Lincolnshire: Let’s embrace the ratings system

• Produced own story boards mapped across the nine standards as part of its evidence gathering – the exercise helped the council tell its story and prepare staff and external partners for the fieldwork
• Celebratory lunch was held after the site visit by the Care Quality Commission (CQC) to thank everyone involved for their input
• Final report is being shared with executive and the scrutiny committee and taken out on roadshow to staff and providers to ensure transparency and re-emphasise the opportunity to improve further.

Lincolnshire County Council was the first council to go through a pilot assessment. Council Executive Director for Adult Care and Community Wellbeing Glen Garrod said he was motivated to put Lincolnshire forward because he believes it is time for social care departments to open themselves up to a system of inspection with ratings.

“In the public sector care providers, the NHS, children’s services, the police, probation and the fire service are all given ratings. There is no reason for social care not to get them either. 

"Indeed, I think it will help us develop a stronger public narrative about what social care does and, what good looks like. We are after all responsible for spending a significant amount of local government funds. We can use this to help the public better understand what we do.”

Putting together the “evidence chest” took four to five weeks in total. The work was coordinated by a core team of four, led by one of his assistant directors. “It’s a major undertaking,” said Mr Garrod. “Within the 48 separate evidence documents we provided there is a lot of information to prepare, check and upload.

“And you really have to double-check it to make sure you are not making any own goals. We have a mature system of case file audits, but one cannot rely exclusively on that to ensure case files are showing the best of what colleagues are doing in practice. As a result my head of safeguarding checked all the files submitted.”

As part of putting together the evidence chest, Lincolnshire made the decision to produce story boards setting out what the council was doing for the nine standards which frame the assurance process.

“The evidence they were asking for did not map across directly to the standards so we thought it would be a good way of telling our story. We brought people together in each topic area to help produce them.

“Each one ran to 20 to 30 pages. It was probably too much in the end – I think they could be reduced to five to 10 pages. But we think it was definitely a worthwhile exercise. It was a good way of preparing colleagues, internally and externally, for the fieldwork so they understood what we were saying and gave them a chance to consider what they would say.”

Mr Garrod said there were actually two distinct phases ahead of the on-site visit by the CQC – the preparation and the visit itself. "You really start getting ready for the fieldwork as soon as the evidence gathering has come to an end."

“It was actually my PA and some of her colleagues who did most of the logistical effort. You have to make sure you have the rooms set-up well, booked out and the time in people’s diaries organised so everyone is in the right place at the right time.

With over 90 people interviewed this is a major undertaking. The CQC sent 10 people and they effectively took over a wing of county hall. It would have been better if the CQC team had got out to speak to people where they work, but Lincolnshire is just too big for that.”

Mr Garrod said the council also spent time ahead of the fieldwork talking to the CQC about which staff were to be interviewed as everyone was learning from the first pilot. “We were eager that they interview the director of public health – in fact they were one of the people the CQC spoke to first after the principal social worker.

“That wasn’t planned, but as it happened it worked really well as they got to speak to leaders in prevention and front-line practice at the start of the on-site and I think that helps set the scene before they go on to speak to frontline staff.

“We also wanted to highlight the importance of housing, even though we are a two-tier area and housing does not sit with the county council. They were not so interested in the Better Care Fund work we are doing. It seems like they want to keep a clear delineation between assessment of adult social care and the forthcoming CQC programme for Integrated Care Systems.”

During the site visit, the senior management team spent the whole week together so they could deal with any issues that arose as well as sending out an evening briefing covering how the inspection was going. At the end of the week Mr Garrod hosted a lunch for those who had taken part. 

It was a chance for me to say thank you and for us all to reflect and celebrate what had happened. We felt it was right to acknowledge everyone’s contribution. People were standing up and talking about their experience. The room was buzzing and two hours went by very quickly.”

As Lincolnshire was the first council to go through the process, Mr Garrod said he fully expects the approach by the CQC has and will be refined.

“It will certainly be streamlined – we started in April and really it has continued to November. Ideally you would get the process down to two or three months. In my view one would need four or five weeks for the evidence gathering – there is no way round that.

“You also need to set aside sometime to deal with things even once the fieldwork has been completed. The CQC came back for more information about things we had mentioned as well as interviewing some of the people whom for one reason or another they could not speak to on the site visit.

“The important thing is not to under-resource the effort. Our core team were working full-time on this and we had to arrange backfill for them. You need the right people too. I chose my assistant director because he has a real eye for detail and is prepared to challenge.

“You also need to think about what you are going to do when the report is produced. I told everyone who was being asked to take part that the report will be shared with them so they can see what is in it. We are planning roadshows to take it out to staff.

Finally, be aware of your weaknesses and be open about them – don’t let the CQC be the ones to find them. Councils should be given credit for being aware of the challenges they face and, have actions to address them. Even outstanding services will have challenges that they are working on.”