Quality Questionnaire
Summary report 2021
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Introduction We are pleased to be sharing the key findings from our latest Quality Questionnaire, which was undertaken by 2,555 people we support in Autumn/ Winter 2021. Our innovative Quality Questionnaire recognises conventional quality metrics often fall short of measuring the outcomes that really matter to individuals: their quality of life and wellbeing. The value of the care and support we provide at Voyage Care can only be meaningfully measured through the experiences of each person we support. Despite the ongoing challenges and continued restrictions due to the COVID-19 pandemic which had a significant impact on lives of the people we support in this period, the Quality Questionnaire findings reveal that overall quality of life outcomes have not been adversely affected over the course of the last couple of years. COVID-19 hasn’t detracted from our focus on outcome attainment, reducing health inequalities and ensuring the people we support continue to strive to meet their personal goals. However, we recognise there is more to do in some areas to support people to emerge from the shadow of the pandemic. These include managing the health needs and behaviours of the people we support as well as enabling them to access their communities for leisure and education opportunities. It is in these areas we will focus our efforts in the coming period as we continue to learn to live with COVID-19. Voyage Care have more services rated Good and Outstanding by the Care Quality Commission than any other provider; and our Welsh and Scottish services are 100% compliant. That we continue to provide highest quality care and support, despite the many challenges of the pandemic, is due to the enduring professionalism and resilience of our +11,000
colleagues. They have enabled those we support to stay safe, active and well through their focus on person-centred practices.
I want to be more independent and be able to do my own things, in my own time and own way!” Nicola Person we support
Why do we undertake the Quality Questionnaire? Quality Questionnaire measures quality of life using nationally recognised and research-based indicators, with a focus on issues such as health, choice and control and participation in daily life and their local community. Its engaging easy read format facilitates wide participation from the people we support; the value to them is enormous as people can easily track their personal progress over time and how their support is enabling them to achieve their goals. For the wider organisation, given the statistically significant population who undertake the Quality Questionnaire, it enables us to identify positive trends, and the insights gained shape our approach to implementing improvements, both locally and organisation wide. Voyage Care is a relentlessly curious organisation, committed to continuous quality improvement. In addition to regularly seeking out feedback from our regulators and fellow health and care professionals, the Quality Questionnaire supports our mission to put the direct experience of people at the heart of all we do.
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About the respondents Participation in the Quality Questionnaire is open to all the adults we support in receipt of 24-hour support (excluding people who use respite services). People have the choice whether to take part and are free to decline to answer some elements of the questionnaire. Where requested, our colleagues support people to participate to the extent they wish to. The questionnaire is available in a range of formats to encourage the widest participation possible. The latest questionnaire was completed by/ for 2,555 people which is a slight increase on the previous year.
2,555
questionnaires completed
Over 900 people have participated in all four years of the Quality Questionnaire. Around two thirds of the respondents live in our registered care homes and the remainder in supported living. The spread of ages and gender of respondents is commensurate with the wider demographic mix of people we support.
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What do the findings tell us? The resilience of the people we support is evident in the findings, which demonstrate people have sought to make the most of the opportunities available to them despite the pandemic. Many of the metrics relating to community engagement are beginning to return to pre-pandemic levels, a trend we expect to continue as restrictions ease further. The dedication of our teams to enhancing the lives of everyone we support is clear in the findings and over time we are supporting people to make meaningful changes that benefit their daily life. Whilst, as expected, some promising trends tracked over recent years slowed, in general findings have held up well with some improvements in key areas, such as seeing family, accessing annual health checks and having choice and control in their daily lives. It is perhaps unsurprising that the majority of areas where findings are less positive, compared to pre-pandemic data, are those which were most directly impacted by COVID-19 restrictions, such as accessing health, leisure and community activities and vocational training, education or employment. It is in these areas, along with continued efforts around positive approaches to behavioural management, that we will be
focusing on in the next twelve months. It is important to note that unlike many aspects of daily life, care settings continue to be subject to additional measures around the management of COVID-19 which have a direct impact on some of the decisions the people we support make in their daily lives. The pandemic has had a significant impact on how everyone feels about engaging with our wider communities and their practical ability to do so. As restrictions continue to ease everyone is on a personal journey in respect of learning to live with COVID-19 and what they feel safe and comfortable doing. The transition to the new normal will take longer for those we support; we are supporting each individual in a person-centred way to grasp the opportunities available to them. We must also acknowledge how the increased level of guidance, and the frequent changes to it, as well as the impact self-isolation requirements had on staffing consistency, have been challenging for care settings and fundamentally changed key aspects of how they operated through the pandemic. The necessary focus in this time on PPE, testing, vaccinations and infection prevention and control has led to the plateauing of progress of some aspirational national initiatives. It has impacted on the capacity to focus on continuous quality improvements and this is, in places, reflected in the outcomes reported through the Quality Questionnaire. As COVID-19 recedes we have clear plans in place for re-setting expectations in order to ensure managers are empowered, within regulatory and governance frameworks, to make more decisions locally again to meet the needs of people they support and their teams.
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Quality of life outcomes measures Extremely high scores continue to be achieved for core outcomes.
