We all know that ‘good’ and ‘outstanding’ care is both a shared goal and a shared endeavour. That is why clear rating characteristics will be an important part of our suite of guidance and support for providers, our colleagues and people using services.
However, providing a clear definition of outstanding care is not always easy. We can all recognise when something feels outstanding but the challenge is how to quantify that to share and replicate it.
A recent research report produced by The King’s Fund in partnership with CQC explored the characteristics of outstanding health and social care. Drawing on evidence, stakeholder interviews and workshops, it identified five key principles that distinguish outstanding care from good care:
- Truly person-centred care.
- Compassionate and inclusive leadership.
- Equity and inclusion.
- Continuous learning and improvement.
- A purposeful focus on achieving positive outcomes for people using services, staff and the wider system.
These principles are evident in many of the outstanding services we see, including in the services visited by the BBC and described in this BBC article, which asked what it takes to be rated as outstanding.
Shared learning and inspiration
Alongside the turnaround in our approach to assessment and inspection, we are looking carefully at what the sector can learn from both the outstanding practice we see and the concerns we identify that lead to regulatory action.
When we analyse enforcement activity in adult social care, three areas consistently emerge: governance, safety and staffing. These are not new challenges but they remain the foundations on which high-quality care is built. They are also woven through the key principles identified by The King’s Fund.
The most common issue we see is not a single isolated failing but weaknesses in governance. Where leaders have effective oversight, understand risks in their service, listen to feedback and maintain accurate records, they are much better placed to identify concerns early and drive improvement. However, when governance arrangements are weak, problems can go unnoticed until they begin to affect people’s experiences and outcomes.
We also continue to see examples where risks are not identified, assessed or acted on quickly enough. Whether this relates to responding to changes in a person’s health, maintaining safe environments or ensuring equipment is used appropriately, strong safety cultures rely on organisations constantly asking themselves where risks might emerge and how they can be mitigated before harm occurs.
Staffing remains another critical area. High-quality care depends on having enough people with the right skills, knowledge and support to meet people’s needs. Providers that invest in recruitment, training, supervision and workforce wellbeing are often the organisations best able to deliver consistent, person-centred care and respond effectively as needs change.
We worked recently with the Care Workers’ Charity and its advisory board who shared that uncertainty around inspections can sometimes create unnecessary stress for staff in services. To improve people’s understanding about us and our inspections, we have recently published a Care Workers’ Guide to CQC on our website.
The guide sets out who we are, our purpose and what we expect from care workers while we are inspecting. By providing clearer information, we hope to support care workers, reduce uncertainty and help create a positive inspection environment where people can focus on delivering high-quality care.
Sharing for improvement
Importantly, our intention in sharing these three themes from concerns is not simply to highlight where things go wrong. We want to help providers understand the patterns we are seeing and use them to reflect on their own services.
Many of the most successful providers regularly challenge themselves on questions such as:
- Do we have effective oversight of quality?
- Are we learning from incidents and feedback?
- Do our staff feel supported and confident?
- Are we identifying risks before they become problems?
Asking these questions and reflecting on the inspiring examples of outstanding care that we share can help to drive improvement.
As we develop our future regulatory approach, our ambition is not only to identify risk more effectively but also to shine a stronger light on excellence, innovation and good practice across adult social care. By sharing learning from both enforcement activity and outstanding services, we can support a culture of continuous improvement that benefits people who use services, care providers and the wider sector.
For more CQC insights, read this issue’s Straight Talk. Then share your thoughts on this Inside CQC by commenting below.
Chris Badger is Chief Inspector of Adult Social Care and Integrated Care at CQC.
Email: [email protected] Linkedin: @Care-Quality-Commission