CQC Quality Statement

Theme 4 – Leadership: Governance, management and sustainability

We statement

We have clear responsibilities, roles, systems of accountability and good governance. We use these to manage and deliver good quality, sustainable care, treatment and support. We act on the best information about risk, performance and outcomes and we share this securely with others when appropriate.

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Moving and Handling in Health and Social Care, Health and Safety Executive

This chapter is adapted from the above guidance.

1. Introduction

Moving and handling people, property and equipment is a common feature of daily working practices for many members of staff. Poor moving and handling practice can result in:

  • back pain and musculoskeletal disorders;
  • moving and handling accidents – which can injure both the person being moved and the employee;
  • discomfort, injury and lack of dignity for the adult being moved.

Employers must reduce the risk of injury to staff and adults using care services by:

  • avoiding manual handling tasks that could result in injury, where practicable;
  • assessing the risks from moving and handling that cannot be avoided;
  • putting measures in place to reduce the risk, where reasonably practicable

Staff must:

  • follow appropriate procedures and use the equipment provided
  • inform line managers of any problems
  • take reasonable care to ensure that their actions when involved in moving and handling tasks do not put themselves or others at risk.

2. Moving and Handling Risk Assessments

Moving and handling risk assessments help identify where injuries and problems could potentially occur and how to prevent them. The person carrying out the assessments must be trained and competent to identify and address the risks from moving and handling activities.

A moving and handling assessment should include:

  • consideration of the person’s needs and ability, task, load and environment;
  • identify what is needed to reduce the risk for all the tasks identified;
  • record the assessment and controls necessary in the adult’s individual care and support plan;
  • periodic review of the plan, as well as if the adult’s needs change;
  • arrangements to monitor handling activities;
  • ensuring competence of staff, equipment provision and management arrangements.

2.1 Identifying Risk

Activities that may increase risk may include assisting with:

  • person transfers;
  • treatment;
  • daily activities (such as bathing) with adults with specific needs.

Stresses and strains arising from adopting awkward or static postures when caring for and treating people should be addressed during the risk assessment.

Risk assessment should be part of a wider needs assessment process to achieve the best outcome. Health and safety issues will then be identified and built into the complete care package.

2.2 Individual risk assessments

The assessment should be person-centred and involve the service user where possible, or their family, in decisions about how their needs are to be met. This can reassure the adult about the safety and comfort of any equipment to be provided, and how it will help to ensure their safety and that of the staff who work with them.

The outcomes of the risk assessment and the inclusion of the findings in the adult’s care and support plan (see Care and Support Planning chapter) should be documented in their case records (see Case Recording chapter).

The risk assessment should include information about the adult’s moving and handling needs detailing whether the requirements are during the day, at night, or both specifying:

  • what the adult is able/unable to do independently;
  • the extent of their ability to support their own weight;
  • other relevant factors, for example pain, disability, fatigue, tissue viability or tendency to fall;
  • the extent to which they can participate in/co-operate with transfers, whether specialist equipment is required and the number of staff needed to perform a transfer;
  • whether they need assistance to reposition themselves / sit up when in bed/chair, and if not how this will be achieved;
  • specific equipment that is required and the type;
  • arrangements for reducing the risk and dealing with falls where the adult is assessed as at risk.

Some adults may become upset or agitated when being moved, particularly if they do not feel safe or reassured. Others, though willing to assist at the start, may become frightened during the manoeuvre and are unable to continue. These are situations where injury to the adult, staff or both parties may be more likely to arise. Training may prevent injury occurring in such circumstances.

3. Monitoring and Review

Risk assessments should be reviewed periodically and whenever circumstances change to ensure they remain current. This should also form part of the adult’s care and support plan review (see Review of Care and Support Plans chapter).

There should also be arrangements in place to ensure that moving and handling activities are monitored to ensure that correct procedures, techniques and equipment are being used.

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CQC Quality Statements

Theme 3 – How the local authority ensures safety in the system: Safe systems, pathways and transitions

We statement

We work with people and our partners to establish and maintain safe systems of care, in which safety is managed, monitored and assured. We ensure continuity of care, including when people move between services.

What people expect

When I move between services, settings or areas, there is a plan for what happens next and who will do what, and all the practical arrangements are in place.

I feel safe and supported to understand and manage any risks.

