Helping quality improvement in social care – listening to Registered Social Care Managers’ voices

Caroline Norrie Dr Michelle CornesCaroline Norrie (left) and Michelle Cornes are, respectively, Research Fellow and Senior Research Fellow at the Social Care Workforce Research Unit. (735 words)

Members of the Cumbria Registered Social Care Managers Network (CRSCMN) met recently to discuss what support is needed to help social care services make quality improvements in care homes and domiciliary care agencies.

Care home and home care managers were joined by a representative from Care Sector Alliance Cumbria who has responsibility for the recruitment and retention element of workforce development in this rural county. Michelle Cornes from the Social Care Workforce Research Unit (SCWRU) is Facilitator of the CRSCMN. SCWRU researcher Caroline Norrie, who has recently been working on two projects about adult safeguarding including whole-home investigations, also attended.

Managers discussed a hypothetical ‘failing’ care home scenario and discussed best practice approaches for making it better. Discussion included exploration of how practices are already changing following the Care Act 2014 and changes in the CQC inspection criteria. These changes were widely welcomed by the group (despite managers’ descriptions of fearsome paperwork or administrative requirements). There was great interest in whether the Care Act will mean that care homes will now be able challenge councils legally if they pay less than the cost of the care. Many managers anticipated this would be conducive to their sustainability. The Essex county council model, where large commissioning teams are replaced by small expert teams working with care homes, was raised as a possible model of best practice.

Various points were collated to feed back to the County Council and Clinical Commissioning Group. These included continual confusion about the Quality Improvement (QI) framework and structures for care homes/domiciliary care (home care) arrangements. Managers felt there was still a lack of clarity about processes and thresholds—for example, how does the Council decide which care homes are ‘failing’ and need quality improvement measures? Questions were raised about whether decisions were based on CQC reports or numbers of adult safeguarding concerns?

There was some feeling that the both Council and the CQC currently carry out reviews, appraisals and make improvement suggestions, but sometimes these are not enforced or followed up. Quality Management Officers (QMO) from the Council are involved in care home improvement. Managers were interested in how all these different bodies could be best used to support homes with different problems. Managers were also interested in learning more about the role of the adult safeguarding team and infection control staff in care home improvement.

Care home and home care managers suggested they would value initial discussions and conversations between outside quality bodies and homes’ managers or deputies to see if matters of concern could be easily resolved. They noted that increased QMO spot checks could be used in a more preventative way, rather than being used to ‘put out fires’ when a home was already failing. Another thorny and long-standing problem noted by managers is that homes and care agencies are in competition with each other, and collaborative approaches between homes involving joint learning and knowledge exchange are not always welcomed by provider organisations.

Managers expressed their appreciation of access to good training, for example, courses around train the trainer, values, leading by example, communities of practice or reflective/mindfulness approaches to staff wellbeing. Furthermore, managers appreciated what they saw as a more supportive approach recently adopted by CQC and QMO with its move away from contact compliance. However, there was a perception among some that there is still a long way to go. In addition, managers bemoaned the cuts in local authority expenditure on social care and noted key personnel had lost jobs which meant those left behind might need to re-design their roles. The role of Healthwatch and possible expansion of their Enter and View powers to social care was mentioned, for example.

As has been raised in other forum meetings, the group observed that quality improvement was also a matter of structures being in place for integration, but that some issues are not always related to care homes or domiciliary care agencies practices. These reflected the substantial organisational divides and sometimes professional ‘silo working’ as well as the way in which some professionals are slow to commit resources even when they were available.

Finally, it was agreed that the current forum for managers to meet and share knowledge was useful. But it was acknowledged that this group is organised voluntarily and has an uncertain future. Should a forum of this kind be run by the Council itself as part of its market-shaping role under the Care Act, and, if not, who will take ownership of this?

Caroline Norrie (@caznoz) and Michelle Cornes are, respectively, Research Fellow and Senior Research Fellow at the Social Care Workforce Research Unit in the Policy Institute at King’s.

Follow the Social Care Workforce Research Unit: @scwru