Inside CQC: Inclusive Services

Debbie Ivanova, Deputy Chief Inspector for people with learning disabilities and autistic people at the CQC, updates on the new strategies and systems aimed to help devise care plans for people with learning disabilities and autism.

In my last column, I shared my early thinking on our programme of work to transform the regulation of services for people with a learning disability and autistic people. Above all else, this programme focuses on making sure services for people with a learning disability and autistic people are safe and meet people’s needs well, in a model of care that promotes choice, independence and control.

In order to do that, we need to change the way we think about supporting people. We need to stop talking about people needing ‘complex care’ and vulnerable people, and shift to a focus on supporting people to lead the best lives they can.

Key areas of focus

We still have a lot to do, but I want to update you on where we are so far. Last time, I shared and explained our three key areas and what they should feel like to someone using a service, which are as follows:

  • Making sure we only register the right services — I use services that support me in the way I want to live and where I want to live.
  • Making sure we support services to improve and take the right action where they don’t — I will not be asked to move to a service that isn’t safe and I won’t be expected to continue to live in a service that doesn’t meet my needs.
  • Making sure we influence the improvement of pathways and wider healthcare of people with a learning disability and autistic people — I can access local services that meet my needs and get the right healthcare when I need it.

Our inspectors are also using updated guidance to help identify signs of closed cultures. This guidance is underpinned by our policy Right Support, Right Care, Right Culture. This policy sets out our expectations of all providers and commissioners of care. Everyone in the system should know what to expect when it comes to our standards. If you are planning on opening a new service, we ask that you contact us first so that we can ensure it’s in line with our policy.

Pilot inspections

We have now completed three pilot inspections using our new methodology. I wanted to share firsthand experiences from our visits to help give a feel for what’s changed. My colleague Nathan, an Adult Social Care Inspector, shares his reflections below:

‘In the pilot, we’re inspecting through a new person-centred lens, which has a much greater focus on people using and living in these services. We’re also in multidisciplinary teams, which has been a real success. These inspections move away from the systems and processes a provider has in place and are much more about getting under the skin of what is really happening in these services, focusing on people and their outcomes.

‘We’re only one part of the system and can’t do this alone. My message to providers, commissioners, social workers, registered managers and others would be to collaborate and work towards a shared goal of helping people with disabilities who may need support to lead the lives they choose, in the places they want to be. We must all take accountability for our decisions and behaviours.’

On these visits, we’re inspecting at telling touch points in people’s daily life, such as their time to eat, go to bed or when a staff handover is taking place. We’ve also increased observation and the amount of time we spend speaking to people in the service, as well as using more Experts by Experience. Our teams are using new tools like the Quality of Life tool to better evaluate people’s care plans. The primary purpose of this tool is to improve CQC’s ability to consistently identify and take appropriate regulatory action in services that fail or are failing to meet the needs, aspirations and skills development of people with a learning disability and/or autistic people. We’re currently evaluating the pilot and hope to roll it out across more services in the next few months.

We’re not accepting care that is not safe and doesn’t meet people’s needs. We’ve taken action on every inspection in the pilot, stopping admissions through urgent imposition of conditions in hospitals and cancelling the registration where care does not improve.

My next column

Some autistic people can struggle to access health and social care services and many have negative interactions with the NHS because reasonable adjustments aren’t made. In my next update, I’ll focus on how important it is for there to be a good understanding of what it means to be autistic and explore our programme with a focus on autistic people.

Debbie Ivanova is Deputy Chief Inspector for people with learning disabilities and autistic people at the Care Quality Commission. Share your feedback and comments on Debbie’s column below.




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