Richard Banks and Vic Citarella of the Social Care Association make the case for a consumer-led approach to excellence in care homes and with support providers.
‘In all the consultations I’ve been involved in all my life – and there have been many- no proposal was as unpopular as the excellence scheme for adult social care’. A reported quote from Care Quality Commission Chief Executive Cynthia Bower as the Department of Health confirmed that the proposal for a scheme to assess and recognize excellence in adult social care services was dropped. The proposal was undoubtedly flawed in many ways, but it is important that employers and care professionals in the sector don’t leave it at that. A means to identify and communicate high quality social care must be found. People who use social care have a right to expect it and those of us privileged to work with them require a way to support constant critical examination and improvement.
What we have now in England is the Care Quality Commission whose job is to make sure that care provided by hospitals, dentists, ambulances, care homes and services in people’s own homes and elsewhere meets government standards of quality and safety. These essential standards cover all aspects of care, including:
- Treating people with dignity and respect.
- Making sure food and drink meets people’s needs.
- Making sure that that the environment is clean and safe.
- Managing and staffing services.
Previously inspection of social care support such as residential care homes and home care services have been judged against a star rating system that has now finished and the Care Quality Commission are concerned with compliance to the standards alone. Many organisations that provide social care support believe they do better than the standards and want recognition of their higher standard. People seeking support services are interested in a way to differentiate between the merely compliant and the truly excellent. So there is nothing fundamentally wrong with the basic idea of an Excellence Award. The positive responses from the social care sector to the Social Care Institute of Excellence underpinning work commissioned by CQC shows the commitment to improvement. It identified four essential elements of excellence. Three concern improvements in people’s lives as a result of using the service, these are:
- having choice and control over day-to-day and significant life decisions
- maintaining good relationships with family, partners, friends, staff and others
- spending time purposefully and enjoyably doing things that bring them pleasure and meaning.
the fourth relates to the organisational and service factors that enable the outcomes to be achieved and sustained.
This is good foundation material for excellent practice and cannot be wasted. Given that the Department of Health and CQC have not found a way to build on such solid theory maybe it is time for the adult social care sector in England to take the lead; learning from the flawed implementation to date and the consultations.
Instead what appears to have happened is that providers and commissioners have come together to torpedo the proposals. This makes it even more important that they stop treating social care excellence as an issue to do with financial management, contract compliance and procurement and accept a consumer-led model. There is a real need for a ‘think shift’ here that really strengthens the position of people who use social care services.
From compliance to quality
The public must have confidence in compliance with essential standards and understand what that means. Providers should be able to market their services on the basis of consistently meeting those standards. However if there is to be system of getting recognition of going beyond those standards it should be open to all. There is a need to debate whether a proposed Excellence Award is voluntary or not. Should all compliant providers be supported to go further as at least an aspiration? The shift here is from compliance to quality.
Providers resented having to pay more for a lesser service from CQC. There is a ‘financial shift’ required here as well then. The money spent by commissioners on double checking compliance through contract monitoring is money squandered. That this is being repeated in each of the 150 local authorities across England in different models is costly for providers and confusing for the public. Local authorities should refocus their contract monitoring investments on supporting providers to evidence quality (through an Excellence Award). They should do this by creating a partnership managed sector-led improvement fund across local economies. This can both assist achieve excellence but also support failing providers if necessary.
Aspiring to excellence
Consultations have pointed up that any excellence award must be:
- Open to all providers who are compliant with essential standards and want to participate
- Funded as an alternative to the prevailing model of contract monitoring
- Simple but be capable of gradation as in: aspiring, progressing and demonstrating
- Consistently and credibly evaluated involving both service users and qualified sector specialists.
Good care support providers are involved in a programme of constant improvement with the people who use their services and it is this dynamic activity that they would like to be reflected in a new approach to marking excellence. What we are striving for is for care homes and support providers that meet standards excellently now but are seeking ways, alongside those people supported, to secure that excellence by aspiring to further improvement.
An approach that achieves that would be one that starts and finishes with the consumer - those people who depend on the social care support service. Such an approach would be both about what matters to those who use the service and carry the authority of the lived experience of those people. Clearly the managers, care workers, family and other carers need to be party to this approach but it should stand or fall on the capacity to truly engage people who use the service.
In outline the approach could be that realistic aspirations for improvement are set by discussion with people who use the service in the coming period of time (3 months or maybe alongside a care planning cycle). Action plans could be established by registered managers, as lead professionals, with care workers to make progress towards those aspirations and determine how that will be demonstrated. Evidence and analysis is carried on throughout and an assessment made at the agreed point by the same mix of people who use the service that set the aspiration. For the organisation they are seeking an upward spiral of service improvement. To meet the aspirations set the organisation is likely to invest in additional support activities such as finding practice based research to inform improvement, workforce development, key worker schemes and supervision practice plus planning how resources can enhance the care environment. As important as these support activities are they are always supplementary since the only achievement that matters is the evidence of the experience of the people who rely on the social care support in the care setting.
The mark of excellence for the organisation is achieved by adopting the approach and showing assessment against aspirations set by the people who use the service. There might be a need for external facilitation and/or verification. This could be a paid role but best if managed by peer reciprocal support from other provider organisations or via existing trade and professional bodies. As a linked activity organisations providing services (maybe with commissioning organisations or Health and Well Being Boards) might want to set up local hubs that distribute and collect practice based research, act to advise organisations blocked in some way from progressing improvements and serve to ensure that information about the excellent service providing organisations is readily available (Directory/websites) to the public. Such a hub might also act to provide events that allow people to prepare for future care needs by considering the issues, options and support available before crisis.