In order to effectively discuss a CQC “Outstanding” inspection and how to get ready for one, we need to spend a moment defining “Outstanding”: What does outstanding look like?
There is a slide in module 5 of our Lead to Succeed that describes the four CQC ratings and next to outstanding it says “the service is performing exceptionally well”. As we said a couple of blogs ago, we are well beyond meeting the standards and the regulations when we get to outstanding which is why only the top 3 or 4 percent of organisations actually achieve it.
What do CQC look for in order to give an outstanding rating?
As part of my research, I found this document from Skills for Care https://www.skillsforcare.org.uk/Documents/Standards-legislation/CQC/Good-and-outstanding-care-guide.pdf (286 page document) which is full of useful stuff. It also describes the Provider Information Collection (PIC) that CQC were trialling, but in the end the best bits of the PIC were incorporated into the Provider Information Return (PIR). This is taken from page 42:
“Promote creative ways to mitigate risk”
“Use evidence, analysis, learning and external expertise to make improvements”
“Staff are exceptionally kind and compassionate and regularly exceed expectations”
“Use creative, innovative and efficient approaches that go the extra mile”
“Have a strong, visible person-centred culture”
These are just a few examples, and some of you may have noticed that there is one example from each key question. So if we know what outstanding providers do, and there are many more examples in the document linked above, can we build some sort of benchmarking process that facilitates a plan of action to move us towards outstanding – maybe we could think of it as our “outstanding plan”. Think back to the “outstanding log” from a couple of weeks back: if you have an “outstanding plan” alongside an “outstanding log”, the inspectors will see your intention and be able to guide you accordingly.
Why “Well Led” the fifth key question is so important
When you look at the five key questions and the KLOEs (Key Lines of Enquiry) contained within them, it is understandable to think that first key question, “Safe”, is the most important because it has six KLOEs within it, compared to “Caring” for example which only has 3 KLOEs. (It is also worth noting that key questions are not KLOEs). However, allow me to share a couple of stats, from module one and the very beginning of Lead to Succeed:
94% of “good” or “outstanding” services had either “good” or “outstanding” in the fifth key question – “Is the service well led?”
84% of “inadequate” services had inadequate leadership.
However, since the publication of the figures above in the CQC State of Health and Social Care 2014/5 report, CQC has revised the first figure, and it is now:
99% of “good” or “outstanding” services had either “good” or “outstanding” in the fifth key question – “Is the service well led?”
I am not suggesting that any of the five key questions is any more important than any other, but if the service is not well led, it is extremely unlikely to be outstanding in the other key questions. Moreover, it is really interesting that CQC has been clear (link below) in its recent updated “How CQC regulates, monitors and inspects adult social care services” that the fifth key question “Is the service well led?” will always be included in both focused and comprehensive inspections”
Additionally, if you do not submit your PIR in time, (see page 4 in above), the highest rating CQC can give you for the “well led” key question is requires improvement, which further reinforces the importance of Well Led.
I believe this is why Skills for Care has developed both Lead to Succeed and the Well Led program and supported them with Workforce Development Funding as well.
Funnily enough, I was tidying my office the other day and came across a notebook from 2007 and some notes I had taken at a Skills for Care conference where leadership had been identified as the critical factor in what made a service 3 stars or excellent, as it was back then. Not much has changed, except now we have brilliant programmes to develop the leaders of the future.
Find out more about the Skills for Care programmes here:
Remember the “Mum test”
I always used to say, what about the “me test” – would I be happy here?
I did a bit of digging before writing this blog and found another really useful document: https://www.cqc.org.uk/sites/default/files/20170420_celebratinggoodcare2017.pdf
In the introduction it says: “Our Inspection model is built on what matters to people”, and this is the basis of the five key questions. However, reading it made me think that that is much more than either everyone’s training or current policies being up-to-date.
As this post has become much longer than I had anticipated, I am going to share the second half next week…
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