Shooting the messenger

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

Critical inspection reports were again in the headlines this week as my colleague the Chief Inspector of Hospitals, Professor Sir Mike Richards, declared Addenbrooke’s and the Rosie Hospitals in Cambridge inadequate after a comprehensive inspection earlier this year.

Perhaps the reaction to deflect attention from individual failings, focus on wider system issues and call the process into question is natural and human. Of course, understanding the context and why some organisations do not meet the standards we expect while others do, will help us to identify how we can encourage improvement. But none of that should deter us from lifting the lid on problems within institutions so that they can be resolved.

Read the report

There is ample evidence throughout the report that specific issues were not recognised or addressed; there was a disconnect between managers and staff and concerns raised by patients and families were not responded to well. In these circumstances it is right and proper that the independent regulator acting on behalf of people using services speaks out and requires remedial action. To criticise that by suggesting CQC is some part of a conspiracy to undermine the NHS is to do a disservice to the people using Addenbrooke’s or any other service.

If you need any further persuasion — please just read the section on maternity services and compare it to the concerns raised by Bill Kirkup in his review of maternity services at Morecambe Bay. It should not take inspectors to turn up to get action on long-standing, operational problems but it seems that wake-up call is still required in some of the services we regulate.

Response

How providers respond to a critical inspection report is key to whether the necessary improvements will be secured. While I am sure staff and the local community in Cambridge were dismayed and disturbed by the judgments in the report, I hope they were reassured by the determination of the chair Jane Ramsey to put things right:

“I would like to say sorry to our patients for a lack of effective systems and processes across our trust, which led to the CQC rating our hospitals as inadequate.

“We will take rapid action to address concerns and maintain our record of safety and high-quality care.”

Social care responses

We face similar issues in adult social care and I see a wide variation in the responses from providers. Some appear to want to shoot the messenger in a way that thoroughly undermines my confidence that they will address the problems we have identified:

• “We are … deeply saddened by the decision to attack the ability of our staff team. … To suggest that customers are at risk is irresponsible and unprofessional.”

Others point to the system or how the service has been commissioned in defence of their problems:

• “She said expectations of the CQC regarding residents’ access to activities were based on an “ideal situation” and that sometimes differed from what the home had been asked to provide.”

Some seek refuge in the positive rating for their service being caring:

• “Service users are more than happy. I have no complaints from any families or professional people.”

To the first group I acknowledge that we may have differences of opinion and I have never suggested CQC is perfect, but sometimes this approach is tantamount to bullying, which is not acceptable. To the second group, I recognise the stresses and strains in the social care system but this does not mean we should compromise on quality for people using services — if our reports are pointing up deficiencies in what has been commissioned, please use that as evidence in your contract negotiations. To the third group, I reiterate comments I have made before — we have some amazing, dedicated staff in social care but if they are caring despite the system they work in then they will get burnt out, disillusioned, leave or worse.

Improvement

CQC’s purpose is to make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve. A positive response from providers to a critical inspection report that recognises the problems and resolves to take action is an important step along the way to that improvement. Thankfully, this is a more common response:

• “We accept that there were a number of failings … which fell below the standards our clients and staff should expect. We apologise for that and have taken immediate steps to put things right.”
• “The welfare of the people we support is our absolute priority and we take all feedback from the Care Quality Commission (CQC) extremely seriously. We were very disappointed with the results of the inspection … and immediately took action to address all of the feedback we received. … We look forward to demonstrating this progress to the CQC and will continue to strive to provide the best quality care for every resident — this is our absolute priority.”

One way of doing that is to learn the lessons from our inspection findings — both what to avoid in our inadequate reports and what to work towards in our outstanding reports. I spoke about this last week at the Quality Forum for Think Local Act Personal and, very helpfully, Des Kelly from the National Care Forum shared the key messages in his own blog — take a look!

Keep calm

Last week I visited the Anchor Integrated Care & Housing Village, Denham Garden Village service with Anchor Trust’s Chief Executive Jane Ashcroft. The service had recently been rated as Requires Improvement. The disappointment was obvious but so was the determination to ensure the necessary improvements happen, as you can see from the poster on their office wall. I think that’s the kind of attitude that breeds success!

Originally published at www.cqc.org.uk.