The sixth question

England’s care inspectors, The Care Quality Commission (CQC), have published their strategy.

To much relief in the sector, their plans include going back to inspecting the quality of services, as well as whether services are compliant with minimum standards. They were stripped of this responsibility with the end of the ‘star ratings’ system and have now had it restored to them by government.

The old star ratings system was a blunt instrument at best, although we liked it in the Shared Lives sector because Shared Lives always came out as being about twice as high quality as other kinds of regulated care. Things have moved on and it’s encouraging that CQC is trying to become less reliant on inspections or data collection alone in rating services. They have started using experts by experience and I hope that this move is accelerated: no one is better placed to judge whether a service is really good than people who use services and their families, and no one is better placed to gather those views than other people who have had personal experience of services.

CQC faces the challenge of regulating NHS as well as social care services. This is a vast range of organisations, from large hospitals to small Shared Lives schemes, for instance. The quality rating system for the NHS is being developed first, so it’s vital that the social care system is not just adapted from the health version, but is developed with social care’s very distinct ethos at the forefront. That means that co-designing the new system with citizens, providers and local commissioners is a must.

The five things CQC says it will consider whenever it looks at a service are all very sensible, but if the new quality rating system is to work for social care, a sixth is needed. The five questions it says will always ask about services are:

− Are they safe?

− Are they effective?

− Are they caring?

− Are they well led?

− Are they responsive to people’s needs?

This feels a comprehensive list as far as, say, a hospital A&E department is concerned. A social care service, however, could answer ‘yes’ to all of those, but the people living there still be unhappy. The sixth question which CQC must ask and which any good quality social care service will be able to answer is,

– Are you helping people to live good lives?

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