The care sector was very pleased when the Care Quality Commission (CQC) decided to introduce a quality ratings system. During the time of CQC’s predecessor body, the Commission for Social Care Inspection, there was much discussion about quality ratings, and this led to the introduction of the star ratings system. At first, many care providers were not convinced that this was a good idea, but as time went on, and there was the opportunity for care providers to be acknowledged for their quality, the system gained a great deal of recognition and support.
When the Commission for Social Care Inspection was abolished and CQC became the regulator, the organisation was in such chaos that many of the advances and developments that had been pioneered by the previous regulator were consigned to history. For the first few years of its existence, CQC struggled to deliver its primary function of regulating health and social care services, and did not have the knowledge, skills or capacity, to develop a quality ratings system.
Following several years of inadequate performance, CQC was cleared out and a new management team, Chair, and set of commissioners were appointed to lead the organisation into the future. The new team had a much clearer focus on the role of regulation, and a commitment to ensuring that the public understood and could differentiate between services on quality.
This has led to the development of the new rating system. Since its introduction, we have seen a lot of services rated as ‘Good’, but very few who have attained the top rating of ‘Outstanding’. There is a significant difference between being rated as ‘Good’, and achieving the top accolade of ‘Outstanding’.
Some of the services that have been rated as ‘Outstanding’ have decided to come together and form a group, which will have two distinct objectives. The first will be to support one another to maintain their ‘Outstanding’ status, and the second purpose is to support services that are either ‘Good’ and aspire to being ‘Outstanding’, or who have been rated as ‘Requiring Improvement’ and need the help and support of other services to turn them around, and improve their CQC quality assessment.
One of the things that has often been said about CQC, is that it is quite inconsistent in the way in which it makes judgements and I know this has been exercising the senior staff within the Commission. They are making a lot of effort to improve consistency, and to ensure that there is a more level playing field between the different areas that they regulate. This is not an easy task, and I think CQC will admit that it is a long way from where it would like to be. That said, it is making progress and regulation is beginning to improve.
However, I have visited many of the services that have been rated as ‘Outstanding’, and I think there is a great degree of consistency within this cohort of providers. As I go into the services and talk to residents, their families and the staff, there are certain things which come through time and time again, and which are elements of an ‘Outstanding’ service.
The first thing that is noticeable in ‘Outstanding’ services is the rigorous commitment to putting the resident at the heart of every decision. ‘Outstanding’ services understand that they are the servants of the people who live there and everybody is committed to enabling and empowering people, so that they have as much choice, autonomy and control over their lives as is possible. This is no easy task in services where people are living together, but ‘Good’ and ‘Outstanding’ services really understand that, above everything else, it is the experience of the people who use the service and the contentment of their families and friends, which is the number one priority.
Another aspect of ‘Outstanding’ services, which is really evident, is the way in which they have open and transparent cultures. There is a willingness to be accountable, and when things go wrong, the response of the service is to talk about it and to inform people, not to try to brush it under the carpet. This approach to openness and transparency gives residents and their families a real sense of confidence in the organisation, and it also leads to a culture of learning by experience.
I was talking to a member of the care staff in one ‘Outstanding’ service, and I asked them how they had found the CQC inspection. Normally when I ask this question, I am greeted with staff who tell me that it was a nerve-wracking and difficult experience, and that they felt under pressure, and under scrutiny. By contrast, the care worker I spoke to said that, ‘she and her colleagues were really looking forward to the CQC inspection because they were sure that they would learn a lot from the inspectors, and perhaps get tips and insights on how they could do things better’. This open and positive attitude will have set the tenor for the inspection. Often, if we exhibit negative energy, then it produces a negative response in the person we are dealing with, but in this case, openness led to a positive experience of inspection.
One of the things that is so noticeable about ‘Outstanding’ services is that they never cease to look for ways in which they can improve. Not one service that I have visited that has attained an ‘Outstanding’ quality rating has shown any sense of complacency or smugness. There is a real feeling that this is a great achievement and that everybody should be congratulated for it, but I have never seen it used as an excuse not to strive to do better.
I am also impressed by the way in which ‘Outstanding’ services train, acknowledge, and support their staff. The quality of a care service is dependent upon every member of the team, working tirelessly together to ensure that the service continuously reaches the quality that the service aspires to deliver. In ‘Outstanding’ care services, I see, first of all, shared values amongst all of the staff. There is also an acknowledgement that everyone is part of the staff team and this includes all the ancillary and support staff. It was brilliantly summed up for me by one member of the ground staff who told me that his role was to create a lovely environment, and to ensure that people were welcomed into it and enjoyed the surroundings. The fact that he understood why he was creating a fantastic garden and how important it was to the quality of people’s lives is also a good example of the way within which ‘Outstanding’ services make care, support and personalisation everybody’s business.
I have also been impressed by the way in which the catering staff in ‘Outstanding’ services really embraced their role. Not only do they deliver nutritious and appetising food, but they also think about the environment within which it is delivered and how they can ensure that mealtimes are a constant source of enjoyment for the people living in the care service. I saw a brilliant example of a catering team who had developed a Come Dine with Me experience and who had worked with residents to create a menu and then got relatives’ families in to taste, and judge it. This was great for residents, and it also was an important way of involving families in the life of the care home.
Setting the bar
The first cohort of ‘Outstanding’ services has set the bar very high for the rest, but I am confident that this sector will rise to the challenge and find many ways in which it can improve its care and deliver services that enable people to have a life, rather than just good quality support. In all the ‘Outstanding’ services that I have visited, the thing that’s characterised them has been the commitment to the quality of people’s lives, rather than just the quality of the service.
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