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

Those of us who care about social care face an age-old dilemma. We despair that the image of these services is tainted by stigma and undermined by scandal but we know to address the problems that exist we have to be open and transparent about what they are — insight is the first step to improvement.

Equally we know that there are great services with dedicated staff committed to supporting people and caring for them with dignity and respect. Celebrating their achievements can help to show others how to improve and restore confidence in services overall, but in doing so we may be accused of dismissing other problems.

CQC sits on the horns of this dilemma — our purpose is clear, we make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve. We encourage that improvement both by taking action to ensure inadequate services change or cease and by rating services as good and outstanding to show what can be done. The contrast between inadequate and outstanding is stark and was clearly demonstrated to me this week.

Old Village School

On Wednesday morning we published the report for the Old Village School inspection carried out in August. It makes shocking reading, especially so given this inspection followed hard on the heels of our inspection in June which clearly identified the action the providers needed to take. By August things had got worse, not better and deteriorated even further from 3 August to 6 August.

You can read it for yourself but these are just some of the quotes from the report:

“People said they did not always feel safe. One person said: ‘I was left in the garden for two to three hours with another person and not a soul came near us. The side door was closed because of the wind and this frightened the other person. It frightened me too. The other person was tapping on the window to come in. I was shouting for the nurse. Eventually someone came but by then the other person was crying and cold.’”

“A visiting healthcare professional told inspectors one person who received continuous oxygen therapy had been found blue and in distress and the night nurse on duty had not taken the necessary steps to replace the empty oxygen cylinder. The healthcare professional visiting the home had to intervene to make the person safe.”

“The provider had not ensured that the service was caring and people’s dignity was often compromised as a result. One person told us: ‘I was left in an armchair from nine thirty in the morning until five or six at night without being moved. My bottom was killing me and I was dying to go to the toilet. They knew but forgot and would not let me go to the toilet and said I had to use a bed pan. It was too embarrassing for me.’”

Marlborough Court

On Wednesday afternoon, I visited Marlborough Court which was awarded an Outstanding rating for their inspection published in August. You can contrast the quotes from the Old Village School with this selection from Marlborough Court:

“Relatives were positive about the care provided. One person told us, ‘The level of care is really good — fantastic’ and another commented, ‘They know everybody, their patience is boundless. They take a lot of flak.’ We saw one relative or carer tell a staff member, ‘You do your very best. You need a medal.’ Another person told us, ‘Everyone knows [my relative’s] name and treats her with respect.’ Other comments from relatives or carers included, ‘Staff take a pride in their work, they really care.’”

“The Union Jack unit was accredited as a Positively Enriching And Enhancing Residents Lives (PEARL) dementia service. Staff had received additional specialised training in dementia as part of this organisational accreditation process and staff talked about the significant improvements made in practice on the unit in the past three years. Staff spoken with were proud of the specialised service being provided on the unit. One staff member told us, ‘It used to be institutionalised here, everyone followed a routine. It’s now person centred so not just about people and their illness, it’s about people who can still make choices for themselves.’”

“The registered manager told us that their approach to ensuring dignified and compassionate care at Marlborough Court was ‘management down’, running through the whole service, and talked of the importance of looking after their staff. Staff in turn spoke about the importance of treating people with kindness, dignity and as individuals. One staff member told us, ‘Most of all when the residents are happy, then I am happy.’ Another member of staff said, ‘I treat people as if it is my mum, it’s all about people being happy.’”


Achieving Outstanding is tough — and deliberately so, but as Marlborough Court demonstrates, it can be done. This was a service with problems in the past which has been well and truly turned round by a determined manager and dedicated staff. The atmosphere in the Union Jack unit was so positive and cheerful — I had a lovely chat with a lady enjoying her tea and biscuits. Relatives were full of praise and the staff were confident and welcoming. There are already people booked in to visit and find out how they achieved their top rating, so good practice can be shared.

So a day of contrasts with the two faces of adult social care on show — both reinforcing the important role CQC has to tackle poor care and celebrate the best.

Originally published at

We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store