Birmingham: We were the perfect test bed for CQC

• The workload is immense – social care departments will not have experienced anything like this for a decade
• Ensure your self-assessment, evidence and data aligns to support your key assertions
• Care Act refresher training put on for staff.

As the second biggest city in the country, Birmingham City Council Corporate Director for Adult Social Care Professor Graeme Betts thought it would be the perfect testing ground for the new Care Quality Commission (CQC) assurance process.

“We are diverse and have high levels of deprivation so we thought putting ourselves forward would be an ideal world to stress-test the new process. 

If you can get it working here, you should be able to get it working anywhere. We also wanted to put ourselves in front of the regulator – we think we have a good story to tell.”

Birmingham established a core team to oversee the assessment process, which started in May 2023, led by Adult Social Care Assistant Director Quality and Improvement Maria Gavin and Rebecca Bowley, Head of Business Improvement and Support for Adult Social Care. They worked with project management, business support, IT and communications colleagues to coordinate the evidence gathering and the fieldwork visit arrangements.

Ms Gavin said: “You cannot underestimate the amount of work involved. We submitted in the region of 250 different documents under the 48 categories. Some, such as the annual safeguarding report, were just a matter of uploading existing documents, but a number had to be tailored to what the CQC was after.

“For example, one of the categories related to information and advice: provision and access. As a large diverse city, we do that through a variety of ways – websites, a contact centre, third sector organisations and neighbourhood networks. We had to pull this together with a briefing note. It was just a two-page document, but without it the information would not have made sense.

“Doing that across lots of different categories is a huge amount of work. There were also 50 case files we had to compile, which we had not expected as we anticipated CQC asking for access to our client record system. For the 10 people CQC identified we then needed to make sure each one was willing to speak to the CQC – and not everyone was ready to do that.

“We were given three weeks to finish it but had to ask for a small extension of a couple of days, particularly due to the bank holiday which fell in this period.”

Once the evidence gathering was complete the attention turned to the visit by the CQC. This took place in the middle of August with up to nine CQC assessors over four days. The core team had to be boosted to around 16 to help coordinate the visit with interviews carried out across two different sites.

“There is a lot to organise, booking rooms and greeting people,” said Ms Gavin. “There were over 40 separate meetings, a mixture of one-to-one and in groups, involving around 150 staff. There was one meeting with carers on Microsoft Teams that did not work out as planned so we had to reorganise that for another day.

"As you would expect, the CQC was particularly keen to talk to frontline staff. There was some anxiety from staff to speak to CQC at first. We made sure we kept staff fully up to date with the whole CQC process during regular meetings we were holding.”

Alongside this, the council also organised Care Act refresher training that all social care staff took part in. “It was really practical – looking at how staff were fulfilling the Care Act requirements in their everyday work,” said Professor Betts. “It really helped to set them up for the fieldwork and was certainly a worthwhile thing to do.

We actually found in the end staff really enjoyed talking to the CQC – I remember groups were buzzing afterwards. It was an opportunity for them to demonstrate what they do and how it makes a difference. I think it reminded them of why they do the jobs they do.”

Professor Betts said councils must be prepared for the amount of work involved in the process. “Our core team were pretty much working full time on this. We are all used to doing peer reviews in social care, but quantitively and qualitatively this is so different.

“t requires much more work – you cannot underestimate that. It is 10 years or so since anyone in social care has experienced inspections like this.

“You cannot leave any stone unturned. Everything flows from the self-assessment questionnaire. You really have to evidence what you say in that and then show with the case tracking that you are doing that. If you get that right then that flows into the fieldwork. You have a clear narrative.”

But as part of that, you have to be open about your weaknesses, said Professor Betts. “You have to ask yourself: do you want to tell the CQC about your weaknesses or do you want them to tell you? 

This process will uncover weaknesses and you are much better to be transparent and set out what you are doing to tackle them. Where we have backlogs we spelt this out and set out how we were planning to tackle it.”