CQC State of Care Report and quality improvement

Prompted by the very recent publication of the Care Quality Commission’s (CQC) State of Care Report for 2014/15 (CQC 2015), the Social Care Elves have been busy mining the archive for research they’ve blogged on recently that could be useful for adult social care providers who want to provide what CQC define as ‘high-quality’ services.

Some providers need a bit of help as CQC note that the quality of adult social care is variable across England. They inspected 4,294 adult social care services (which amounts to 17%), and the ratings were as follows:

1% Outstanding
59% Good
33% Requires improvement
7% Inadequate

In particular they found that quality can vary in relation to ‘who you are and what you need’. They note that people with mental health problems or long-term conditions and some people from black and minority ethnic communities were less likely to report experiences of good care and support. Overall, it appeared that the nursing homes they inspected had the most work to do to improve.

Adult social care in England is looking patchy but research evidence could help with the stitching.

What does CQC inspection evidence suggest ‘high-quality’ is?

Based on inspection evidence, CQC found three distinct factors, with specific features, that appear to lead to high-quality care:

Engaged leaders building a shared ownership of quality and safety

Effective engagement and communication with staff and people using services.
The skills, experience and visibility of management.
A strong and positive organisational culture.
Learning when things go wrong.
Governance processes to support and underpin success.

Staff planning that goes beyond simple numbers

Safety isn’t just about having the right number of staff.
It’s also about having the right mix of staff with the right skills to meet people’s needs.
Staff training and development are also important.

Working together to address cross-sector priorities

Ensuring the resilience of the health and social care system and improving and maintaining quality will require coordination and collaboration both at a national and local level.
Services and different parts of the system must work together to ensure the sustainability of health and social care.
All sectors must improve their ability to recognise safeguarding issues through good staff training and shared learning.
Data must be collected across all sectors to enable a good understanding of what works.

(CQC, 2015)

So what research blogs have the Social Care Elves found for providers and staff seeking to improve their services and support to the highest quality?

CQC found that engaged leaders, staff planning and working together are key for delivering high-quality services and support.

Engaged leadership

There are a number of research blogs from the Social Care Elf that are relevant to leaders and managers in adult social care, particularly those who work in nursing home and residential care provision.

To create a positive organisational learning culture, with skilled managers and staff, leaders in social care need to be aware of the role research evidence can play in making decisions about care and support improvement. Lindsey Pike’s blog about a study looking at evidence based practice (EBP) in social work has important messages for social care providers who want to create an organisational culture that can use and learn from evidence.

CQC recommend that leaders should have effective engagement with staff and service users, and Gerry Bennison’s blog on health and social care leaders’ responses to service user involvement provides some useful evidence. He looked at research showing how managers need to attend properly to the challenges of service users and their organisations.

As CQC data is showing, some BME people are reporting fewer good experiences of adult social care services and support. Jeanne Carlin looked at a study on BME carers’ satisfaction with adult social care services and found that they didn’t have sufficient accessible information about services and were concerned with bureaucracy, language barriers and the cultural or religious appropriateness of services.

This piece of research indicates some key areas for equality and diversity that leaders should attend to, as does the study in a blog by Sarah Carr on research about the physical and mental health related quality of life of older LGBT people. It showed that positive sexual identity was associated with good mental health related quality of life, so LGBT people need to feel safe to be who they are when using social care.

As CQC advise, collecting data is also important for understanding what’s working, and there are validated measures for monitoring many aspects of social care performance – but which ones should leaders and managers use? For older people in care homes, quality of life measures are a helpful way of finding out how they are experiencing their life. Clarissa Giebel looked at a systematic review which concluded that a measure called QUALIDEM was best for people with dementia and one called the Psychosocial Quality of Life Domains questionnaire was best for people without.

Staff planning

The research blogs on experiences of care workers in residential and nursing care home settings by Jo Moriarty and Jill Manthorpe highlight some fundamental but complex issues about the value of relationships and emotional labour in what is commonly thought to be a task-centred job. This research seems vital for nursing home providers and managers if they want to improve quality of care. In another blog, Jill Manthorpe discussed research which found that older people receiving social care see it as a matter of relationships, something that also has distinct implications for staff recruitment and training in residential care and nursing home settings.

Moving into evidence for community-based care providers, Jenny Fisher’s blog on a study looking at the performance of very small care and support providers (‘micro-providers’) showed that the quality of personalised care and support, satisfaction of both service users and staff and certain outcomes can be better in well-managed, very small providers. Staff reported having more autonomy and time to build relationships, while service users said the personal connections and continuity were important for acheiving their chosen outcomes. In small organisations managers and staff could communicate more directly and effectively.

The elves have been mining the archive for research blogs to support CQC’s recommendations on high-quality adult social care services and support.

Working together

CQC found that communication, coordination and collaboration across the different players in health and social care is important for achieving high-quality care.

Social care elves Mike Clark and Caroline Struthers have looked at studies on care co-ordination for older people and case management for people with dementia. Mike’s blog also highlights the variation in quality of care co-ordination across the local authorities in the study, with joint working between health and social care still being very patchy. Caroline found that in case management for older people, the jury was still out when it came to finding reliable evidence about which model was most effective. The message here is that social care practice and research need to work closely together to find out more about what works for joint working and care co-ordination on strategic, service and individual service user levels.

Robin Miller, our go-to elf for integration, discussed a useful systematic review on the best measures to use for evaluating how well services are working together in an integrated way. Meanwhile at the frontline, Tanya Moore looked at a study on inter-professional working between general practice and social care. She found that effective communication and respect across professions cannot be assumed, but needs to learned and developed.

The CQC report highlighted ‘safety’ as being a particular concern and included ‘safeguarding’ as a key task for joint working and shared learning. Important messages for joint working between agencies on safeguarding are in blogs by Jill Manthorpe and Lindsey Pike. While Lindsey discussed evidence on what works best for adult safeguarding, Jill looked specifically at indicators for good practice in cases of self-neglect.

Social Care Elves are at your service

Research plays a crucial role in testing what works in adult social care and therefore needs to be used by all adult social care service providers to inform service development and improvement so that outcomes and quality of life for service users are the best they can be. Of course not all research is of good quality, nor is it reliable or accessible.

This is why at the National Elf Service, there are scores of experts in the guise of elves helping to make the most relevant and reliable research freely accessible to all those in adult social care as well as in health. This collection of blogs shows how help is at hand for those wanting to use research for quality improvement.

For providers concerned with the continuing professional development, skills and knowledge of managers and staff, there’s a very reasonable subscription service to enhanced features, where colleagues and experts can connect to discuss evidence and exchange knowledge and staff can track learning and professional development.

So sit back, watch this film and discover how the elves can help with service quality improvement.