The Care Quality Commission (CQC) has recently published ‘Driving improvement’, a resource for adult social care.
This resource contains a collection of case studies which detail the journeys of nine services that received ‘inadequate’ ratings and/or enforcement action but which were able to make improvements and achieve a ‘good’ rating.
Andrea Sutcliffe, Chief Inspector of Adult Social Care, has noted that by sharing the learning she hopes that the case studies will help others improve. At the end of each of the cases the Home Managers have set out their top tips for improvement: ‘practical ideas that any service can put in place to improve how things are done’.
The lack of information sharing in relation to good practice found by the CQC is something which clients have often raised with my team. We hope that this is a sign of things to come from the CQC.
Chief Inspector’s foreword
In her foreword, Ms Sutcliffe acknowledges that these are challenging times for adult social care, noting pressure on resources, increasing demands and expectations and work force shortages. Ms Sutcliffe explains that while there can be no room for complacency, it can be done. The CQC has seen 82% of services rated ‘inadequate’ improve: 42% to ‘require improvement’ and 40% to ‘good’. Ms Sutcliffe goes on to mention that:
- Staff are key to achieving sustainable improvement – having enough staff, training and developing them to be capable and confident.
- The importance of leadership shines through – having managers who know how to get things done, who can motivate and inspire and create a transparent and open culture.
We set out a brief summary of the key themes that the CQC identified when conducting reviews of the nine services:
Reaction to the initial inspection report
For some staff the report can come as a relief, as they may have been struggling – doing their very best but unable to deliver the care they wanted to. For some, the report was a wake-up call; providers who allowed standards to slip, perhaps due to a range of pressures.
Good managers engage with staff, people who use services and their families and are open to suggestions but set parameters and take tough decisions where necessary.
Failing organisations tend to have cultures in which staff are afraid to speak out. They do not feel listened to.
Typically, when a new manager took up the reins, they wanted to see care plans. In most cases these were lacking in detail and did not show that the care being provided was person-centred. It is not possible to provide good care if the care staff do not understand the needs of the person being cared for.
Some providers realised they had to tackle the staff-to-resident ration without delay. There was an understanding that people who use services are best served by having a stable group of staff they know and who know them.
While establishing a more stable staff foundation was important, tightening recruitment processes helped make sure that new staff coming in were suitable, and improved induction policies led to staff being better prepared. Another feature of poorly performing providers was a lack of training.
Working with partners
Most of the featured services received support from the corporate provider, if there was one, or commissioning bodies.
Building a community
Providers that aspire to ‘outstanding’ look beyond their own walls and seek to be part of their local community.
Response to resource
The CQC has published a number of comments in response to the resource. Rhidian Hughes, Chief Executive of the Voluntary Organisations Disability Group (VODG), notes that this resource takes us beyond the determinants of poor quality care towards a much richer, and practical, understanding of how to move services from inadequate to good. Providers can follow the conversation by using the hashtag #DrivingImprovementACS on social media.
For completeness, it is worth noting that similar resources have been prepared for NHS trusts, mental health trusts and GP practices together with separate publications highlighting the contributions of individuals who have made a difference in each of the sectors.
Responding to the CQC
We will certainly be drawing these publications to the attention of our adult social care clients in the first instance.
We appreciate that for providers dealing with the regulator is often a time of heightened anxiety and perhaps frustration to some extent, as is highlighted in the ‘Driving improvement’ resources.
For some providers, it will only be on receipt of enforcement actions that they appreciate the extent to which services are not performing as they would wish.