Andrea Sutcliffe - The current role of CQC and expectations for the future - Thursday 14 December 2017

“It’s absolutely vital that collectively – regulators, providers, funders, commissioners – we focus on good quality care,” Andrea Sutcliffe told Care Conversation delegates.

As the independent regulator of health and adult social care in England, the Care Quality Commission’s (CQC) role was to “take it back to the humanity of social care”, she said. Key to this was the ‘mum test’ – “is it good enough for my mum or anyone I love?” – and the core issues around any service were whether it was safe, effective, caring, responsive to people’s needs and well-led.

“It’s important to anchor it there, and make sure that what we do as regulators focuses on that,” she said. The more recent developments in CQC’s approach are about ‘evolution not revolution’, she pointed out, “building on the experience of the last 3 years of comprehensive inspections. It’s not about box-ticking, it’s about really getting under the skin of services. But we also want to make much better use of information from providers and people who use services so that the inspection isn’t the be-all and end-all. It’s about monitoring and being able to spot things early that indicate whether services are deteriorating.”

Part of this would include a new ‘provider information return’, she explained, a digital platform that providers could download and use to help reduce the burden of duplication, and there would also be a greater emphasis on leadership and “taking a long, hard look” at those services that were consistently in need of improvement. “Constantly bumping along at ‘requires improvement’ is not sustainable. So it’s about trying to encourage better joint working with the health service where that is helpful, but also ensuring that we don’t tolerate poor quality care.”

The last two years had seen the organisation become much more vocal about its concerns, she said, and in 2016 it had warned that social care was approaching a ‘tipping point’. “Are services closer to that now? The funding situation is clearly not sustainable, but in terms of quality of care we can be positive about an awful lot of services.” Although 78% of services were rated as good, that meant that one in five were not good enough, she stated. “You would not want your mum to be using some of those services. So we have to balance that positivity with the fact that it’s not good enough everywhere.”  

There were also ongoing concerns around unmet need, she stressed. “We’re definitely in a very precarious situation. So it’s not a tipping point, it’s more like a variety of tipping points, with large variations across the country.” The need for access to good quality nursing staff was driving problems in London and the South East, with the impact of Brexit adding to the pressure. “People talk about the impact on the health service, but twice as many EU citizens work in social care than health and the numbers of applications are definitely dropping.” The best services “really get” person-centred care, she said, and there was a huge number of front-line workers “completely dedicated to doing a great job”. Unfortunately this could sometimes be in spite of, rather than because of, the system.

In terms of social care’s position within the broader system, one of the biggest causes of delayed transfer of care was waiting for home care packages, she pointed out. “That gives us a very clear indication that the system as a whole is failing the mum test – there are people stuck in a hospital bed when they really don’t need to be there.”

A forthcoming interim CQC report would reveal that while “a lot of systems are talking the talk”, this was not reflected in the alignment of individual organisations and system priorities, she said, and there were also major challenges around workforce recruitment and retention. The organisation was also looking to make changes to registration as well as introduce provider-level assessments. “What happens within a corporate entity obviously impacts on what happens at an individual location, so provider-level assessments will help to reduce duplication and give us a much more holistic view of a service as a whole.”

In terms of the forthcoming social care green paper her main concern was that “we’ll just talk about funding and have a bun fight about that, which will be a huge missed opportunity,” she warned. “We need to have a mature conversation with the general public about what social care should look like, otherwise we’ll just be putting money into a system that’s not attuned to the changes we’re going to see over the next ten or 20 years. In terms of staffing we also really need to get the message out there that this is a hugely rewarding career with real opportunities for progression, and we need to think about what providers are doing to create a climate in which people feel valued. The only way the system will work will be if all the elements are working together to get it right.”