What Good Looks Like In Adult Social Care (DSCR) - Sekoia

What Good Looks Like: Digital Social Care Records (DSCR) in Adult Social Care

Cover picture for the blog post What Good Looks Like: Digital Social Care Records (DSCR) in Adult Social Care

Good quality records reflect your service, showcasing that it is run safely and with a compassionate mindset. They display effectiveness and high-quality care. And communicate to relevant individuals what’s needed and when. All this in a place that’s easy to locate.

This rhymes with a digital alternative to what has previously been done on paper. And is the reason there is real momentum behind Digital Social Care Records (DSCR). Both in terms of funding and focus.

What will the shift from paper-based record keeping to a digital one bring? What will a “Good” rating from the CQC look like?

This article will explore how you can achieve a better standard in your service. And the role of the CQC and what your inspector should and will be looking out for in an inspection.

What a digital care planning system gets you

Your care plans and recordings are the foundation for achieving good outcomes for the people you support. And evidencing it to the inspectors. Easily done when digitised but also possible with immaculate paper records.

Following the 2020 CQC interim guidelines, some of the accepted wins are easily collated. Here’s a list that shows the various aspects of digital records. Straight from the horse’s mouth.

Once implemented, a good system will:

Provide real-time information about the care and support people need and receive
Guide care professionals delivering support, even when people’s needs change, so they can respond adequately
Display and compare data to improve the safety and well-being of the people you support
Share information quickly and correctly to support the provision of health and care services
Minimise risks such as medication errors, dehydration, falls and other untoward events
Assist vital health and care roles in your service with detailed information
Simplify the access to any record for both professionals and the people you support
Manage and support staff doing their job effectively and efficiently
Eradicate the need for physical space to store documents, once this is cloud-based
Optimise the use of personnel and other resources across your service.

Lofty promises which can only be realised if the system is implemented properly. A good DSCR system implemented poorly will net none of the benefits. DSCR is a tool that needs to be used in the intended way. Otherwise, there will only be frustration and apathy towards it.

What does a good DSCR system look like?

In the words of the CQC, “a good records system delivers good outcomes from the point of view of people who use services”. These outcomes are the same whether the records are on paper or digital.

One way of illustrating or questioning these outcomes is by using the recommended “I statements”. These are to be viewed from the perspective of someone using services and can be used by everyone in the sector.

So, do I have records that are…

Person-centred describing what is important to me, including my preferences and needs
Accessible in a way that I choose, and I can understand
Legible so my information is recorded clearly and can be easily read by those supporting me    
Accurate and does not contain errors
Complete with no relevant or essential information about me missing
Up to date containing my latest relevant and essential information
Always available to the people who need to see them when they need them 
Secure protection of my privacy and confidential information. Only the people who should see my records can see them (in line with Data Protection legislation, including GDPR requirements)
Helping the service that supports me to run proper quality assurance systems and processes. Including assessing, monitoring and minimising any risk to health, safety or well-being

A good DSCR system addresses all “I statements” in an intuitive manner. Contrary to its paper-based counterpart a digital system can be more insisting.

For instance, requiring a certain form to be recorded and completed before allowing a staff member to tick an activity as done. Think requiring documentation of where on the body you inject insulin on a body map for an activity called “Insulin injection”.

Standards digital records need to meet

Go back 5 years and few organisations used a digital social care records system. Go back 15 years and most of the suppliers of such systems hadn’t even been created yet. This is a burgeoning field with few universally agreed-upon standards.

No standardised format or system. Records can be fully digital or a mix of paper and digital. No matter the format though, the records need to live up to the Key Lines of Enquiry, mapping from evidence to individual KLOEs.

That said, all records need to adhere to basic legislation such as Regulation 17 of the Health and Social Care Act 2008, GDPR and the Data Security and Protection Toolkit.

Should the KLOEs be amended to reflect the added benefits of digital records? The standards elevated? Difficult questions to answer but the CQC are keeping an eye on them. Hence the interim nature of the guidance from September 2020. We suspect there will be more thorough demands coming in terms of showcasing good quality care.

Creating and maintaining good digital records

For any inspector, the real purpose of any type of evidence is to illustrate compliance with their given frameworks. To show how a service complies with some of the following points.

  • Are you focused on outcomes?

    • Does the provider describe how the system they are using helps improve the quality of care they provide?
    • Does the provider showcase clear objectives linked to outcomes for the people they take care of?
    • Is there a plan in place to monitor, measure and review these outcomes?
  • Do you involve the right people?

    • Have involved their staff in setting up the systems and any piloting. All staff who have access to records have appropriate training and support in place
    • Have involved people using their service and the people who matter to them. They can prove how consent and individual preferences are captured and that they understand the benefits
    • Will work with suppliers to continuously improve how the system works. This includes maintaining software and hardware, and updates across all devices
  • Manage the change successfully. Providers:

    • Have an appropriate level of planning and governance in place to pilot and implement the new system. This includes migrating information and stopping the project safely if it is not successful. We would expect the scale and formality of governance to depend on the size of the organisation and the scale of the change
    • Have reviewed their processes and made any changes needed to maximise the benefits of the new system – it may not just be a case of digitising what they currently do
    • Are confident of how information will be accessed and shared with others. This includes people using services, family members and other health and social care providers. Providers should be clear about how long they will keep records and how they will destroy them (per relevant standards)
  • Understand and meet relevant standards and regulations. Providers:

    • Understand data protection and data security requirements and can demonstrate how they are meeting them. They have clear and robust policies about consent, privacy and equality

Undoubtedly, a comprehensive list of just a few of the guidelines social care services are expected to comply with. And the reason why a surprise inspection from the CQC is few people’s cup of tea. But with digital records, it is much easy to demonstrate compliance with the guidelines – and the record keeping happens automatically.

What can providers expect from CQC?

For providers that are already using a digital records system, or considering introducing a digital records system, or moving to a new system, the CQC has committed to:

  • Be transparent in their expectations of providers using digital records systems.
  • Be consistent in their approach to providers’ digital records systems.
  • Be clear about how they use information from providers about their records system to prepare for inspections
  • Be open to discussing digital records systems with providers
  • Making sure inspectors and advisors have a good understanding of the main digital records systems available. And that they understand data protection law, including GDPR
  • Making sure inspectors know how to access the information they need on inspection. And that they bring the right Expert by Experience or specialist colleague to support that inspection

DHSC has recently published their vision for digital technology. They provide guidance for Local Authorities and care providers. Read their vision for what good looks like in adult social care here.

How will CQC inspectors access digital records on visits?

As digital records have become more commonplace, CQC inspectors have also become more confident in using Digital Social Care Records systems. Most DSCRs support creating a guest log-in that inspectors can use to access any information they should need.

CQC inspectors can’t be expected to know every single DSCR system out there but the ones who are accredited on the Assured Supplier List will be a safe bet.

How will digital records systems influence the way CQC regulate?

Being able to access an individual’s records digitally will open the door for more remote inspections requesting information online. This will save time for both inspectors and managers – and allow for more frequent inspections.

So, a main area of focus will be on sharing data. Aligning the language used by inspectors, staff and DSCR suppliers. A standardised framework. Something that won’t magically appear but needs close collaboration.

The CQC are open to this and recognises the potential. In the words of Chief Digital Officer, Mark Sutton:

”CQC knows that good quality records underpin safe, effective, compassionate and high-quality care. They ensure that the right information is available to the right people when they need it. They are an essential part of achieving good outcomes for people. CQC also know that digital record systems far exceed the capabilities and benefits of paper-based records. We fully support the adoption of Digital Social Care Records.”

Listen to the full statement below 👇