1. Introduction

Local authorities must keep a register of people who are severely sight impaired and sight impaired.

Registration is voluntary, however individuals should be encouraged to consent to being registered as it may assist them in accessing other concessions and benefits. People who agree to be registered may be entitled to some benefits, for example, an increase in personal tax allowance, a reduction in the cost of a TV licence, a free bus pass and parking concessions under the Blue Badge Scheme. It is important that strong links exist between local authorities, health services and voluntary organisations to identify those who may benefit from registration.

The data which registration provides the local authority are also of benefit in service planning for health and care and support. However, individuals’ access to care and support is not dependent upon registration, and those with eligible needs for care and support should continue to receive it regardless of whether they wish to be registered.

Local authorities should help health and social care organisations to work together to meet the needs of people who have sight loss, for example, ensuring that care and support services know what help somebody needs in their home when they leave hospital. Timely assessment and care and support planning that is integrated with health care and person centred care offer the potential to make improvements in experience and outcomes of people who are sight impaired, as well as improving system efficiency.

2. Registration

If the person consents to registration they will be included on the local authority’s register and be provided with a registration card. The register can also be used by the local authority to ensure that information about services is made accessible to that person for example to ask if support could be given to assist them to participate in electoral events.

3. The Certificate of Vision Impairment

The Certificate of Vision Impairment (CVI) formally certifies someone as being sight impaired or as severely sight impaired. Where the patient has given their consent, a copy of the CVI should be sent to the local authority by the hospital staff. However, people in receipt of a CVI should not be added to the local register until they have given their specific consent to the local authority for registration.

Local authorities may take the date of certification given on the CVI as the effective date of registration. If the adult has not given their consent for their name to be added to the register of sight impaired adults, however, they should still be offered a needs assessment.

The CVI is an important source of information for local authorities in relation to their registration duties. The local authority should satisfy themselves that the CVI is completed correctly and it contains valid signatures as required (currently the consultant ophthalmologist and the patient) when receiving a hard copy of the form. Electronic versions and paper copies of CVIs should be accepted for registration.

3.1 Certification

The CVI is issued by a consultant ophthalmologist to the patient certifying as sight impaired or severely sight impaired. The DH guidelines in the Certificate of Vision Impairment: Explanatory Notes for Consultant Ophthalmologists and Hospital Eye Clinic Staff states who should be certified as severely sight impaired and sight impaired.

Certification is not the final stage, but often it is the point when people begin to accept the severity of their sight loss and get access to practical and emotional support.

It is expected that NHS services will keep the completed certificate, signed by the consultant and the patient, for their records. Where the patient has given their consent, a copy of the certificate should be sent to the relevant local authority and the patient’s GP within five working days of its completion. The ‘Certificate of Vision Impairment Explanatory Notes for Consultant Ophthalmologists and Hospital Eye Clinic Staff provides information on this.

Local authorities should note that there will also be people who have a reduced / low vision but do not meet the criteria for certification who may need to be considered in service planning.

3.2 Transferring and retaining the CVI

The CVIs should be kept until the person moves to another area or has passed away. In the event of a person’s death, the local authority should keep the CVI for at least six years after the person’s death as it may be necessary for tax purposes to establish if a deceased person was registered with a local authority.

3.3 Making contact

Upon receipt of the CVI, the local authority should make contact with the person issued with the CVI within two weeks to arrange their inclusion on the local authority’s register (with the person’s informed consent) and offer individuals a registration card as identified on the CVI registration form. Where there is an appearance of need for care and support, local authorities must arrange an assessment of their needs in a timely manner.

To minimise unnecessary costs and maximise the ability of people who have sight impairment, they should have early access to information and advice in an accessible format so that they can adapt to their situation as quickly as possible and obtain any aids and support that will help them to manage their lives better.

4. Continuity of Care

A person may decide to move home and live in another local authority area (see Continuity of Care). The first local authority should ensure that the person’s care and support needs will continue to be met during their move. The process requires the original authority to provide the authority the person is moving to with relevant information to support the move such as a copy of the person’s care and support plan, their latest assessment, and any other documentation the second authority requests. This should include a copy of their CVI. The second authority should register the person with the person’s consent on their register, and the former authority should remove that person’s name to avoid duplication.

