Social care services are unique – just like the people who use them. Each service is different, adapting to the needs of the people it cares for and enabling its staff to shape how they deliver care in the best way. Despite these differences there is an expectation and requirement to ensure that all registered services at least meet minimum standards of quality. How do we, as the regulator, ensure consistency across such a wide range of provision?
It is important to remember that the regulations in the Health and Social Care Act underpin everything that we – and you as providers – do. They form the legal foundation for how services are run and what people can expect from good care. Our assessment framework, including the quality statements and evidence categories, is rooted in these regulations.
However, several independent reviews made clear that the single assessment framework introduced in 2023 was not working as intended to streamline assessments. Rather, it was causing confusion and frustration for providers and the public. Instead, the assessment framework should translate the law into clear and practical expectations, helping providers understand what good care looks like and how to demonstrate that they are meeting regulatory responsibilities. So, over the last 18 months we have been working on improving our assessment framework to do this.
Improving how we regulate
At the end of last year, we held a public consultation to ask people what we should change to improve the assessment framework. We had over 1,700 responses to the consultation, with a great response from adult social care providers. The responses included a range of helpful ideas that we are using to shape what we do next.
Later this spring, we will publish a response that summarises the feedback we received along with draft assessment frameworks, including a specific framework for adult social care. We will engage further to help refine the frameworks and develop definitions of what good-quality care looks like. This is to develop the characteristics that underpin each of our four ratings – called rating characteristics. We will do this through online and face-to-face engagement with providers, colleagues and the public, starting from this April. We are also working to improve our digital and technology systems and strengthen our registration processes.
All these improvements and changes are to make it clearer and easier for us to regulate and for providers to be regulated by us. I want to make regulation simpler for everyone. Working together to describe practically in detail what is expected at each rating level will help providers and the public to understand what good care looks like. Keep an eye on our bulletins for how to get involved.
Recognising excellent care
One of the privileges of regulation is being able to see the breadth and variety of services that make up the patchwork of adult social care. We recently rated SignHealth Longley Road in South London as ‘Outstanding’. This residential care home is a specialist setting providing long-term care for deaf adults who have mental health needs, learning disabilities or both. Using the approach in our guidance, Right support, right care, right culture, we found staff delivering care that respected each person’s unique communication needs and cultural identity.
All the staff were fluent in British Sign Language (BSL), and almost all were deaf themselves. Using BSL and visual aids ensured that information was shared clearly and people were supported to express their views and make choices about their care. They created an environment where people could communicate freely and feel genuinely understood. The golden thread running through effective services like SignHealth Longley Road is that people are the priority and are supported to live their fullest and best lives – to thrive, not just survive.
As we work together to define and refine the descriptions of the ratings in our draft assessment frameworks, we will continue to make sure that people’s experiences of their care are fundamental to our judgements. I am really clear that delivering personalised care is the foundation of all that we do in the sector, and this provider exemplified this. We look forward to continuing our conversations with colleagues, providers, stakeholders and the public to ensure our new frameworks work well for everyone and reflect this.
Did you respond to the public consultation on changes to improve the assessment framework? If so, what did you suggest? Comment on this column or join the conversation to share your thoughts.
Chris Badger is Chief Inspector of Adult Social Care at CQC. Email: [email protected] X: @CQCProf