Des Kelly OBE reflects on the discussions from the latest Residential Forum workshop
“Improving quality in social care is a collective effort”, so said Sally Warren, Deputy Chief Inspector of Adult Social Care at CQC, as she addressed the Residential Forum workshop, on the role of regulation in service improvement, held on 7 & 8 April 2016. There was a lot of support for the idea of ‘collective effort’ around shared understanding of quality in which providers, professionals and staff, commissioners and funders, regulators, and the public, all have responsibilities and accountabilities.
The workshop discussion reinforced the view, (expressed many times before), that the primary responsibility for quality rests with the provider of care and support services. And the fact that quality cannot be inspected into a care services was a point also made. The workshop was the latest in a series hosted and led by charity, The Residential Forum, on key themes of interest to the residential care sector for all client groups. The event was opened by presentations from Sally Warren, Rhian Huws Williams, Chief Executive, Care Council for Wales and Gordon Paterson, Head of Inspection, Older People’s Services, Care Inspectorate Scotland. The perspective on regulation from three UK countries offered fascinating contrast at a time when the question of scrutiny vs improvement is of interest to both policymakers and the public.
There was a sense that the journey of improvement in social care has been varied significantly in different parts of the UK with political leadership (or leadership from care sector bodies) also varying considerably. One of the distinctive features of the Residential Forum has been a continued commitment to sharing learning across client groups and the UK. The Residential Forum has its origins in the Wagner Committee which produced ‘Residential Care: A Positive Choice’ and many subsequent reports and practice guidance intended to improve care in residential settings over a period now close to 30 years!
As with every theme debated at a Residential Forum workshop it is easier to identify the problems and difficulties than the actions necessary to overcome the challenges. The delegates wrestled with the interrelated nature of the issues: a deep dive into regulation as improvement or scrutiny soon highlights the tensions around commissioning practices; relationships and trust; risks and responsibilities; training and development; funding and finance; moving to outcomes; power and equality; openness and transparency; questions of confidence and consistency in assessments and judgements. It was evident that despite the many gaps, dilemmas and contradictions there is considerable knowledge about the features most likely to secure quality improvement. The regulators have undoubtedly contributed to a changed improvement agenda which builds on standards, intelligence and shared best practice. Arguably regulation and inspection has driven improvement – information from analysis of the quality ratings by CQC appears to support this. But … and it is a BIG but … there is still quite a gulf between the intelligence collected by inspectors and any real understanding about how improvement actually happens or, more importantly, is sustained. Obviously the Registered Manager is really important to the quality in a service, as is the staff team in a care setting, and so bringing together the inspection of a service with the regulation of the workforce makes sense.
Gordon Paterson made a point about ‘too many cooks’ - particularly for Registered Managers - which had a lot of resonance for delegates. He argued that Registered Managers have to manage the demands of the regulator, monitoring by commissioners, the performance expectations of their employing organisations alongside the expectations of consumers and their families. This is certainly a set of potentially competing pressures which are too often insufficiently considered or understood. Ultimately the tension in the relationship between quality improvement and regulation is manifested in the part played by the frontline manager. Ensuring quality improvement is genuinely a shared and collective effort will be vital to securing our future leaders.