The majority of respondents note they: given and are able to exercise choice have access to the information they need
98.5%
have privacy respected
feel happy and satisfied report good nutrition
92.5%
85%
feel safe
feel rested and relaxed
can express their opinions and are taken seriously
At my other house, I put on a lot of weight and no one looked after me properly. Now I’m happy!” Oliver Person we support
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Improving health and wellbeing We are active participants in the learning from deaths of people with a learning disability and Autism (from June 2021, LeDeR) programme and have always maintained a strong focus on health in how we support individuals. However, responses show there is more to do as we emerge from the pandemic to address health inequalities and ensure everyone is supported to access health services and maintain their wellbeing. The findings showed some positive trends in relation to people feeling supported to improve their health and wellbeing, with over 18% of all goals set by respondents being related to their
92.9%
60%
of people had an annual health check
family visits obviously decreased during COVID-19 restrictions, with the easing of restrictions in the latter part of 2021 they are starting to return closer to pre-pandemic levels. Whilst trends in family contact is re-assuring, contact with friends has declined year on year indicating there is more for us to do to support people to develop their social circles.
>60%
of respondents had had a visit with family within the last month
>56%
of people said that family were actively involved in their lives, up from 51% last year.
of people had their BMI checked - with an improved profile
health and wellbeing or physical development. In line with broader national trends throughout the pandemic access to medical, rather than therapeutic, support has broadly shown a decline. For example, only 45% of people were able to visit the dentist, compared to 60% in prior years. The number of people who didn’t visit their GP increased by 80% to 362. Whilst this may indicate improved overall health, it is likely to be influenced by more negative national trends around accessibility of GPs due to both COVID-19 precautions and lack of capacity. We have seen an increased tendency to refer to paramedics rather than address issues in primary care services. Interactions with family and friends are a key contributor to wellbeing and whilst physical
If we didn’t have Quality Checkers, we wouldn’t know how other people want to live their lives. It is so important.” Abigail Person we support, Quality Checker
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Steps to education and employment
Positive behavioural management
It is disappointing that the findings show the proportion of people in employment, vocational training or education has fallen again this year, despite the number of goals being set in these areas being broadly consistent over each of the past three years. Whilst the pandemic has undoubtedly continued to impact on availability of courses and job opportunities it remains a frustration that we are yet to turn this trend around for the people we support.
We are committed member of the Restraint Reduction Network and, through embedding the five themes that comprise our pledge, our team of in house behavioural therapists continue to have a positive impact on enabling the people we support to better manage their behaviours. It is pleasing to see instances of behaviours that challenge are reducing year-on-year and the severity of behaviour is broadly comparable with the pre-pandemic period. Six out of the ten types of behaviours that challenge showed a decrease in frequency in the latest findings, and only one of the increases was by more than 1%.
6.3% 3.9% of respondents are in vocational training or education
of respondents are in full/ part-time employment or have undertaken voluntary work
As restrictions ease further and opportunities open up again, we will be launching a refreshed campaign with resources and tools to upskill and support people to access education and employment. We recognise they deliver many advantages for individuals, with feedback demonstrating those accessing education or employment feel more independent, valued, connected to their community and enabled to achieve their goals and aspirations. Our Quality Checker programme has been a notable success, creating structured volunteering opportunities for people we support to develop their confidence and build vital skills for moving on to other learning and employment opportunities. We have an ambitious target to double the size of the team to 100 Quality Checkers over the next year and are trialling opportunities for people to volunteer in a similarly structured way as part of our staff recruitment process.
Whilst restraint continues only to be used in the minority of occasions, instances of responses of ‘never used’ have markedly increased for all five types of control techniques comparing favourably 2021 to pre-pandemic rates. There was also an overall decrease in psychotropic medications in 2021, reverting to pre-pandemic levels, but as part of our commitment to STOMP we will continue to drive this down further. The continual downward trend and positive outcomes around behaviours are due to our investment in training and development of our teams but also due to time spent at home during lockdown and the opportunity this presented to deepen relationships and understanding. As we emerge from the pandemic a key focus will be ensuring the positive trends in relation to behavioural management and restraint reduction are maintained whilst also enabling people to become more active citizens again. Key objectives for the next period are to further increase of the use of Positive Behaviour Support Plans and achieve further reductions in reported restrictive interventions.
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Next steps We will continue to undertake the Quality Questionnaire each year, refining the process and interrogating the findings to ensure we are doing all we can to enable the people we support to live the life they choose. There have been further improvements in the process this year and we are committed to making it more accessible and easier to complete in coming years. The introduction of a portal has allowed managers to understand underlying trends for each individual we support and how local trends compare to the wider organisation. Benchmarking of the findings against national health and quality indicators continues and in the coming year we will be refreshing quality of life metrics against CQC’s quality of life tool and aligning them to developing regulatory standards in Wales and Scotland too.
The Quality Questionnaire is one of a suite of tools and systems we use to capture both quantitative and qualitative feedback from all our stakeholders. We cross-reference the findings and this insight leads directly into refinements we will make to practice development; what do we need to do more of, what we should improve and what we should stop doing. As we enter a new phase of Voyage Care’s journey following a challenging period through COVID-19, we are focused on how we deliver our purpose; carrying forward everything we have learned to build upon our already sectorleading performance. We are excited by the opportunities presented as COVID-19 recedes and look forward to making progress in the areas identified as our key priorities for this coming year.
I want to try and grow my own vegetables and cut down my carbon footprint to help the environment!” Tom Person we support