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

Criticism hurts, of course it does. We are all human and very few of us get out of bed in the morning to do a bad job. So it is perhaps understandable that when we are criticised, responses are defensive, explaining away the negatives and claiming that everything is now sorted.

That may apply to care services rated as requires improvement or inadequate by CQC; an NHS Trust criticised for failing to adequately review unexplained deaths; or CQC’s effectiveness under the spotlight from the Public Accounts Committee.

A defensive response may be understandable but that does not mean it is acceptable. A more appropriate response is to concentrate on putting things right. I have written before that the first step to improvement is insight — if we recognise that we have issues to address then we are part way there to resolving them. If, however, we seek to obfuscate or shoot the messenger then we fail to give the public, people using services, their carers and everyone we work with confidence that we know what we are doing and are capable of putting things right.

As Mark Harvey reminded me on Twitter — my advice is to take it on the chin and do something about it.

Proud of the boss

So, in the face of criticism from the Public Accounts Committee who felt we are not yet an effective regulator of health and social care, I am proud of our Chief Executive, David Behan’s response.

David acknowledged the recognition from the PAC that substantial progress has been made since 2012 but was honest in saying “we have always maintained that there is more we have to do…these are not new issues and we are working hard to improve our performance.”

Making progress

Anyone who has attended, watched on YouTube or read our monthly board papers will know that we have been transparent about the problems we are tackling and managing our performance is key to that. As someone called to account at the Board, in our Executive Team meetings and in my regular one-to-ones with David, I can assure you that scrutiny is meaningful and can be intense. Equally, I am sure that my Deputy Chief Inspectors would feel the same about their accountability in our team and individual meetings.

I know that not everything we do in adult social care is as good as it could be. Take timely report publication for example, an issue the PAC specifically mentioned. When we first started our new approach, we were very worried about consistency and the need to quality assure all the reports. We established, what I freely admit, was a monster of a process that delayed reports.

We have learnt from that, streamlined the process, and really focused on moving reports through quickly (without compromising on quality), and at the last board meeting reported that the average time taken to publish reports has now fallen below the 50 day target. We should never rest on our laurels and I’d like it to be quicker but we are making progress.

David echoed these sentiments in his statement too when he said:

“We are not complacent and are working confidently to improve what we do and how we do it.”

Making a difference

There are various measures of our effectiveness — how well we use our resources and how efficient we are in delivering registration, monitoring, inspection, rating and enforcement. But perhaps the most important is our impact — what difference do we make to the lives of people using services?

This can be difficult to measure as regulation is just one of many influences on the quality of services — starting with the voice of people using services, their families and carers; what staff do; how providers organise things; what resources are available from and expectations set by commissioners and funders. We know there are difficulties, for example, in the recruitment and retention of staff and the challenging financial context. So when things go well, you can’t say it’s all down to the regulator (nor when it’s all gone badly either).

What we can say though is that we are improving the information available to the public through the clarity of ratings and detail in our reports; some services that we rated as inadequate or requires improvement have delivered improvements; we have taken, as a proportion of our inspection activity more enforcement action; and in celebrating good and outstanding care we know we have inspired others.

There’s much more to do but here’s just one bit of feedback we have received recently from a provider:

“We feel that working in partnership with you has contributed to our success and achievements and would like to thank you for your support and look forward to our continuing successful working relationship…you truly inspired me right from our first CQC inspection together.”

High Expectations

This progress has been achieved by the commitment and dedication of our staff working in co-production with people using services, their families and carers as well as providers, commissioners and other partners. Of course we have more to do and the expectations of others are rightly set high. But I am confident that with a senior leadership team that is prepared to address not duck the challenges and a team dedicated to making a difference for people using services, their families and carers, we can continue to make progress and be the regulator everyone wants us to be.

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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