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It will come as absolutely no surprise that England's health and social care system is under pressure. 2015 has seen its share of new legislation, changing care needs and tough financial demands, but the Care Quality Commission’s (CQC) recent State of Care report shows improvements are happening. By the end of May 2015, the CQC re-inspection of 123 services showed that 50% had improved and for adult social care nearly 60% of services were rated either good or outstanding. 




The CQC noted that adult social care providers have been “asked to do more for less”, but despite these pressures, many providers have managed to improve or maintain quality. It’s interesting then to take a look at what the CQC has found that works best amongst those services rated outstanding, and just as importantly, what it has learned from the 7% that deteriorated since they were last inspected. 

The importance of leadership


94% of the services that were rated good or outstanding overall were also good or outstanding for their leadership. Engaged leaders that build what the CQC calls “shared ownership of quality and safety” has been earmarked as one of the critical components in improving quality. Effective engagement and communication with social care practitioners and service users is paramount and creates a strong and positive organisational culture that learns when things go wrong and where services are working well. 

Safe staffing levels


Breaking down the figures further, the report shows that up to 31 May 2015, the CQC had inspected and rated 17% of adult social care services. 59% of these received a good or outstanding rating overall, with 33% of services rated as requiring improvement and 7% being inadequate. 

The CQC’s biggest concerns relate to the safety of services (where 10% of adult social care services were rated inadequate), with staffing issues considered a key area for improvement. For those rated good or outstanding, well-planned rotas and robust recruitment procedures were in place, to facilitate safe, high-quality care 24 hours a day. Poor performing services on the other hand had more issues with staffing levels, especially at weekends. For some services, the CQC reports that they are “struggling to recruit the right staff”, with the vacancy rate across the sector at 5%.

But it’s not just about the number of staff that dictates how well a service performs, which is also recognised in the report. Having the right mix of social care professionals and ensuring they are trained in specific areas can have a huge impact on service delivery, not to mention the job satisfaction that comes with this.

Those rated outstanding expectedly showed they have a culture that encourages staff with their continual professional development, and offer support through regular appraisals and supervision.  

A co-ordinated effort with social and health care


As we begin to see the early workings of the NHS Five Year Forward View, the report suggests that areas where social and healthcare services are working together to “address cross-sector priorities” are already reaping the benefits. In order to continue to improve services, the CQC recommends that “data must be collected across all sectors to enable a good understanding of what works”, and that all sectors must improve their ability to recognise safeguarding issues. 

Of course, as the two service areas become more closely aligned, there will be a need for a common understanding of quality and how it is measured. As we understand it, from April 2016, the CQC intends on piloting an approach to assessing the resources in NHS Trusts alongside its inspection on their quality of care. 

There is also a greater emphasis now being placed by the CQC on looking at ways the quality of care in local areas can be assessed beyond each individual service, of which further information will be made available next year. 

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