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Position Statement 20/21

Shane Mills

Director of Quality and Mental Health / Learning Disabilities

I write this foreword in June 2021, when we appear to be coming out of what has been an extremely difficult and unique past 14 months. The Covid-19 pandemic continues to disrupt services, as well as our way of life.

As the pandemic progressed, the QAIS adjusted its quality monitoring processes whilst progressing other work streams that resulted from the pandemic. This work included supporting the independent sector to source Personal Protective Equipment and access staff and patient testing and vaccinations and commissioning emergency surge bed capacity. We have worked closely with providers and commissioners of services in order to ensure that safe and effective care was continued to be delivered through this difficult period.

The process of providing adequate assurance of framework provision has been very difficult through the pandemic. Many of our reviews have been undertaken using procedures drastically different to previous methods of reviewing services. There have been many occasions where, due to issues relating to the Covid-19 pandemic, we have been unable to attend sites in person. This has meant that we have had to develop and enhance other processes and reporting in order to gain the assurances required. We have done this by the increased use of technology, such as, Microsoft Teams, teleconferencing etc, along with the use of our Secure File Sharing Portal.

The QAIS therefore developed a three stage model for reviewing services. This was called React, Recover and Return:

React- was stage one of the review and monitoring process during the early part of the pandemic when there was caution about visiting services. The QAIS, in conjunction with Health Inspectorate Wales (HIW), led on the monitoring of Independent Hospital provision within Wales and Care Inspectorate Wales (CIW) held responsibility for the monitoring of Care Home provision. The purpose of the React stage of the process was to ensure that data was captured in relation to Staff and Patients who were symptomatic of Covid-19, reduction in activity at sites, access to Section 17 leave, rating of each site in relation to Covid-19 status, support to access PPE, testing etc. Through this period the QAIS met regularly with Welsh Government, HIW, NHSE and CIW in order to share findings/concerns etc.

Reporting of incidents, safeguarding and complaints have continued throughout the pandemic.

Recover- was the stage where remote reviews of services began. This stage (and subsequent stages) included Care Homes. These reviews were undertaken via pre-arranged remote meetings with evidence of compliance being submitted via the secure file sharing portal. This type of review was undertaken whenever the QAIS were unable to attend the site.

Return- is the final stage in the process and is in effect a return to the pre-pandemic process of reviewing services. The QAIS are currently in this stage and are again attending sites in order to undertake reviews of services.

79% of residents placed in care homes were placed within 20 miles of a postcode significant to the resident. As of 31st March 2021 there were 309 residents placed under the National Framework for Care Homes compared to 195 residents placed on 31st March 2019.

Of the 11 patients placed under the CAMHS Hospital Framework last year 8 were placed within 50 miles of a significant postcode.

Although facing significant disruption I am pleased the QAIS still managed to undertake reviews of 88 sites through a a mixture of on-site and remote reviews. There are some ongoing concerns in relation to providers:

There was a (3%) increase in the number of incidents reported across the Adult Hospital framework, although the severity of those incidents was less.

We have reported that there has been a reduction in the proportion of standards met this year compared to last year in CAMHS sites.

As we continue to recover from the pandemic the QAIS will re-establish on-site reviews and support providers to improve the quality and address deficits of care.

The QAIS, in conjunction with NHSW Shared Services Partnership, will develop a new improved, combined (Adult/CAMHS) framework agreement which will launch on 1st April 2022.

Although this Annual Position Statement has been produced in such exceptional times, I am pleased to say that providers, supported by the QAIS have worked tirelessly to provide safe and quality services through a very difficult period.