Three jobs hiding inside one word #
When a service says notes are a burden, it is usually talking about three separate things that happen to share a name:
-
Writing the note The carer who did the visit
Not a candidate. It is an account of what happened, by the person it happened to.
-
Assuring the notes The office, usually at month end
A candidate. It is a set of checks against records that already exist.
-
Retrieving a note Whoever is answering a question or a complaint
A candidate, in the sense that finding things quickly is an indexing problem.
Services that try to automate the first job get very little and risk a great deal. Services that look at the second and third usually find the hours they were looking for.
How big is the note taking load? #
The clearest published figure comes from Florence, a care staffing supplier, which surveyed 222 NHS and social care managers and published the results on 4 October 2023.
43%
Rota scheduling, the biggest consumer of time
Florence, 4 October 2023
30%
Documentation and record keeping, second
Florence, 4 October 2023
46%
Say paperwork prevents them doing the job they should be doing
Florence, 4 October 2023
A residential care home manager quoted in the same survey put it plainly.
More time is being spent in front of a computer screen rather than talking to people. It feels like the paperwork is more important than the care now.
It is a supplier's survey and a self selecting sample. We flag that every time we use it, because the point of this site is that you should be able to check the figures we quote.
What the record has to be #
CQC's Regulation 17 requires providers to securely maintain accurate, complete and detailed records in respect of each person using the service. Three separate words: accurate, complete and detailed.
Which parts of this run on rules #
- A completed visit with no note attached to it
- A note logged well outside the visit window, which is either a timing problem or a note written from memory
- A care plan or risk assessment whose review date has passed
- A body map, wound record or similar that was started and not completed
- A note that mentions an incident with no corresponding incident record
- Any request for a person's records that needs a complete set gathered from more than one place
Every one of those is a comparison between two things the service already holds. None of them requires anyone to read a note and decide what it means, which is precisely why they can be caught reliably and why they are the boring, unglamorous end of the problem.
Which parts do not, and will not #
- What the note says
- Whether what it describes is a concern
- Whether a pattern across several notes means somebody's needs have changed
- Whether to escalate, to call a GP, to raise a safeguarding alert
Those are care decisions, and no automation on this site would touch them. The same applies to anything that would draft clinical or support content for a person to sign off without reading, which we deal with on AI and care planning.
If you are thinking about recording or transcribing visits #
Plenty of suppliers are selling this.
A recording made in somebody's home captures their voice, their health, and very often other people in the household. That is special category data, your service is the controller for it, and processing that is likely to result in a high risk requires a data protection impact assessment before it starts.
The ICO sets out what counts as special category data and when a DPIA is needed, and those two pages are linked at the foot of this one. We would rather point you at the regulator than offer an interpretation of it.
If you want to size the assurance work first, the cost of admin time calculator works from your own hours, and what CQC looks at covers where those checks end up being read.