A. Andrea Sutcliffe, Chief Inspector of Adult Social Care at the Care Quality Commission responds.
Anyone who is receiving health and adult social care services has a right to receive really great care. It has to be good enough for my mum, your mum or anyone’s loved one and – for the past seven months – we have been rating every adult social care service so that people can be clear about whether we think the care they receive deserves that description.
Much attention is rightly focused on the occasions where people experience poor-quality care. On a daily basis, my inspection teams across the country find and report on services failing the people they are meant to support. Sometimes this is as a result of routine, unannounced inspections and sometimes the result of information shared with us by staff, relatives or other agencies. We know that’s what makes the headlines and tackling poor care to encourage services to improve, change or close is a vital role for us at the CQC.
But we also know that behind the headlines of poor care, there are thousands of services that we would be happy for anyone we love and care for to use. Our new style inspection process and ratings system is helping to highlight this and I am really pleased to celebrate those services that are getting it right.
As well as shining a spotlight on all of the great care we find, another vital role for the CQC is about being a driving force for change that improves the quality of care that people simply deserve. We do this not only by encouraging improvement where care is poor, but by identifying excellence and finding ways to share practice that we have identified as ‘Good’ or ‘Outstanding’ so that other providers can learn from the best.
Examples of some of the ‘Outstanding’ adult social care I have had the pleasure of celebrating, from our inspection work so far, includes:
- Home Instead Senior Care in West Lancashire – one of the first adult social care services to be rated as ‘Outstanding’ for how it cares for and supports people with physical disabilities and mental health needs. In particular, the CQC highlighted the service’s person-centred approach, including the emotional support that it factors into care plans and its principles of kindness, respect, dignity and compassion.
- St Cuthbert’s Hospice in Durham – an ‘Outstanding’ care provider that puts individuals and their personal needs at the heart of its effectiveness and was found to follow palliative care principles that promote autonomy and independence for as long as possible. Reporting in January 2015, the CQC heard comments, including, ‘The staff and volunteers are just brilliant’.
- Robert Owen Communities – Domiciliary Care East Devon – an ‘Outstanding’ homecare service providing support with personal care for 30 people with learning disabilities, sensory impairments and physical disabilities. The CQC’s inspection report commends the service for its person-centred approach with residents enjoying as much independence and freedom of choice as possible and staff encouraging them to become active members of their local communities.
- Prince of Wales House in Ipswich – an ‘Outstanding’ care home that has been praised for the innovative and creative practice used by staff and a clear commitment by managers to continually improve. Residents, their relatives and health professionals told inspectors that care at the service was excellent and that staff were kind, caring and always went the extra mile.
What underpins ‘Good’ and ‘Outstanding’ care?
In our new approach to inspection, we assess the quality of care that providers are delivering on the basis of five key questions: asking whether a service is safe, effective, caring, responsive to people’s needs and well-led.
We know these questions are what matter most to people. They identify shortcomings and where we can take action if providers are failing people who use their services. But importantly, our system also finds ‘Good’ and ‘Outstanding’ care that we can shout about and share.
To help people who use services, their families and carers as well as providers and staff to see our inspection judgements as robust and reliable – and to help them make better choices about their care – we have also set out what ‘Outstanding’, ‘Good’, ‘Requires Improvement’ and ‘Inadequate’ care should look like.
This really allows our inspection teams to get under the skin of adult social care services so that providers know what we are expecting and families know how we will consistently rate their services.
A summary of the CQC’s characteristics for each rating level looks like this:
‘Outstanding’: Innovative, creative, constantly striving to improve, additional key characteristics that make the service exceptional and distinctive.
‘Good’: Consistent level of service people have a right to expect, robust arrangements in place for when things do go wrong, open and transparent.
‘Requires Improvement’: May have elements of good practice but inconsistent, potential or actual risk, inconsistent responses when things go wrong.
‘Inadequate’: Significant harm is likely to occur, shortfalls in practice, ineffective or no action taken to put things right or improve.
Based on sample inspections so far, there are three emerging themes that ‘Good’ and ‘Outstanding’ services share:
- They provide care that is person-centred – designed around the individual and with their involvement.
- They have a clear ‘line-of-sight’ from senior leadership to the frontline staff and services.
- They check how well they are doing and seek ways to improve.
Our annual report on the state of health care and adult social care has also shown that there is considerable variety in the quality of care provided in England. Among the best care we have found is in services that acknowledge there is always room for improvement – they are proactive about seeking feedback and learning from concerns and complaints.
It can be done
There are many ‘Good’ services, but what is it that pushes these services across that boundary into ‘Outstanding’? I encourage you to take the time to read some of our reports to see for yourself, but here are some of my initial thoughts.
- They go the extra mile – one quote from a community professional about Home Instead, ‘it is very refreshing to work with an agency who really do care and provide an excellent service above and beyond their role’.
- They really focus on supporting their staff through induction, ongoing training and support and by involving them in the development of the service. Staff at Robert Owen Communities spoke with pride about the people they supported, one said, ‘It’s a privilege’ and another said, ‘I feel I make a difference’.
- The care is person-centred. Paul Marriott, Chief Executive at St Cuthbert’s Hospice, said the heart of what makes the hospice ‘Outstanding’ is its ‘shared culture and values among staff’. Our CQC inspection heard people being asked whether they would like a bath that day and individual care was planned to support the ‘total wellbeing’ of each person. This included physical, psychological, social and spiritual needs.
- They pay attention to the details that make all the difference to people – for example, garden furniture at the Prince of Wales is engraved in memory of previous residents and located in what was their favourite place in the garden.
I could go on with many more examples, but the stand-out theme for me in all of our ‘Outstanding’ and ‘Good’ rated reports is the focus on care that embraces the individual and those around them.
Some more examples from our findings so far include:
- ‘People and staff had high expectations of what each person could achieve and showed determination to succeed.’
- ‘Staff, skills, hobbies and interests were matched with the interests of the people they supported.’
- ‘The management team provided strong leadership and led by example.’
- ‘Staff were encouraged to challenge and question practice and supported to change things.’
- ‘The environment had been arranged to promote people’s wellbeing. Staff worked creatively to best use the space to support people’s independence and personal identity.’
Making a difference
While we may despair at the poor services that exist, the joy of seeing and hearing about ‘Good’ and ‘Outstanding’ services is that it demonstrates truly excellent care can be provided and does make a real difference to people’s lives. The message from our inspection findings so far seems to be: focus on the person, support your staff, pay attention to detail and always try to improve.
Of course there’s a lot more to it than that but I hope I have given you enough of a taster to read through some of our reports and see what can be done so that people can get the best care they deserve.
What are your thoughts on what makes ‘Good’ or ‘Outstanding’ care? Join the debate below. Subscription required.