The first authority will be able to invoice the second authority for the cost of care, from the date it is agreed between the respective local authorities that the adult acquired a place of ordinary residence in the second area (see Ordinary Residence).

5. Care Planning

Providing excellent services for blind and partially sighted people – A guide for local authorities, published by Royal National Institute for Blind People (RNIB) and Action for Blind People, is a good practice guide that helps inform local authorities’ understanding of the extent and impact of sight impairment, the main causes and risk factors and the effects on people’s lives.

Having carried out a needs assessment, the local authority must prepare a care and support plan for everyone with eligible needs or other needs which it is going to meet. Where someone has sight loss, this should be recorded in the care and support plan (see Care and Support Planning chapter).

Local authorities should consider securing specialist qualified rehabilitation and assessment provision (whether in-house, or contracted through a third party), to ensure that the needs of people with sight loss are correctly identified and their independence maximised. Certain aspects of independence training with severely sight impaired and sight impaired people require careful risk management and should only be undertaken by professionals with relevant experience and training. This type of rehabilitation should be provided to the person for a period appropriate to meet their needs. This will help the person to gain new skills, for example, when training to use a white cane. See Care Act 2014 and Sight Loss (ADASS).

This makes it clear that rehabilitation for sight impaired people is a specific form of reablement and is not limited to the usual six week period for rehabilitation as this could take longer. There are some characteristics which define rehabilitation as being distinct from other forms of reablement. It is therefore not appropriate to take a one-size-fits-all approach, and the local authority needs to ensure that individual needs are met appropriately.

6. Other Registers

Local authorities may also establish and maintain a register of people living in their area who have a disability (a physical or mental impairment which has a substantial and long term adverse effect on their ability to carry out normal day to day activities) or who need care and support or are likely to do so in the future. (This is a power to maintain a register, as opposed to a duty to do so as per the sight register.)

Inclusion on registers is voluntary and with the individual’s informed consent. However local authorities should encourage individual’s consent to inclusion on the register as such registers may support the establishment of an accurate and useful local record of people whose needs may change over time, for example:

  • someone with a progressive long-term condition whose needs may increase over time;
  • when the person on whom they are mainly dependent for their care has stopped providing care;
  • those who are ordinarily resident but may be receiving temporary care and support out of area, or in-patient treatment in health services, but who are likely to require care and support on their discharge or return.

Local authorities may wish to link the information collected to the Joint Strategic Needs Assessments (JSNAs) as well as the Joint Health and Wellbeing Strategies. They may also, as part of local JSNA and Health and Wellbeing Strategy development, want to look at this information alongside complementary information from other partners, for example, information drawn appropriately from registers of people with learning disabilities or particular health conditions which are held by GPs, in order to produce a comprehensive and accurate shared local picture.

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1. Introduction

The Data Protection Act 2018 specifies the duties of local authorities and other agencies in relation to holding, storing and processing of the personal data of living individuals (referred to within the Act as data subjects). Such information will either be held on IT databases or in hard copy.

The Act terms people who request information from the council that it holds on them  ‘data subjects’.

The Act terms staff who control the manner and the purpose of personal data processing ‘data controllers’.

The Act allows data subjects to know about and obtain information held on them by the local authority and other agencies.

2. People Eligible to Request and Receive Information

In most circumstances it is only people (data subject) who  the council holds information on who are allowed to receive information held about them by the local authority. The information provided by the local authority must only relate only to them and no one else.

If a solicitor makes a request on behalf of a client to access their case records, the solicitor must obtain written consent from the adult which allows the solicitor to receive the information. This consent must be sent to the local authority as part of the application.

2.1 Capacity

Although there are no specific provisions in the Data Protection Act regarding access of records in relation to people who lack capacity, the Mental Capacity Act 2005 enables a third party to exercise subject access rights on behalf of such an adult. It is reasonable to assume, therefore that an attorney with authority to manage the property and affairs of an adult will have the appropriate authority. The same applies to a person appointed by the Court of Protection to make decisions about such matters.

3. Information People are entitled to Receive

In theory people (the data subjects) are allowed to receive all non-exempt information (see 3.1 Exempt Information below) held about them by the local authority. People making such requests should be asked what information they specifically want to see. This will reduce the likelihood of a request being denied due to the inclusion of exempt information.

