The CQC, quality and culture

Over the last eighteen months or so the Care Quality Commission (CQC) has significantly changed the way it inspects health and social care providers, i.e. hospitals, care homes, domiciliary care services, mental health services, as well as expanding its remit, for example by now inspecting GP practices. Instead of the old ‘pass-fail’ approach, where the focus was on whether providers were compliant with the statutory regulations, there is now a ratings system: ‘outstanding’, ‘good’, ‘requires improvement’ or ‘inadequate’. Furthermore, each inspection now uses a much broader range of measures to assess quality.

For many providers, a CQC inspection can be quite daunting, and the consequences of a ‘requires improvement’ or ‘inadequate’ rating are potentially quite damaging to the provider’s business and reputation. However, what often gets overlooked in the flurry of activity (and not to say panic!) that surrounds a CQC inspection is the fact that the ratings, and the rationale that accompany them, are essentially saying something very important about the culture of the particular service that is being inspected.

This may not seem immediately obvious, but just to take one example: if the CQC reports that a care home is not providing proper safeguarding training for its staff, then this is likely to impact negatively on the provider’s rating for the ‘safe’ domain. Now, what’s the explanation for this inadequate training? It could be time, money, complacency, or a combination of these. At the end of the day, however, I would argue it’s a problem with the culture of the provider: if the management and staff can’t see that safeguarding its vulnerable residents is its top priority, and that proper safeguarding training is a key element to this, then I would say there is something seriously wrong with the ‘mindset’, i.e. culture,  of this organisation.

Or to take another example: the situation where the CQC reports that there are issues surrounding adequate staffing, particularly at night. This could easily impact on the rating of at least one if not two or three domains. Again, what is this saying about the provider, and particularly about its priorities?

The crucial point here is that the CQC ratings can be a useful ‘measure’ of a provider’s culture, but they do not explain why the culture is like it is. And the problem here is that unless there is a proper understanding of the culture things are unlikely to change for the better. Yes, the provider may introduce new policies and procedures, new staffing rotas, and so on in order to ensure it ‘scrapes through’ to a ‘good’ rating, but is this really going to rescue it’s reputation if it’s deemed to be ‘inadequate’ or even ‘requires improvement’? It’s more likely that the management need to take a much closer look at what’s going on ‘behind the scenes’, so to speak; in other words to get a firm grip on the service’s culture.