An update on engaging people on our closed cultures work — Kate Terroni, Chief Inspector of Adult Social Care, reports on the first Expert Advisory Group meeting, part of the closed cultures project at CQC.

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At the end of June, I blogged about what we want to achieve with our closed cultures work and how we would set up a group to engage with us. This month, I wanted to update you on the discussions we had in our first meeting about a new care planning resource we are developing and where we go next with the work.

This group is key to our closed cultures project — ensuring that there is input to the work from people with lived experience of closed cultures; their families or carers; organisations who represent such people; as well as national organisations, and health and care providers.

We heard from previous pieces of work like our restrictive practices review that people wanted to be involved at beginning and throughout a project, so this is what we want to achieve with this group.

We also wanted to ensure the group represented a variety of stakeholders with different backgrounds and experiences to inform our work — and we’ve committed to 50% of the group being people with lived experience, or families or representatives of those who have experienced such care.

Last week we met for the first time. We (virtually) introduced ourselves and talked about how people’s expertise and experience will help inform and achieve the aims of the closed cultures project.

‘We’ve committed to 50% of the group being people with lived experience, or families or representatives of those who have experienced such care’

As a presenter at the meeting, I was also joined by one of our experts by experience, Sarah-Louise for the session on the new care planning resource. Sarah-Louise helped to deliver a presentation which set up the main topic of discussion for the afternoon — CQC’s role in ensuring that high quality, person centred care planning is being delivered for people at risk of a closed culture, and how we effectively check this.

We had some really interesting conversations about the fact that our inspectors need to be able to better identify when good and bad care planning is happening in settings where there may be a closed culture.

We acknowledged there’s a gap in our ability to do this at the moment. People talked about the importance of family members being actively involved with people’s care plans, as well as the person themselves ‘owning’ their plan. The group talked about how inspectors can be assured that the care plan is what is happening for the person, and how that evidence can be gathered. For example, one person highlighted that an incredibly detailed care plan might not always lead to people actually doing the activities like visiting the shops or playing sports.

‘An incredibly detailed care plan might not always lead to people actually doing the activities like visiting the shops or playing sports’

Reflecting on the first meeting, Sarah-Louise commented that “we really do want this group to be a driving force for change — something that genuinely makes a difference — rather than just another ‘paper exercise’.” I fully echo these sentiments and I was really pleased to see such a range of voices in the ‘room’ for the first meeting that has taken place.

These voices of people who use services, their families, the providers, and frontline staff are crucial to improving the way we inspect closed cultures. We know it’s difficult for some people to engage in large noisy meetings, but we had some feedback that doing virtual meetings can open up opportunities to people that might find this difficult — as they are joining from the safe space of their home.

The group agreed that these important discussions need to lead to action that improves outcomes for people, which makes it even more critical that we can demonstrate what we did with the advice the group has given us. Following the first meeting we will be relaying the thoughts of everybody who took part in the discussion into how we work as a regulator that can effectively identify where there’s a closed culture and embed human rights into the work our inspection teams do. We will then feed back to the group how their advice has been implemented. This is how we will continue to run this group.

‘These voices of people who use services, their families, the providers, and frontline staff are crucial to improving the way we inspect closed cultures’

I want to use this blog to update as many people as possible on the progress we are having on the work, and also the challenges we may have. As we know, closed cultures are not new, and our attempts to improve these services are not new either — so we must continue to work together to make progress in this area.

Our next EAG meeting is just over a month away and I will update you on the discussions we have at that meeting next time. There will be much more constructive, thought provoking, and challenging discussions and work we need to do in continuing our engagement with our Advisory Group. Our next topics for discussion include communication aids that our inspectors can use to engage with some people in services better.

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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