Quality measures allow a provider to assess performance and quantify organisational processes and structure. I’ve worked in health and social care for 35 years and am one of the few people who has been both a provider and a commissioner. This has enabled me to see our sector from a range of perspectives and understand the need for quality measures. Whilst the vast majority of staff and managers are well intentioned people with good values, things can and do go wrong. Healthcare is a highly regulated environment with quality measures and a safeguarding framework which aims to protect vulnerable adults, but which can sometimes feel punitive. Navigating your way through the inevitable challenges that face any organisation providing services is tricky. Sometimes, the priorities and pressures make it difficult to see the wood for the trees and an outside perspective can be really helpful. In addition, in an environment where commissioners sometimes assume a lack of openness and transparency on the part of providers, it can be highly beneficial to be able to say that a completely independent investigation has been carried out to measure quality, and its findings shared.
Verita has operated for almost 20 years carrying out the most rigorous and thorough investigations, consultancy and complaints work for charities, business and other organisations. Verita is best known for its work in quality measures in healthcare and has carried out high profile investigations and consultancy assignments for the government, regulators, commissioners and providers. More recently, Verita has been applying its expertise in social care. The ability to forensically analyse what has happened, identify the causes and the lessons to be learnt is equally applicable in social care. Similarly, to healthcare organisations there are serious incidents that can and do take place which can sometimes lead to death in social care environments. These incidents can result in criminal prosecution of the provider and massive reputational damage. In my experience, some of the biggest safety risks in social care are drowning, choking, scalding, epilepsy-related deaths, falls, dehydration and inappropriate use of bedrails.
When I was chief executive of a large learning disability provider, we had several major incidents. One of the most serious involved the scalding of a multiply disabled young woman who was placed in a hot bath by two staff members who didn’t check the temperature. They were both sent to prison for six months for wilful neglect. Because we took prompt action, carried out a very detailed investigation and were completely transparent about what had happened, we were actually praised by both safeguarding and the CQC. The CQC told me that they had considered prosecution but had decided not to go down that route because of the thorough and prompt way in which we handled the incident and its aftermath. You will all be aware of providers that haven’t handled incidents well and have ended up chastised in the media. Defensiveness and lack of transparency often characterise these situations and incense the next of kin who just want to know the truth.
As well as the management of individual incidents, it’s important to have effective governance processes so that health and social care organisations can measure the quality of their services, learn lessons and hopefully spot early warning signs so that problems can be prevented before they happen. In the learning disability sector, the best indicators of a service that’s in trouble are high sickness, high turnover and low training compliance. If you can implement quality measures and spot the problem early it’s not too difficult to fix; all too often it isn’t spotted until it’s too late, for example when CQC turn up and give the service a bad rating. One of the things I have found most rewarding recently has been carrying out governance reviews as part of the Verita team, helping organisations measure what works well and improve quality of care.
Another area where an independent perspective can be helpful is in deciding whether and how to challenge a CQC rating. Overall I think the CQC do a good job, but there are undoubtedly situations in which the judgement reached on the quality of a service is not balanced, fair or proportionate. A particular instance which annoyed me when I was a Chief Executive was a great service being rated “requires improvement” because CQC hadn’t been notified of a safeguarding case. We had spoken to the local safeguarding team for advice about a relatively minor incident. They advised that it didn’t meet the threshold for safeguarding and so we didn’t bother notifying CQC. The regulator said the fact that we’d spoken to safeguarding, even though the incident had been deemed not be a safeguarding case, meant that they should have been informed. Working with my Verita colleagues we helped a provider challenge their rating for “well led”. When we looked in detail at the evidence, it was clear that CQC could not justify the conclusions that they had reached.
To find out more about quality measures in healthcare and how Verita might be able to assist your organisation, please book a free consultation or contact Ed Marsden on 020 7494 5670 or [email protected].