Andrea Sutcliffe, chief inspector of adult social care at the Care Quality Commission (CQC), used her annual address to the Health+Care conference to highlight her desire to see an improvement in the ratings that care services receive from the regulator. CQC inspections remain a source of anxiety across the sector, and she spoke to a packed theatre full of delegates very eager to hear what she had to say.
Having first outlined the latest data on the current state of the care sector (see: Spotlight on care services), Ms Sutcliffe went on to unveil a new publication from the CQC that shares experiences from services that have managed to increase their rating, with the aim of helping others to do the same.
The role of the CQC, she said, is to “shine a spotlight on services. It is a mirror for people to see what they are doing, and what it is they need to do to improve. We have also got a duty to share the insight that we have got to help those services to improve, and to draw out some of the lessons. One of the things that we have been looking at over the past year is how can we learn from those services that have made that journey of improvement.”
The CQC visited nine care services that had either been rated ‘inadequate’, or had had enforcement action taken against them, that have “really, really worked hard to get themselves to ‘good’”. It found out how they reacted, what they did, and what they learnt, and talked to service users, their families and carers, chief executives, board directors, managers and staff, and other professionals. Driving Improvement, published in June, draws on the insights from these case studies. Andrea Sutcliffe encouraged all delegates to read the publication, saying there are some “great tips in there. I think they are brilliant, because they are really, really authentic.”
In addition, the CQC used the platform of Health+Care 2018 to launch a set of new resources looking at some of the critical safety issues it has come across, particularly, said Ms Sutcliffe, “when we have prosecuted services because of failure to provide safe care and treatment”.
These aim to share learning from safety incidents, and describe critical safety issues in health and social care, looking at what has happened, what the CQC and providers have done about it, and steps that others can take to avoid it occurring in the future. The resources are the first in a series, and Ms Sutcliffe encouraged delegates to contribute messages that they consider should be shared for future resources.
The CQC has identified leadership and culture as the key issues in driving improvement within organisations, and for achieving an outstanding rating. Ms Sutcliffe said it was important that staff were genuinely involved, and “empowered to do the right thing”. She emphasised the need for patient-centred care, with comprehensive care plans that truly reflect a person’s wants and needs, and for a “consistent compassionate workforce”, with limited use of agency staff. Ms Sutcliffe urged services to work with partners to “foster an improvement culture”, to build a relationship with their CQC inspector, and to “bring the community in” and make local connections. Maintaining a focus on quality is also necessary, and she advised: “Talking to the health service is really important now as well … making sure that there is much better communication, and the health service has got to step up to the plate on this one too.”
The end result for those services that are successful at driving and maintaining improvements, she believes, will be the provision of “seamless services for the person, not the system”.
BOX 1: Spotlight on care services
The ratings are based on five key questions – the key lines of enquiry (KLOEs). These are: is the service safe, caring, effective, responsible, and well led?
Currently, 79% of adult social care services in England are ranked as ‘good’, and 3% are ‘outstanding’, which Andrea Sutcliffe, chief inspector of adult social care at the Care Quality Commission (CQC), described as “fantastic”. She said: “It has been a slow burn, but we are beginning to see services that we have previously rated as ‘good’ understanding what they could do to make that leap into ‘outstanding’.” However, she pointed out, that means that nearly 1 in 5 services are still being graded as “not being good enough, 2% of those services being ‘inadequate’ – and that continues to be a real worry”.
Ms Sutcliffe highlighted again the importance of leadership. “That question about whether the service is well-led has been so crucially important to us in really understanding what makes an outstanding service, and what actually encourages services to improve,” she told delegates.
“When we go back to those services … that are ‘inadequate’, nearly 80% of them do improve, and that is fantastic. It is not quite so good for those services that we have rated as ‘requires improvement’; only about half of them improve at the next inspection, and we need to encourage that to happen much more as we go forward.”
Services received the highest grading against the KLOE ‘Is the service caring?’, a consistent finding since the ratings began in October 2014. Ms Sutcliffe explained: “What that is demonstrating, I think, is how dedicated and committed the staff that work in adult social care services are. They really do want to do a good job. Again, we continue to see that ‘leadership’ and ‘safety’ are the areas where we fall down; and that means that some of those staff are being caring, but they are doing it despite the system, not because of the system, and they have not got the wraparound support.”
Box 2: Take five steps to ‘outstanding’
Jonathan Cunningham is the owner of Rosebank Care Home, a 17-bed residency specialising in learning disabilities that was graded ‘outstanding’ 18 months ago. He told delegates at Health+Care 2018 that there is a “little bit of luck” involved, and said that retaining the rating was a “real challenge”. He also took over as registered manager at Birkdale Park Nursing Home last November; it was previously rated as ‘requires improvement’ and has now achieved a ‘good’ rating.
In a spirited, heartfelt presentation that ranged from taking a selfie with the audience to a closing rendition of Morecambe and Wise’s ‘Bring me sunshine’, Mr Cunningham outlined five steps to achieving an ‘outstanding’ rating: the need for services to collaborate, the use of IT and social media, empowering staff, the performance of regular audits, and providing strong leadership. He called for “impassioned, driven leadership on the shop floor”, and wrapped up with an exhortation to delegates to “please connect”.