David Finney gives his guide to understanding the next phase of CQC Inspection.
The Care Quality Commission (CQC) has begun a new phase of inspections, where the legal authority to award ratings to providers of substance misuse treatment services will come into effect. Also, some of the lessons learned will begin to impact upon the knowledge bank which inspectors are accumulating.
These ratings, once awarded, have to be published and displayed, according to the regulations – so there will be no hiding place if your service is failing in any way. Commissioners and people who wish to use your service will definitely be able to find out how you have fared.
Most providers honestly believe that their service is a good one, but I believe that many are providing an outstanding service – they just don’t realise this or give it that name. The question is, can you convince CQC that a service is good, or even outstanding?
First of all, ensure that all the basics are in place. There is no point in trying to highlight some excellent practice if matters such as health and safety, staff training and supervision, medication administration, quality assurance, governance arrangements etc are not being well run.
Secondly, look to the NICE guidance which is relevant. This will be a secondary document that CQC will refer to when assessing practice. This is especially important for detoxification services.
Thirdly, examine the CQC rating characteristics listed in their methodology, (otherwise known as the Key Lines of Enquiry). When you write the pre-inspection material required from you by CQC, directly refer to their own criteria. This is a chance to shine and highlight what is outstanding about your service.
Fourthly, look at other CQC inspection reports to see what has already been identified as good practice and ask whether CQC would find that in your service or not. If not, is there any way that it could become part of your practice?
Meanwhile, these are some of the areas that may demonstrate good practice:
CQC criteria are that risks are proactively anticipated and that service users are actively involved in managing their risks. Good recovery involves people building and owning their resilience to maintain sobriety or whatever goals they have chosen. To do this, an awareness of risk and an ability to personally own the strategies to overcome their risk factors are vitally important and could be demonstrated through documents as well as conversation with service users.
Developing staff skills and knowledge
CQC criteria involve the continuing development of staff skills, competence and knowledge alongside proactively supporting staff to acquire new skills, use transferable skills and share best practice. There are examples of opportunities to share best practice in staff briefings, and skill development is actively encouraged through clinical supervision and in-house workshops. Also, many services actively encourage external training and development.
Access to support networks in the community is actively encouraged
Many services offer regular opportunities to be involved in AA, NA, Smart Recovery etc, as well as their own aftercare, which offer ongoing community-based support.
Integrated person-centred pathways of care
Many treatment services effectively combine the wide-ranging complex needs of their clients in one integrated care plan, which enables people to understand and build their own recovery.
This is a crucial domain for CQC, so demonstrating that staff are passionately motivated in their work and that there are robust quality assurance processes in place will score highly.
There are many more examples to explore further. Our conference on 17 October will seek to discuss ways to prepare for the next phase of inspection. We hope that there will be a representative from CQC present alongside other key professionals to assist us.