3.1 Exempt Information

In some circumstances it may not be possible to allow people to access to some or all of the information in their records, for example if it mentions another person (see 3.2 Third Party Information below), if giving them the information may cause them harm, or if it is needed for the prevention or detection of a crime. The person should usually be told the reason why it is not possible for them to access their records.

Correspondence between local authority departments and its legal services department is privileged and therefore also exempt from disclosure.

3.2 Third Party Information

Responding to a request may involve providing information relating to another individual who can be identified from that information. This is third party information. In most cases, the local authority will require written consent of that third party before disclosing the information to the data subject.

4. Making an Application

The person making the request should find out in advance from the local authority whether fees are payable (customer to add local information).

Requests for access to information are called ‘Subject Access Requests (SARs)’. These must be made in writing in relation to information held by the local authority on the person. For more information and a suggested template letter see Find out how to Request your Personal Information.

5. Timescales

The local authority has 40 calendar days to respond to a written request. This allows time for personal information to be collated all involved departments within the local authority, analysed to ensure it does not contain exempt information (see 3.1 Exempt Information) and decisions made about whether there is such information that cannot be given to the person.


– End –

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If hard copy files are still in use, the customer should populate this section. It should contain:

  • an overarching statement about the importance of file organisation – why it is important for example risk management, handover of cases, legal document, ease of access to information;
  • a contents list of the sections of a Safeguarding file;
  • a description of the contents of each section of a Safeguarding file;
  • a contents list of the sections of an Adult Social Care file;
  • a description of the contents of each section of an Adult Social Care file.

 The customer should also add a link to local electronic records procedures here.


– End –

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Audio & Quick Read Summary

CQC We and I Statements

Theme 3 – How the local authority ensures safety in the system: Safe systems, pathways and transitions

We statement

We work with people and our partners to establish and maintain safe systems of care, in which safety is managed, monitored and assured. We ensure continuity of care, including when people move between services.

I statements

When I move between services, settings or areas, there is a plan for what happens next and who will do what, and all the practical arrangements are in place.

I feel safe and supported to understand and manage any risks.

Further Reading

Relevant chapters



Data Protection: Legislation and Guidance

Relevant information

Professional Standards and Professional Standards Guidance (Social Work England)

Social Work Recording (SCIE)

Data Protection and Working from Home (Information Commissioner’s Office) 

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CQC Quality Statement

Theme 4 – Leadership: Learning, improvement and innovation 

We statement

We focus on continuous learning, innovation and improvement across our organisation and the local system. We encourage creative ways of delivering equality of experience, outcome and quality of life for people. We actively contribute to safe, effective practice and research.

Audit is an essential part of a learning organisation; it supports continuous improvement, responds to user feedback, complaints and quality assurance.

An audit cycle can address service delivery, professional roles and responsibilities or new ways of working, for example: performance management, supervision, outcomes for adults with care and support needs and their carers, case recording and integrated working.

Audits may be conducted on a short or long term basis, and measure simple or complex issues.

Essentially, an audit involves reviewing the way care is provided against agreed and quality standards.

The audit framework has four stages:

  1. Preparing and planning
    • Identify and agree an area of care which requires audit: this may be an issue highlighted by adults or carers, or is one that has emerged as a high risk for example a new area of service / practice or an area for improvement.
    • Agree the aim, objectives and standards: useful guidance includes SCIE or NICE (see Organisations) or local/ best practice standards;
  2. Reviewing quality
    • Develop audit criteria that measure performance against agreed standards: these are the specific elements that describe the quality measurements;
    • Collate and analyse data, report results: as part of this stage, the process for providing feedback to those who took part should be agreed and planned. This includes adults and carers, staff and relevant others;
  3. Improving practice
    • Consider results and formulate improvement plan: the results from the report should be discussed by the quality assurance group, senior management team as appropriate, and other relevant meetings. Discussions may include the potential causes of the problems (for example lack of resources, inadequate knowledge / skills, lack of awareness of procedures), which should be improved and how. Discussions may also include adults, carers and staff;
    • Implement the improvement plan: it may be that amendments to practice may have already occurred as a result of doing the audit;
  4. Sustaining improvement
    • Repeat the data collection to measure improvement: it is important to re-do the audit cycle for a second time in order to discover whether the agreed actions have taken place.


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