Quality improvement support

The integrated quality service (IQS) improvement and escalation policy was published in 2022. This sets out the role of audits and interventions deployed by IQS to promote quality improvement in the care market.

Audits

Provider assurance market management solution (PAMMS)audits broadly replicate a care quality commission (CQC) inspection, provide a detailed draft report to providers outlining areas for improvement, and award an overall rating when published. Areas of non-compliance are addressed by provider action plans, which IQS monitors via desktop and follow-up threshold crossing visits.

Quality monitoring visits (QMV) threshold crossing visits are used either to follow up on compliance with areas identified for improvement at PAMMS or CQC inspections or to make focussed enquiries into urgently arising matters, safeguarding concerns or complaints.

Integrated working

Quality improvement nurses (clinical commissioning group (CCG) staff) complement our quality monitoring officers (NCC staff) in forming a single, joined-up IQS, drawing on the health and social care skillsets and specialisms of each.

In addition to their support for our audit activity, quality improvement nurses are engaged in the development and commissioning of responsive training and project activities dedicated to care providers.

Examples of this are the roll out of:

• ISTUMBLE (fall prevention and management system)
• ReSPECT (end of life 'do not attempt cardiopulmonary resuscitation' (DNACPR) successor scheme)
• Hydration and dementia champion initiatives

Clinical aspects of enhanced health and wellbeing in care homes are also actively promoted and/or delivered by IQS team members.

Subject matter leads

All IQS team members adopt an area(s) of specialism to act as subject matter leads, ensuring the team has contemporary knowledge of best practice and enhancing the quality of support to the care market.

Our subject matter leads have specialism in areas such as:

• Dementia
• Health and safety
• Medicines
• Learning disabilities and autism
• Mental capacity act (MCA)
• Infection control

(This is not an exhaustive list)

Bespoke training and guidance

In response to trends in compliance shortfalls, IQS works with partners to produce training and guidance to support the care market. Recent examples include:

• Fire safety for home care providers (in collaboration with Norfolk fire and rescue service)
• Medication safeguarding guidance (in collaboration with Norfolk safeguarding adults board)
• MCA training for providers (with safeguarding)

Support for procurement and commissioning

IQS has an integral gatekeeping role in assessing and advising on the quality of tenders, escalating serious or serial non-compliance and/or breaches of contract, and taking action in line with the improvement and escalation policy.

Working with external partners

Key links with external partners include:

• Norfolk care association (NorCA)
• Norfolk and Suffolk care support
• Healthwatch Norfolk
• Care quality commission

Routine engagement and activity of mutual interest to care providers commissions and delivers training and identifies projects.

User voice

Work to engage, develop, and draw upon experts-by-experience as a feature of IQS audit activity will be piloted during 2023-2024.

Expansion of remit

In 2022-2023, day opportunities and domestic abuse settings were introduced into the portfolio of IQS remit. Quality monitoring and improvement interventions promote adherence to contractual duties from a quality perspective.