About Care Quality Commissions (CQC) inspections
I've just glanced at the 'news' section, where I came across this (banner/introduction):
'Care Quality Commission Report 2013/14
26/11/2014
In 2013/14 the CQC began to introduce a new, tougher approach to inspecting care services. The more rigorous, expert-led inspections are starting to give a deeper understanding of the quality of health and social care than ever before.'
Can I just point out, that unless I totally misunderstood a recent CQC consultation, that 'expert-led inspections' DOESN'T mean 'led by the 'professionals''.
I think a significant change in 'the CQC's mindset', is that they now more formally and strongly introduce the feedback/perspective of laymen who have been service users: the term the CQC uses is, if I'm remembering correctly, 'experts by experience' (EBE).
'Experts by experience' are now part of CQC inspection teams, and they are often people who have experienced the type of service being inspected as a patient or relative - that tends to mean that the EBEs 'are looking at the service from a different perspective'.
This is actually quite tricky: the CQC consultation made it clear that the CQC's 'approach' to inspection, was to very much focus on how effective service outcomes were, and also 'how using the service felt from the user end'. But service providers, do like 'targets to be assessed against', and it is very difficult to quantify [as a defined target/measure] 'how good it feels to a service user, to use the service you provide'. I could see, as I engaged with the CQC's consultation process itself, how there was 'a sort of drift back, to the assessment of 'easily measurable things' instead of 'patient experience and satisfaction' [which are much harder to measure, than are 'hard' indicators].
'Soft' things can be very important, but unlike 'hard' things, these 'soft experiences' are very difficult to fit into a 'target-based culture'.
I'm not sure, that I explained that at all well !
HI Mike
I think you did explain it very well, and I can see where you are coming from. However having experienced several inspections that also involved experts, I think it can be vey useful having that different perspective. whilst 'experts by experience' do bring a very different and often much 'softer' approach to inspection they are able to moderate some of those hard targets by bringing 'practical reality' to the process. I was left with a very strong feeling that their internal standards were probably much higher than those of the CQC Inspectors and were much more based on outcomes for service users than on the processes that underpinned those outcomes. I believe that the overall effect was for a much more rounded and practical approach to inspection that often identified the things that we as providers were already aware of, but had not focussed on. Maybe I was just lucky in having experiences that were based on good working relationships between CQC and Expert inspectors who were well versed and trained in the standards and took a proportionate and helpful approach to the inspection process itself. [That is not to say we 'got away with anything - I think we were probably more closely observed as a result]. I guess what I am saying is that I have experienced the system working well and resulting in positive outcomes and developments for residents and the provider.
Hi Liz,
I definitely didn't intend to suggest that experts by experience were likely to be any softer during inspections than the professional [expert] inspectors - if anything, my instinct is that the experts by experience could be 'harsher'. At least some of the EBEs, will be coming from a position of having personal 'bad experiences' of the type of services they are inspecting - that 'sharpens your gaze' a lot.
I think the difference 'in what people bring to the table' can be easily understood, if you think about headaches. The 'professional experts' about 'headaches', would look at lots of people with headaches, and investigate things such as blood flow in the brain with a headache, and hormones present, nerve activity, etc.
But that doesn't explain how it feels, to be suffering from a headache - you understand that, by having a headache yourself. The experts by experience, 'have had a headache themselves', using this analogy.
There was a recent piece about some 'critical' CQC hospital inspections on Nursing Times:
Somebody has posted this comment:
'Golcarnall | 19-Jan-2015 1:53 pm
I completely agree with Anonymous | 19-Jan-2015 11:02 am
My organisation has been through three CQC inspections and have always "scored well" ( twice at 3 stars and once at adequate) but I am constantly amazed at how CQC inspectors will take a comment and take it out of context - it really is the worst kind of snapshot management.
The last inspector that we had did not understand our client group and took at face value everything he heard, stating that it was up to us to manage such perceptions and "turn them round" - we still got an 'adequate' (top marks at the time) but he left making us all feel that we only just manage to scrape by..... which is far from the case.
Instead of it being a process that could have been used for positive change it felt like a witch hunt. He frightened my staff and left them demoralised - all in the name of patient care of course......'
This mention of 'taking comments out of context' and of 'not understanding ...' is why 'inspection' is so hard. Unless you consider events within their overall context, judgements about the 'reasonableness' of actions are flawed; and what people 'understand' heavily depends on 'where they are standing' (something which is very much true, as soon as the word 'safeguarding' enters a conversation: in my Last Year(s) of Life discussions, there is a tension over what is to be 'safeguarded' [in simple terms, are you supposed to be protecting patient self-determination, or are are you supposed to be safeguarding life - very contradictory objectives, and that particular issue is the root of many professional-lay disputes]).