As a dedicated nurse and care provider I see the need to raise standards in health and social care (H&SC) as a really important thing, and in fact, do welcome the new regime being rolled out in how the Care Quality Commission (CQC) inspect services.
We are all in the business of reputation management and promoting the great work we do and aspire to do, aren’t we? My main area of work outside of the numerous roles I have in and around H&SC is as a care home owner and lead for a progressive coalition of over 50 residential care providers across Devon where we are committed to ‘sharing to learn’ including a robust peer review process – with one of our fundamental principles based on the view that continuous improvement is a journey and ‘we’re not there yet’.
Currently we are seeing a trend of very low numbers of services such as hospitals, primary care centres, specialist NHS providers and social care services like domiciliary and care and nursing homes receiving the much coveted ‘outstanding’ outcome (see the four outcomes section).
I am owner and director of two non-nursing care homes. One was inspected with the new regime at the point of its introduction last October – anxiety provoking but energising and ultimately validating was how the inspection felt when we were given a ‘Good’ outcome. But we did in fact feel disappointed to not be given an ‘Outstanding’.
Our second smaller home (16 bedded specialist service for people living with dementia primarily as opposed to our 20 bed broader less dementia focused home) was inspected over three days last week; ending on the 24th July. We had a very thorough review of what I have described as ‘having the deepest drawers in our darkest cupboards looked into’! Overall we did genuinely feel that although it was emotional, it was also a positive and affirming experience that went well.
Check our blog for more detail “we had our CQC inspection – and we’re feeling good” posted on the 24th July (see Resources section).
Since then, arising from our own continuing reflection on the experience combined with the many and multiple media news items highlighting poor care across H&SC, we have come to the view that ‘Outstanding’ can create its own negative consequences and risk. Here are some of the reasons for this:
1. Many people fear the envy factor and the danger in being an outlier, even those with glowing reports.
2. It is often said that ‘there is no greater laughter than seeing a fast man running fall over’ – hard, and perhaps cynical, but often true – being singled out for praise can lead to negative consequences – basic systems theory is at play here!
3. Expectation management creates increased pressure to do even better and deliver even greater improvement.It’s also said ‘there is only one way to go once you reach the top’ – often cost pressure requires savings to be made in organisations that can lead to compromised care, many regard this as what happened in Mid Staffs.
4. The time demands made on leaders, managers and senior staff to share the magic and the secrets. Promoting what you did and how you did it can become an unwelcomed burden and detract you from the focus on your own core work, and the humility and dedication that gave you the outcome in the first place.
5. Lastly, although I feel there are more cautionary concerns based on the adage, ‘be careful what you wish for’, is the very real danger of your staff being poached or headhunted by jealous onlookers! The risk is where perhaps larger struggling organisations desperate to ‘turn around’ their own inspection failings offer your staff, who they perceive as ‘rescuers’, significant pay increases leading to your own ‘talent haemorrhage’. Hard to resist this one sadly as there is a sparsity of staff across the H&SC workforce.
I tweeted recently to make a hesitant point about the latest group of providers (152 social care services in the midlands) being announced with only one regarded as ‘Outstanding’ and expressing a heart sinking feeling about this. I did congratulate Lawton Rise Care Home in Stoke with genuine praise and positive comments after reading their exceptional report but do feel a mixture of envy and concern for what happens next for them. I said ‘Outstanding’ is both a holy grail and potentially a poisoned chalice – but is this a commonly felt opinion, I wonder? On balance and said with mixed emotions I feel that ‘Good’ is good enough, but this won’t stop us trying for better.
The four outcomes
The new regime offers 4 possible outcomes:
1. Outstanding (fewer than 1% so far getting this).
3. Requires improvement.
4. Inadequate (leading to potential enforcement, regulation and closure).
Blog: “we had our CQC inspection – and we’re feeling good” http://www.pottles.co.uk/blog.html
George Coxon, RMN, is the specialist mental health advisory board member for Nursing in Practice, MHNA chair and regional lead for Wales, Director of CCH (care provider), the Independent Commissioning Advisor for Devon, and chair of the Devon Residential Care Quality Kit Mark.
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