On 27th May, the CQC launched its five year strategy for the ‘changing world of health and social care’, designed to ‘improve care for everyone’.
The CQC’s strategy combines learning, experience and contributions from the public, service providers and partners. The CQC states that the regulation will be more ‘relevant to the way care is now delivered, more flexible to manage risk and uncertainty, and will enable the CQC to respond in a quicker and more proportionate way as the health and care environment continues to evolve’.
Whilst the CQC’s role as a regulator will not change, the way the CQC works will be different.
What is CQC’s strategy?
The CQC’s strategy is set out in four themes:
- People and Communities: regulation driven by people’s needs and experiences focused on what is important to them as they access, use and move across services.
- Smarter Regulation: a more dynamic, flexible approach that provides up-to-date high quality information and ratings, easier ways of working with the CQC and a more proportionate regulatory response.
- Safety through Learning: regulating for stronger safety cultures across health and care, prioritising learning and improvement and collaborating to value everyone’s perspectives
- Accelerating Improvement: enabling health and care services and local systems, to access support to help them improve the quality of care where it’s needed most.
During the CQC strategy launch, tackling closed cultures featured as a CQC priority with two powerful and thought-provoking videos from Issac Samuels and Alexis Quinn who have both lived experiences of closed cultures. They shared their experiences and the impact upon them.
The CQC describes a closed culture as a ‘poor culture that can lead to harm, including human rights breaches such as abuse’; in these services, people are more likely to be at risk of deliberate or unintentional harm. The abuse at Whorlton Hall, Mid Staffordshire and Winterbourne View and other services have highlighted the damaging effects that a service with a closed culture can have on people.
The CQC has developed guidance for inspectors on how to identify and respond to closed cultures. The guidance includes indicators of what the CQC will look out for when inspecting services. Services, which has one or more of the ‘inherent risks’, set out below, will be closely monitored:
- People experiencing poor care, including unlawful restrictions.
- Weak leadership and management.
- Poor skills, training and supervision of staff providing care.
- Lack of external oversight.
What providers can expect to see over the next 12 months:
As the CQC begin to implement their strategy over the next 12 months, along with the continued focus on infection prevention and control and decisions around care home visits and DNACPR, providers can expect to see:
- A focus on culture during the registration and inspection process.
- An emphasis on safety, learning & improvement.
- Piloting of a new CQC assessment framework.
- Onsite inspections to continue as a core part of CQC activity, whilst moving away from comprehensive onsite inspections as the main way of updating service ratings.
How can providers prepare?
- Review infrastructure to support digitalisation, sharing of information and smarter regulation.
- Review the approach to obtaining feedback from people with lived experiences with the aim for feedback to become part of day-to-day practice.
- Review how people who live in and receive services are involved in decisions about their care and the wider service provision.
- Review how management information is collated relating to accidents, incidents, falls, medication errors, safeguarding along with practices around lessons learned, actions and the capture of evidence and the impact and contribution to service improvement.
- Review complaints, whistleblowing, safeguarding, MCA, DoLS policies to ensure they are up-to-date and accessible to staff and the people who live in or receive services. Ensure that blanket decisions relating to care home visits and DNACPR are not part of practice.
- Review workplace culture and deal with any pockets of closed cultures.
- Ensure staff are competent, well supported and supervisions are planned and take place.
- Provide leadership development opportunities to support leaders on how to develop a positive workplace culture and effectively manage change to support digital transition.
What does this mean for social care?
From my 22 years’ experience working in social care sector, both at management and director level, across care at home, supported living and care home services, combined with the last 18 months as a social care consultant, coach and facilitator of the Skills for Care leadership programmes, my professional view is that the sector may have become too compliance focused rather than focused on the people living and receiving care and support services. I was therefore pleased to hear how identifying and responding to closed cultures is a priority for the CQC and how looking through the eyes of people who have lived experience of services and systems has informed and shaped CQC’s strategy.
I hope the emphasis on culture and lived experiences will redress the compliance vs people balance and we see: people at the centre of decisions about their care and support; open positive cultures across care and support services; shared learning to inform service improvement across systems, along with the recognition and respect for our valued social care workforce, equal to that as experienced by our NHS colleaguess