Quality Compliance Systems (QCS), a leading provider of content, guidance and standards for the social care sector, has asked Ed Watkinson, a former CQC inspector, to explore, examine and demystify the remaining two themes that make up the CQC strategy. In the second of two articles, Ed Watkinson reviews ‘Safety through learning’ and ‘Accelerating improvement’.
In a bold new vision, the Care Quality Commission (CQC) has set out a strategy, which it says combines `learning and experience’ with `valuable contributions from the public, service providers’ and its partners.
As a result, the CQC says its strategy, which covers four key themes (‘People and communities’, ‘Smarter regulation’, ‘Safety through learning’ and ‘Accelerating improvement’), will be more `relevant’, more `flexible’ and more `responsive’ to cope with the ever-increasing challenges that the social care sector faces.
The CQC also says that the new directive will ensure that it achieves its core aims – to not only ensure that social care providers deliver `safe, effective, compassionate and high-quality care’, but that the CQC gives them the tools to change.
Safety through learning is nothing without a strong culture
When we talk about safety, the word ‘culture’ should always closely follow. In this theme, the CQC has shown that it is deeply committed and passionate about ensuring that every service has a strong culture of safety embedded within it, which includes a focus on `learning and improvement’.
I think when we consider a culture of safety, it’s important to see it through the context of recent events. The CQC has learned a lot from the pandemic and while ensuring care services are safe has always been a pre-requisite, it has perhaps been pushed even higher up in its list of priorities.
For the CQC, safety is inextricably linked to learning and improvement. Its argument is ̶ if a culture in a service is not right, then that particular service is not going to learn from its mistakes. If the provider is not learning from errors made, the CQC’s view is how can it improve?
CQC’s view is that a culture within a service must be open, honest and transparent. If it is not, then the likelihood is that the provider cannot be operating a safe service. This brings me on to ‘closed cultures’ or ‘closed environments’ in a service.
It is an important distinction to make. When people think of closed cultures in the social care sector, they tend to think of the Winterbourne View or the Whorlton Hall scandals; abuse was found to be systemic throughout the assessment centres. However, closed cultures, when they are present, do not always impact on an entire service. Instead, they are often found in small teams, who may work together, and share a different set of cultural safety values, which are not in keeping with the CQC’s values, or the social care service they work for.
The CQC is committed to rooting out these closed cultures. However, it’s one thing to promise to banish them from the social care sector and another to actually come up with regulation that works. In my experience, closed cultures are exceptionally difficult to eliminate for the simple reason that those engaging in them are expert in concealing them.
Richer data taken from multiple sources will help the CQC to identify closed cultures
I believe the CQC’s strategy to expose and eliminate closed cultures is a good first step. While it will focus on mental health services, on learning disability services and on residential care homes, its plan to gather information from a multitude of sources will help the CQC better identify when a service is closed culture.
Critics of the CQC strategy might well disagree. Some might say, that as services with closed cultures do not co-produce and collaborate, how will continuous monitoring, which relies heavily on intelligence and data, make a difference? I would argue that if the CQC comes across a service, which is not actively sharing information, or one where data sources are in short supply, it will signal a red flag. This will in turn prompt the CQC to investigate further.
I also think that content providers, such as QCS, can help Registered Managers to instil a culture of openness within their services. How? Well, closed cultures thrive in information silos, which is typical of service where a closed environment is present. The QCS system, on the other hand, enables managers to cascade policies, procedures, and best practice content down to staff as and when it is required, which promotes top-to-bottom transparency in a service.
Finally, and one of the most important aspects of the new strategy, is the CQC’s desire to `involve everybody’. This means involving service users, those who they judge to be important to them and external organisations, to affect real and profound change. However, the CQC is keen to use the insight which it has gathered `to promote a national conversation on safety’. The hope is that it will lead to a greater understanding and knowledge around instilling a culture of safety in services throughout the country.
In the final part of this article, QCS has asked Ed Watkinson, a former inspector, to explore, examine and demystify the ‘Accelerating improvement’ theme.
The CQC has pledged `to drive improvements across individual services and systems of care’ by `empowering services to help themselves’. But how? It says it will `collaborate and strengthen’ relationships with providers, service users and ancillary organisations.
In other words, the CQC will identify best practice and signpost providers to where it thinks they can benefit from receiving extra support, which will drive improvement. To foster improvement, the CQC has said that it will `facilitate national improvement coalitions with a broad spectrum of partners. Reading between the lines, it would seem that the CQC is keen to recommend agencies that would provide support to services on a consultancy basis – when it is needed.
The CQC is dedicated to `making improvements happen’.
Secondly, the CQC has set out a clear mandate to `make improvement happen’. It has promised to facilitate `continuous improvement’, by being much clearer as to what social care services must do to provide a quality service.
In addition to promising to work in partnership to realise a culture of improvement, the CQC will provide analysis and benchmarking data to services. This will not only help providers to evaluate their services against similar providers but will better enable the CQC to pinpoint areas where it can focus on to ensure improvements are realised locally, regionally and nationally.
Moreover, the CQC has cited `innovative practice and technological change’ as a priority area that every provider should strive for. When you consider that the regulator has traditionally been very much on the back foot regarding technology, this is a huge step forward for the CQC. In the past, it is fair to say that when some inspectors have assessed services, they have not always understood the scope and limits of the technology being used and, therefore, they have not been able to report on it and highlight outstanding best practice. However, going forward, the CQC says it will develop `a co-ordinated, effective and proportionate approach to regulating new innovations and technology’. It has also pledged `to encourage services to play an active part in research’.
The pandemic created the perfect breeding ground for technology to flourish
During the pandemic, video conferencing platforms, such as Zoom and Microsoft Teams, have powerfully demonstrated that technology and innovation can drive efficiency in services. There will be fewer face-to-face meetings with external stakeholder and partners now. Most will take place on these video conferencing platforms. Not only will that save time and money for a sector where budgets are already stretched, but it will also enable care teams to spend more time with service users.
Secondly, video conference technology has allowed service users to stay in touch with their loved ones during the pandemic. It also enabled some partner organisations to continue offering services to people during the crisis and co-production to flourish.
How technology will develop in care homes in the future is unclear. However, it is likely that electronic devices will be deployed much more widely to monitor activity and to support service users. With digital technology just beginning to gain a toehold in the social care sector, I think it is an opportunity for trailblazers to showcase and share innovative practice with the CQC. By innovating, recording, and clearly evidencing where such technology adds value, not only will they give themselves a chance to be considered outstanding; but the CQC will share their pioneering work with the entire sector.
Care Quality Commission – A new strategy for the changing world of health and social care – CQC’s strategy from 2021
Ed Watkinson, Residential Care and Inspection Specialist
Ed has wide experience across a variety of roles in the care sector. He has been a care assistant, registered manager, area manager, care manager and senior commissioner. He has also served as a Planning and Commissioning Manager for Buckinghamshire County Council and as Methodology Developer and Regulatory Inspector for the Commission for Social Care Inspection. Most recently, he has worked as a Regulation Manager for Barchester Healthcare.
In addition, Ed was on secondment with the Care Quality Commission during 2014 and was central to the development, piloting and roll out of the Care Quality Commission’s new inspection methodology as part of their Policy Team.
Quality Compliance Systems is a leading provider of content, guidance and standards for the social care sector. To find out more about QCS, contact our compliance advisors on 0333-405-3333 or email email@example.com.