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

Inspection as a way to support improvement in health and social care has been taking a bit of a battering.

John Burton writing in the Guardian Social Care Network claimed “After 50 years in the sector, I know the CQC rarely improves social care.” It was also reported that the Danish government were abandoning hospital accreditation which was lauded by some as the end of inspection. Don Berwick speaking at the Quality 2015 conference launched (according to my twitter time line) an attack on inspection, suggesting that the only consequence was fear. All this against a backdrop of murmurings throughout health and social care about the value of inspection, its impact and concern about silo working between sectors.

In a short blog I will fail to answer all the criticisms or comment on the various points made in subsequent discussions. It would also be a bit boring, and might come across as defensive, to correct some of the mis-statements I’ve seen. So instead, let me concentrate on three general points:

  • Inspection is not the only answer
  • Inspection is part of the answer
  • The fear factor

Inspection is not the only answer

At CQC we do not believe that inspection or regulation is the only way to improve health and social care services. Our Chief Executive David Behan has led the way in describing the five groups who influence quality:

  • Professionals and staff
  • Providers
  • Commissioners and funders
  • Regulators
  • The public, including people who use services, their families and carers

Each of these groups has an important part to play — and one operating in isolation from the others cannot hope to succeed. So:

Professionals and staff should recognise their personal responsibility for quality care, highlight problems where they exist and take an active part in identifying or delivering the improvements needed.

Providers should organise for quality and create an open and transparent culture that welcomes challenge, is honest about what needs to be done and supports their staff to do it.

Commissioners and funders should understand that quality is not an optional extra and establish an environment where improvement and innovation can flourish.

Regulators have to be clear about their expectations, root them in the experience of people using services, monitor their delivery, celebrate success, encourage improvement and tackle failure where it is found.

The public, including people who use services, their families and carers need to be at the heart of the definition of quality. We have to listen to them, especially when they are telling us that improvement is needed.

Inspection is part of the answer

We understand the limitations of inspection — so why have it at all?

I’d argue that in our complex, fragmented system (especially in adult social care) it is essential. This is because, while I have highlighted the importance of the voice of the public, there is often a power imbalance when you are in a vulnerable situation using health and social care services.

Of course, there are many great services that do not require intervention, but sadly I hear far too many stories of our inspectors highlighting poor care that staff, providers and commissioners have not recognised, addressed or (in the worst cases) even seem to care about. In those circumstances when others cannot be relied upon, it is essential for there to be a safety net of inspection and action to secure improvements for people who are at risk.

I know that the expectations we set and our inspection regime have an impact. Sometimes this is when we have to force change through the use of our regulatory powers or through the efforts of staff and providers who respond constructively to our challenges. That of course has to be sustained — improvement is not just for inspection, it is for every day. As Henry Ford said “Quality means doing it right when no one is looking.”

I am not saying that we are above criticism and that we have cracked the perfect inspection system. Of course not. I do know that over the last two years we have made significant progress in specialising our inspection teams, making better use of intelligence and responding to concerns, having a more rigorous approach that takes better account of people’s views and experiences, providing clearer information in our ratings and holding providers to account.

Some will expect us to do more; others want us to do less. That scrutiny and challenge is helpful and through our own continuous improvement will keep us where we want to be — acting in the interests of people using services, their carers and families.

The fear factor

I understand that inspection may generate fear but that is genuinely not our intention, although it is right and proper that where people who use services are being failed, there is accountability and action is taken to protect people from harm.

But an inspection offers the opportunity for another emotion — pride. It gives staff and providers the chance to show how well they are doing and we are certainly finding that there is much in the adult social care sector to be proud of. Take a look at any of our Outstanding and Good reports to see for yourself.

Healthy debate

Inspection has a role to play but is not the only answer to the quality improvement debate. Improving health and social care will take a team effort from everyone involved — sometimes that will be spurred by inspection and at other times, others will rightly take the lead. It’s not ‘either/or’ but ‘and’.

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.

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