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Driving Up Quality

The Driving Up Quality Code was developed to drive out poor quality in learning disability services. In the first in a series of articles, Peter Kinsey and Sarah Maguire introduce the Code, its aims and benefits.

The provider-led Driving Up Quality Alliance developed the Driving Up Quality Code in response to the abuse of people with learning disabilities at Winterbourne View. The Code was launched in 2013 at the Houses of Parliament and was endorsed by the then Care Services Minister, Norman Lamb MP with the express aim to ensure this situation could never happen again.

The Code asks health and social care providers to make a public commitment to improve the quality of their service provision and welcome scrutiny of their progress by people who use services, their families and professionals.

By signing up to the Code, health and social care providers create a culture of openness and transparency. This is essential to ensure that good organisations flourish and poor provision is exposed and addressed.

The Code is about providers showing a willingness to commit their time and resources to demonstrate that they are delivering good quality services, have the buy-in from relevant stakeholders and are open and transparent in their operations.

The Code is unique as it was developed by the voluntary, independent and statutory sectors in consultation with people who use services, their families as well as the Care Quality Commission (CQC) and commissioners. There was a real desire to listen to the people receiving support, their families and other stakeholders and a real commitment to build lives that have meaning.

Five aims

The Code has a particular focus on people with challenging behaviour who have longstanding and complex support needs. However, it can be, and is readily, applied to services supporting all people with learning disabilities, including those who have autism. The Code has five simple aims which are to:

  1. Drive up quality in services for people with learning disabilities.
  2. Create and build passion in the learning disability sector to provide high quality, values-led services.
  3. Provide a clear message to the sector and the wider population about what is, and what is not, acceptable practice.
  4. Promote a culture of openness and honesty in organisations.
  5. Promote the celebration and sharing of the good work that is already out there.

The Code was deliberately devised as a voluntary process as there is already plenty of statutory and regulatory ‘assessment’ in the sector. The Code is about providers showing a willingness to commit their time and resources to demonstrate that they are delivering good quality services, have the buy-in from relevant stakeholders and are open and transparent in their operations.

It is not intended as a quality measurement tool or to replace other codes and frameworks, but is a process that can enable organisations to think more deeply about what they are trying to achieve and how their behaviour impacts on this.

Providers sign up to the Code publically and are asked to evidence how they meet, or are working towards, meeting the Code. Commissioners are also asked to sign up to the Code and to commit to using it in their commissioning process to improve the quality of services.

Self-assessment

Signing up to the Code is great, however that isn’t enough. The most important aspect is the self-assessment process. This encourages people to come together, take a deep breath and spend some time reflecting on how they work. This means asking people who often spend little time together – people being supported, senior managers, support staff, families, housing providers, commissioners, finance and human resource teams – to listen to each other, recognise the good things, acknowledge the bad and find new ways to drive up the quality of what everyone does.

The self-assessments are then posted on the Driving Up Quality website so everyone can see how they are working towards meeting the Code. It is hoped that providers will go that extra mile and use Experts by Experience and/or other mechanisms to independently verify their self-assessments. Having the self-assessment documents publically available means that people are encouraged to challenge them if they feel they differ from the service being received. These challenges could be from service users, their families, staff, commissioners or members of the public.

Self-assessment is not a ‘tick box’ exercise. Neither is it about services being told what to do by Government, commissioners or regulators. It is about providers wanting to listen, learn and share their stories about what makes good support and striving to ensure they are delivering it.

Benefits of the Code

Apart from being the ‘right thing to do’, implementing the code and self-assessment process brings additional benefits for providers.

Carrying out a self-assessment process involving listening to families, people who are supported by the service and external stakeholders means providers get a good understanding what they do well and what they could improve upon. This kind of feedback is critical to service development but it can also help in achieving a rating of ‘Outstanding’ for the ‘Well-led’ aspect of the CQC inspection process. The CQC has, in fact, produced inspection reports specifically referring to the Driving Up Quality Code under the ‘Well-led’ section.

As well as whole organisations carrying out self-assessments, there are a number of excellent examples of individual services carrying out their own self-assessment process. This shows the eagerness of individual services and staff in being open, understanding how they are performing and hearing honest feedback from everyone involved in the service.

The self-assessment process is all about openness and transparency. This means that it is can be used as evidence that a provider organisation is meeting the requirements of the ‘Duty of Candour’ regulation. The CQC sets out that the ‘aim of this [Duty of Candour] regulation is to ensure that providers are open and transparent with people who use services and other “relevant persons” (people acting lawfully on their behalf) in relation to care and treatment.’

It is also important that Board members actively engage in the self-assessment process. By listening to the views of people who use services, families and external stakeholders and acting on their feedback, this aspect of the Code provides strong evidence that Board members meet the requirement to be a ‘fit and proper person’. The ‘fit and proper persons test’ aims ‘to ensure that people who have director level responsibility for the quality and safety of care, and for meeting the fundamental standards are fit and proper to carry out this important role.’

Commissioners are encouraged to refer to the Code in their tenders and this is happening. Evidencing that they have signed up to the Code and are undertaking the self-assessment process could improve a provider’s chance of obtaining a contract.

When families are looking to place their relatives in the care of a provider organisation, they want to know about the quality of the services they are visiting. Providers who have signed up to the Code, undertaken the full self-assessment and produced a self-assessment report will have good evidence of the quality of the care and support they deliver.

If families don’t know to ask whether a provider has signed up to the Code, providers can be forthcoming with the information and a copy of the self-assessment report. The report can give an honest understanding of what families, people being supported and other stakeholders say about the quality of care. Not only that, but it will also set out what the organisation is doing to address any shortfall.

Drive up quality

The Driving Up Quality Code gives providers an openness and transparency about the service they offer. It enables organisations to assess critically the level and quality of services as experienced by everyone involved, from clients to families, staff and commissioners.

Since the Code was launched in November 2013, over 200 providers and 17 local authorities and clinical commissioning groups have signed up. In the next edition of Care Management Matters, we will be exploring in more detail, how the self-assessment process can be carried out, giving specific examples from organisations that have implemented it successfully involving a range of stakeholders.

Peter Kinsey is Chief Executive of CMG. Email: peter.kinsey@cmg.co.uk Twitter: @PeterKinseyCMG

Sarah Maguire is Director of Quality and Safeguarding at Choice Support. Email: sarah.maguire@choicesupport.org.uk Twitter: @Choice_Support

Have you signed up to the Driving Up Quality Code. Have you noticed the benefits? Sign in to share your thoughts. Subscription required.

You can find out more about Driving Up Quality at www.drivingupquality.org.uk Twitter: @DrivingUpQualit

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