Andrea Sutcliffe, Chief Inspector of Adult Social Care at the Care Quality Commission.
A strange thing happened to me at the weekend.
I was in Berlin walking home with a group of friends after a lovely evening. A very drunk young man fell over as we passed by, got up and started hurling abuse at us — in pretty good English. Like the rest of the group I tried to avoid and ignore him until he kicked out at my brother at the back of the group. At that point I snapped and went into full big-sister protective mode and rushed at the man telling him to leave my brother alone. As everyone else made sure I didn’t do anything even more stupid (thanks guys), it all calmed down and we went our separate ways. But I was shocked — a little bit at what had happened but mostly at my reaction. Responding like that isn’t me at all!
I think I was angered by the injustice of what had happened — my brother had not done anything wrong and while I don’t need to go into details of why I might particularly look out for him, suffice to say my instinct to do so is very strong.
But on deeper reflection I could see that my reaction — while extreme and not to be repeated — does have some connection to my normal approach to life. I hate injustice and I hate it even more when people I care for suffer from it. That is one of the reasons why in my recent appraisal I said that being the Chief Inspector of Adult Social Care is a perfect job for me. I have the opportunity to make a difference to the lives of so many different people — through the influence we can bring to bear in celebrating good care and improving standards but also directly in taking action to tackle poor care. It is a tough and a busy job but also a true privilege.
It would be great if our role was not needed but sadly the stories of poor care we hear and the inadequate services CQC inspectors find show that our role is just as necessary as ever. We have now rated over 4,000 services and with 8% judged to be inadequate and another 33% requiring improvement. This picture is probably a bit skewed as in responding to risk we are likely to see more poor care early on in our new inspections.
The reaction from providers is proving to be very instructive. Some are as worried as us by what we have found and are committed to turning the service around. Others have recognised that the problems maybe run too deep and they cannot make the necessary changes — this may lead to closures or sales. I am sorry for the disruption this can cause people using services, but if it leads to improvements in their care then I welcome that.
Even more worrying though are those providers who refuse to accept the judgment we have made and instead of concentrating on dealing with the problems, spend their time arguing with us. That is not to say that we are above challenge — any public body and particularly one like CQC with the responsibilities and powers we have should be prepared to explain and if necessary defend their actions.
We have done that pro-actively by explaining how providers can meet the fundamental standards, what we will look for in a comprehensive inspection, the characteristics of the ratings and our enforcement policy. Providers have a 10 day period to comment on the factual accuracy of our reports and can also appeal against the rating if they believe we have not followed our process. We are committed to developing and supporting our staff so that our judgments are rigorous and reliable from Newcastle to Newquay and everywhere in between.
I also do not pretend that everything we do is perfect — there have been unacceptable delays in publishing our reports for example and we reported the action that is being taken to address this at the public board meeting last week. We are still recruiting to vacant posts so some teams continue to be under more pressure than we would want — again a topic that we highlighted at the Board last week.
But we have been honest and open about what more needs to be done — an essential first step to putting it right. We are also committed to continuing to work in co-production with providers, people who use services and others to keep our progress under constant review and make necessary improvements.
Our inspections have changed, are now more thorough, usually involve more people and really get under the skin of the service. Beth Britton, a freelance campaigner, observed one recently and wrote about it for The Guardian Social Care Network. Beth concluded:
“Inspection will only ever be a snapshot of a service, but by having a larger team and implementing a more thorough methodology, this regulation was far more comprehensive and insightful than any used in my dad’s time in care homes.”
This new approach has meant that some services that prided themselves on being compliant in the past are now being identified as Requiring Improvement or even Inadequate. I am sure this is a shock to the system but one that should galvanise action to improve. This has been tested recently in the courts when a provider sought an injunction to stop the publication of our report. That action was unsuccessful and CQC was awarded costs. The provider is now appealing the rating so no further comment is appropriate now but you can read the report here.
Brighten your day
But just as I did not let one incident cloud my entire weekend, we need to remember that there are Good and Outstanding services across the country and we are publishing more and more inspections each week that show that. Our latest Outstanding reports include Perran Bay Care Home in Cornwall along with Hale Place Farmhouse and Hale Place Garden Lodge, both in Kent. If you need any inspiration — just read those reports. It will brighten up your day!
Back to Berlin
Berlin is a city full of treasures, interesting sights and moving memorials and I spent the weekend with some fantastic people. The similarities between the weekend and adult social care get stronger every time I think about it!
Originally published at www.cqc.org.uk.