Bettal resoundingly applauds Kate Terroni the interim Chief Executive of the CQC for having the courage to publicly and comprehensively apologise for the failings of the CQC over the last few years. Such failings are myriad, wide ranging and have until now pretty much not been acknowledged.
It is welcome that Ms Terroni has taken the time to write such an email to subscribers to the CQC email updates, but somewhat disingenuously that the message does not appear on the CQC website as news as it should because, as the email identifies, this is about people who use services and the public at large who, probably not being subscribers, do not get to see it.
We welcome the focus on the need to put things right and to listen to people, so in the spirit of the email, we at Bettal want to make some observations based on what is said in the email and what our clients are telling us.
2021 strategy
We are reminded in the email that the CQC remain wedded to the 2021 strategy, https://www.cqc.org.uk/about-us/our-strategy-plans/new-strategy-changing-world-health-social-care-cqcs-strategy-2021. This is the same strategy that has taken now over three-years to not get right and which by the time the CQC has reset, and we believe it will, will itself be outdated and need replacing.
We widely agree with the tenor of the strategy and respectfully draw Ms Terroni and her team’s attention to their own words taken directly from the strategy in the section headed “The importance of Culture” :
Having the right organisational culture is crucial to improving safety. This means safety must be a top priority for all – regardless of seniority or role. A strong safety culture needs everyone working in health and care, as well as people who use services, to play their part. In a strong safety culture, risks aren’t overlooked, ignored, or hidden – and staff can report concerns openly and honestly, confident that they won’t be blamed.
We challenge the Ms Terroni, and the CQC, in reviewing their approach to the delivery of the strategy to lead by example. To retune the culture of the CQC and to, in your own words, “listen properly” and “take on board” the concerns of providers and internal staff who live the reality of the strategy on a day-to-day basis and know what works and what does not.
Culture we are told flows from the top. If “everyone working in health and care” have a role to play, that of the CQC is the greatest.
A fundamental part of the cultural issue which our clients tell us daily is how they are treated poorly, disregarded and how processes and practices at the CQC leave them feeling belittled and treated unjustly. Rarely do these conversations relate to individual staff, they relate to processes – processes which arise from the strategy. This tells its own tale.
Three urgent areas for action
In the letter Ms Terroni is clear that the CQC agenda for immediate action is to:
- Improve how we’re using our regulatory approach
- Fix and improve our provider portal
- Rethink our ways of working
These are noble ideas and again we applaud the sentiment. Perhaps though the issue is that the single assessment framework, the regulatory approach, forces the CQC into “ways of working” that don’t work and may never work no matter how much rethinking takes place. It is concerning that Ms Terroni has committed to using the regulatory when elsewhere in the message she rightly suggests the need to listen to providers.
We challenge Ms Terroni and the CQC to have the courage to review whether providers and staff in the CQC believe the new regulatory approach will work and how it might be made to work before recommitting to it.
One of our clients, a small domiciliary care provider (typical of many around the country), lamented how his company was being judged in the same way as a large inner-city hospital and the local authority he is contracted to. Such players within the health and social care system are so fundamentally different that shoehorning everyone into the same framework and utilising a broadly similar regulatory approach may well have generated the situation Ms Terroni refers to where, “things are more difficult than they should be” and where many providers are “feeling unsupported”.
Summary
Like many other people working in health and social care we welcome Ms Terroni’s wish to be more transparent and also believe that she is right that many CQC staff are great and the feedback from providers has the potential to make the CQC a strong and meaningful regulator again. We remain unconvinced that the current strategy will and can allow this to happen. If the CQC want the trust of health and social care providers they must show that they care about the people working in the sector and listen to them and have the courage to revisit strategies and frameworks they value so of which so many have and continue to question.
Bettal has a well tried and tested suite of policies, procedures and risk assessments which are available to help social care providers concentrate on the important aspects of caring like being with people.
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: 01697741411
Peter Ellis MA MSc BSc(Hons) RN
Consultant
Bettal Quality Consultancy
