The CQC’s single assessment framework, their new approach to regulatory inspection, is being trialled now and is expected to be rolled out later in 2023. While retaining the five key questions - is the service:
• Safe
• Effective
• Caring
• Responsive
• Well led
And the current rating regime:
• Outstanding
• Good
• Requires Improvement
• Inadequate
Finding ways to engage with the CQC Quality Statements
The new regime replaces the key lines of enquiry (KLOE) with quality statements. According to the CQC, https://www.cqc.org.uk/about-us/how-we-will-regulate/five-key-questions-and-quality-statements, these statements establish clear expectations of the care which people can anticipate from providers. The statements are said to be based on people’s experiences and demonstrate what is needed to deliver high-quality person-centred care.
With services, managers and nominated individuals being so familiar with the old regime, finding ways to demonstrate engagement with the quality statements is going to be a challenge for many providers.
Before taking a look at some strategies for engagement and considering how Bettal might be able to support with this, it is worth taking a look at the format of the quality statements.
Each key question has a preamble, which identifies the key elements expected of providers in relation to it. For example, the preamble to safe identifies safety as a priority which should be part of the service culture and that the response to safety concerns needs to be to learn and continuously improve. The theme of continuous learning is then reflected in one of the quality statements which says:
We have a proactive and positive culture of safety based on openness and honesty, in which concerns about safety are listened to, safety events are investigated and reported thoroughly, and lessons are learned to continually identify and embed good practices.
These statements are then related to the regulations which they underpin, in this example:
• Regulation 12: Safe care and treatment
• Regulation 16: Receiving and acting on complaints
• Regulation 17: Good governance
• Regulation 20: Duty of candour
Given services are going to be inspected against these statements, it is important providers start to:
• Think about how they are going to assimilate these quality statements into their service.
• Ensure staff are aware of them.
• Consider how they will demonstrate compliance at inspection.
None of this need be painful or time-consuming for services who choose to do something about these now, although the longer a service leaves it the more difficult it will become.
Because all of the quality statements start with “we”, the key to success in adopting these statements is ensuring the whole team are aware of and, more importantly, adopt and act upon the statements.
Some tips to enable managers to incorporate the statements into the operation of your service
At Bettal, we have been thinking about these quality statements for a while now and here are some of our tips for helping you incorporate them into your service.
1. Providers should read the statements carefully and ensure they understand them and what they require from their service to demonstrate good or outstanding care.
2. Given there are 34 statements, adopting a statement a week means services can get through the statements more than once a year. By adopt we mean:
• Have the statement printed out and displayed at the entrance to the service, changing it weekly.
• Add the statement to handover sheets / duty rosters or whatever documentation is put in front of staff.
• Add them to and discuss what you are doing about them in any newsletters to staff and people accessing your services.
3. Discuss the statements in handover and team meeting identifying what it means to staff and how they might demonstrate in their day-to-day work, e.g., how can we demonstrate that:
We promote people’s independence, so they know their rights and have choice and control over their own care, treatment and wellbeing.
Use these as a discussion point and identify ways in which the team can take ownership of the statements. This is particularly important if the CQC decide to do an on-site inspection during which they talk to staff to check their understanding and adoption of the statements.
4. Ensure the quality statements are discussed in supervision sessions. For example, when discussing care delivery, discuss with staff how they gain consent:
We tell people about their rights around consent and respect these when we deliver person-centred care and treatment.
5. Use policies and procedures which are professionally produced and regularly updated and which have been tested in multiple CQC inspections:
We have clear responsibilities, roles, systems of accountability and good governance. We use these to manage and deliver good quality, sustainable care, treatment and support. We act on the best information about risk, performance and outcomes, and we share this securely with others when appropriate.
This demonstrates a high level of governance without adding to the workload of the provider.
6. Use an evidence table to generate a list of the evidence that you have which underpins each statement. Such a table might be used as part of an internal pre-inspection audit at which you identify and check whether you have the information you need to demonstrate compliance with each statement.
At Bettal, we have produced a comprehensive evidence table for the use of services which subscribe to our Cared4 CQC Compliant Quality Management System, https://www.bettal.co.uk/policies-and-procedures.
Summary
Compliance does not need to be a headache if providers and managers choose to make it part of the day-to-day business of their services. With regard to the CQC quality statements, there will be a period of transition as providers and staff teams get used to their content and what they mean in the way of demonstrating compliance.
The wisest services are already starting to integrate the quality statements into what they do and are raising awareness of their existence with their staff team.
Bettal Quality Consultancy is keen to build on our reputation for being supportive by helping services meet the requirements of the new single assessment framework in general and the quality statements in particular.
If you would like to know more, browse our website, https://www.bettal.co.uk, or get in touch:
Email: info@bettal.co.uk Telephone: 01697 741 411
Peter Ellis MA MSc BSc (Hons) RN
Consultant Bettal Quality Consultancy