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Improving adult social care information to drive up standards

Source: PSE June/July 15

Andrea Sutcliffe, chief inspector of adult social care at the Care Quality Commission, discusses a new online resource designed to help providers improve their services.

Skills for Care and the Social Care Institute for Excellence (SCIE) have developed an online resource – Care Improvement Works – to give managers, owners and staff in the adult social care sector the confidence to challenge and change practice. 

The resource, developed with support from a steering group which included representation from care providers, users of services, carers, commissioners, the Care Quality Commission (CQC) and the Department of Health, allows users to identify products that will support improvement in areas where they may have concerns. 

Speaking to PSE about the launch of the resource, Andrea Sutcliffe, chief inspector of adult social care at the CQC, said: “A lot of providers don’t know what resources are out there that will help them achieve the standards that we [the regulator] are expecting to see. 

“When we say that a service requires improvement – and we’re rating 30% of services at that level at the moment – a perfectly reasonable question is: ‘How do I do that?’ And the Care Improvement Works has been put together by SCIE and Skills for Care in a way that will help providers access the resources available and will help them see how they can either achieve the standards, long before we get there, or – if we are saying that they require improvement – how they can make that improvement happen. 

“I hope this will encourage providers to use the knowledge of what works and apply that.” 

Sharon Allen, chief executive of Skills for Care, added that by combining efforts, Skills for Care and SCIE aim to make it easier for more than 17,000 care providers to find information to support improvement in one place. 

“The Care Improvement Works service is just the start of our plans for joint working to produce practical tools for the sector,” she said. 

Not rocket science 

Care providers can use the online resource before and after inspections – and at any other time – to review their current practice against recognised good practice or to identify products to support improvement. 

All of the products on Care Improvement Works are mapped to CQC’s five key questions and lines of enquiry: Are they safe? Are they effective? Are they caring? Are they responsive? Are they well-led? 

“Very little of this is rocket science,” said Sutcliffe, “but if you’re faced with not knowing what to do, sometimes it can be quite difficult to find your way through that and you may not know the right things to do and what the most up-to-date advice is. 

“I hope this will give providers the confidence to use these resources so that they know they are actually using the most up-to-date information and advice when they are improving their services. 

“I was also very pleased to see that SCIE and Skills for Care structured it [Care Improvement Works] by the five key questions that the CQC is asking. I think that it is already working in alignment with what we’re doing because it is structured in the way that we are asking the questions that we know matter to people who’re using services.”

The CQC will now be directing providers and professionals in the sector to the website and resources as a key place to find improvement information and advice. 

Tony Hunter, chief executive of SCIE, added that both organisations involved in developing the resource are committed to helping care providers along the improvement journey – whatever stage they find themselves. 

“We know it can be confusing to work out where to turn for reliable support, which is why we have come together to, as an initial offer, develop a single entry point to our resources,” he said. 


Celebrating success and reducing failure 

In October 2014, the CQC’s new-style inspections were launched, based around the principle of the ‘Mum Test’, meaning whether the inspectors would be happy for their own loved ones to be treated there. 

The inspections so far have rated about 60% of adult social care services as ‘outstanding’ or ‘good’. But 40% of services have been rated ‘inadequate’ or ‘requires improvement’. The new specialist teams, including trained members of the public (called Experts by Experience), inspect services unannounced based on what matters most to the people who use them. 

Asked how the new resource can help providers deliver the best care in line with the new inspections, Sutcliffe said: “What I want to encourage is that people are not doing things for me and my inspectors – they are doing the right thing for the people who’re using their services. If they are doing the right thing for service users, that will be the right thing for us (CQC).

“I want to get people to see that regulation can inspire that improvement, can celebrate their success when they are rated as ‘good’ or ‘outstanding’ and I think that is very important for the good services and the amazing staff that we do see.” 

However, she added that if improvements can’t be made at some providers where care is “utterly inadequate” they may be asked to leave the market. 

“Overall, I think we all want to see a better social care sector that gets much better press and recognition for the great work that it does do and stops getting dragged down by the ‘inadequate’ services that do exist,” PSE was told. 

Between 1 October 2014 (when CQC’s new inspection approach for adult social care began) and 13 May 2015, the regulator forcibly deregistered 27 domiciliary care service providers operating in 31 locations. And since 1 April, providers have been required to display their ratings on their premises and on their websites so the public can see their rating quickly and easily. 

PSE asked whether Sutcliffe thinks further closures are likely. She said: “Yes, I do. We would only do it in two circumstances. We might do it urgently if we thought people were at immediate risk of harm. It doesn’t happen very often, as I’m sure you can appreciate, but there are occasions when our inspectors go in places and come out and say ‘we cannot leave people in that situation for any longer’. 

“What is much more likely to happen is that we will say either ‘these are the things you need to do to improve’ or we give them a notice of proposal, which says that if they don’t improve over a period of time we will take action that will mean they lose their registration. But that would take much longer and would indeed be a last resort. 

“For me, the much better thing to happen is for services to improve and for the people who are using services not to suffer the disruption that would happen if a service closed.” 

Quality social care through regulation 

Sutcliffe added that the CQC does not believe that inspection or regulation is the only way to improve health and social care services. She highlighted that the organisation’s chief executive, David Behan, has led the way in describing the five groups who influence quality: professionals and staff; providers; commissioners and funders; regulators; and the public, including people who use services, their families and carers. 

“Each of these groups has an important part to play – and one operating in isolation from the others cannot hope to succeed,” she said. 

Sutcliffe will be speaking at the upcoming Health+Care Show during a session called ‘Improving the quality of social care through regulation’. 

The session will outline the CQC’s new inspection approach and rating system. Also, Sutcliffe said: “I’ll be trying to say two things: that we’ve all got a shared responsibility to improve the care of services and that is the right and proper thing for us all to be doing. This will go back to the five influences on quality mentioned. 

“Also, then being clear about what the role of the regulator is in that…and seeing regulation as a way to both celebrate the success that the sector has got but also to tackle the poor care.”

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