It may not be immediately obvious but CQC reports provide a very useful ‘window’ into the underlying culture of the services that they are describing. And I’m not simply referring to the explicit references made in such reports to the culture of the service, which is often included as part of the ‘Well-led’ section. Rather, I’m thinking more about what the descriptions in every part of the report tell us about the basic assumptions, the underlying values, the fundamental ‘mindset’, of the service in question.
Just to give a simple example: if a report describes care plans that are not up to date, gaps in staff supervision and training, and residents who have to wait a long time for their meals, what does this tell us about the culture of the service? Of course, it could be telling a number of different ‘stories’, including staff shortages, incompetent management, a failure of quality assurance, and so on. The key point here, though, is that the first question any manager or provider should be asking when they read such a report is: ‘what does this say about my service?’ rather than: ‘how do I fix this?’, which in my experience is the first question most managers and providers ask when confronted with a negative CQC report.
Of course, ‘how do I fix this?’ is a very important question in itself, but you first need to reflect upon what it is precisely that you are trying to fix in the first place. Going back to the example above, if it becomes clear that most, or even all, of the problems identified here are due to bad management then this requires a very different ‘fix’ than if it’s a matter of chronic staff shortages, which may in turn be a reflection of stiff competition from other providers in the local area who are perhaps paying higher wages or have more attractive working conditions.
So at the very least CQC reports should act as prompts for managers and providers to ask some very searching questions about their service. And yet, and again I can only reflect upon my own experience, this rarely happens – or at least appears not to. And, of course, there are a number of reasons for this reluctance to ask too many difficult questions about the service one is responsible for, which again may say a lot about the culture…
However, it might be helpful to start with a more obvious point, and one that I alluded to earlier; CQC reports tend to be quite opaque when it comes to providing some kind of ‘deep analysis’ of the service they are describing. Or it might be more accurate to say that these reports do not aim at providing such an analysis in the first place, or at least not explicitly. One of the problems with the CQC’s inspection methodology (the five domains, the KLOEs, etc) is that whilst it does a fairly reasonable job in ‘mapping-out’ quality across the whole service, this tends to be only at a fairly superficial level.
On the other hand, and like any map, the ‘quality map’ that is produce by each CQC report invites further exploration, encourages one to ‘home in’ on a particular part of the quality ‘landscape’ to get a clearer idea of what might lie hidden. But as with any map, one needs to know how to ‘read’ it in the first place, to know what all those symbols (words, terms, phrases) really mean. It’s also important to understand how such ‘maps’ are constructed in the first place and for what purpose.
But if it’s that difficult, you might ask, why bother? After all, why not just ‘fix’ the problems highlighted in the report and wait for the next inspection? Although this is a perfectly rational position, and one adopted by many providers who have received negative CQC reports, it has at least two potential fatal flaws. Firstly, and as I mentioned earlier, you might simply end up ‘fixing’ entirely the wrong things, which probably helps explain why not every ‘Inadequate’ or ‘Requires Improvement’ service receives a better rating when the CQC returns to do a re-inspection. Secondly, the specific issues highlighted in any particular report are often only the tip of the iceberg in terms of what they say about the underlying culture of the service. In other words, even if you do manage to ‘fix’ specific problems, this does not mean that you’ve ‘fixed’ the culture, and if so you are simply storing up further problems for the future.