Evolution not revolution

Andrea Sutcliffe, Chief Inspector of Adult Social Care at the Care Quality Commission

My blogging has been a bit woeful this year — the last one was in July, celebrating the launch of Quality Matters . A lot has happened since then to keep me and everyone at CQC busy, but this week marks a key stage in our development with our next phase of regulation starting on 1 November. So I’m back to blogging!

The next phase is not a radical transformation of our approach — that happened in 2014. Rather, we have learnt from our experience, listened to the views of everyone involved (our staff, providers and people using services, their families and carers) and sought to simplify and build on the strengths of the methodology we introduced three years ago. Just as we expect the services we regulate to improve, we know that there will always be things we can do better.

‎Out go 11 different assessment frameworks and in come two — one for health and one for adult social care. In doing so, we have aligned the two where we can and reduced duplication while still respecting the difference between the sectors.

Other changes include improvements in the way we inspect domiciliary care services, a greater focus on those services that require improvement for two or more inspections and in the coming months, the introduction of a digital provider information collection. You can read more about the specific changes and access the revised guidance.

While we have decided not to make wholesale changes in the regulation of adult social care, any change is likely to be disruptive so it is important that we are clear about the benefits we expect to see. For me these reflect the four priorities‎ set out in our strategy for 2016 to 2021.

1. Encourage improvement, innovation and sustainability in care

Key to this is encouraging services to improve. State of Care, published in October, showed that the majority of Inadequate services do improve but the rate is much lower for those that ‎are rated as Requires Improvement. Failure to improve means that people cannot rely upon the quality of the service and it also makes services more vulnerable to sliding into Inadequate. Our more robust approach to these services, in particular focusing on compliance with Regulation 17 (good governance) will make it clear that running a service that constantly requires improvement is not acceptable and has consequences.

2. Deliver an intelligence-driven approach to regulation

Using information to target our resources to the areas of greatest risk or where there has been significant improvement is key to this. A vital element is making it easier ‎for providers to share their information with CQC. We are now testing the digital portal which early in 2018 will be available to all providers to update at least annually but also whenever circumstances change so that inspectors are aware of what is happening in each of the services on their portfolio and can tailor their responses accordingly.

3. Promote a single shared view of quality

We know how frustrating it is for providers when different authorities (regulators and commissioners in particular) have different standards and duplicate information requests‎. The development of the digital portal will make it much easier for information to be shared so that providers, commissioners and CQC can use the same data, based on an agreed definition of quality that will make it easier for the public to see what good looks like.‎ This will also be reflected in better and clearer inspection reports.

4. Improve our efficiency and effectiveness

Many of these changes will help us to be more efficient in the way we work and increase our effectiveness. One example is working with providers across all their locations. This already happens with our Corporate Provider Team for the larger provider groups, and that will progressively extend to all providers with two or more locations. This will enable us to spot trends and risks; share information and encourage improvement more broadly.

No change

What won’t change though is the CQC commitment to act on behalf of people using services, their families and carers. This remains at the heart of everything we do and the Mum Test will continue to guide us — asking that question, is this a service I would be happy for me, my Mum or anyone I love to use? If it is, that is fantastic and we will celebrate it; but if it isn’t, then we have to make sure something is done to sort it.