issues and for team members to raise any matters they wish to discuss. They are an important vehicle for communication and resolution, and while good communication and resolution do not necessarily lead to better quality outcomes, poor communication and lack of resolution do lead to poorer quality in outcomes. For this reason, appropriately anonymised minutes of team meetings should be included in the QA file.
2.3.4 Case file audit
The quality of the records maintained by workers should reflect the quality of the work undertaken. Poor quality records give a poor impression of a service and lead to poorer quality outcomes for people using the service as continuity of care becomes difficult and communication suffers. In addition, records are used in so many ways, from care planning to coroner’s inquests that it is vital they are comprehensive, legible and complete. The case file audit tool has been developed to assist managers in assessing the quality of records and to enable them to give structured feedback on what is working well and how to improve. An anonymised summary of the results of case file audits should be included in the QA file to reflect the quality of recording, together with any action undertaken to improve.
2.3.5 Caseload analysis
The fair apportionment of caseload has been a perennial problem for social work teams. A simple count of cases never reflects the complexity or challenge, and therefore workload may differ hugely between workers who carry the same number of cases. A caseload analysis tool has been developed which reflects the complexity as well as the number of cases which should lead to workers having similar amounts of work, even where the number of cases or the contracted hours of individuals differ hugely. A summary of caseload and allocation should be included in the QA file to demonstrate the capacity and fairness of workload.
3. The QA Audit
Senior managers need to satisfy themselves that quality is being robustly and consistently addressed in each of their teams. Periodic audit of the QA file will demonstrate to what extent the team is addressing quality, whether they are learning from mistakes and how well they are promoting good practice.
There is no hard and fast rule about how often a QA file should be audited; this should depend on the quality of the file. A good quality file which is regularly updated and contains clear actions to improve outcomes, together with a history of achievement may need to be audited less frequently than one which gives more cause for concern. However, no more than six months should be allowed to pass between audits. Included in this framework is a form to evidence the audit of the file. Copies should be included within the file to show how QA compliance is assessed, the robustness of the QA process within the team and to demonstrate continuous improvement through Quality Assurance.
4. Feedback on QA
A range of people may ask for feedback on the QA process – how have services improved as a result of the service undertaking QA. The QA audit form has been designed to give a précis of this and can be shared widely with stakeholders.