North Lincolnshire: We should see it as an opportunity

The Care Quality Commission (CQC) assurance regime should be seen as an opportunity for the council's adult social care, says North Lincolnshire Director of Adults and Health, Karen Pavey. This case study forms part of the resource, 'The return of the regulator: What adult social care needs to know'.

Key messages

  • Explicitly referred to process as an inspection to staff and partners to make clear urgency of what was involved
  • Workshops and mock interviews held to prepare staff for CQC visit
  • Staff were worried about prospect of CQC interviews - but ended up embracing them.

The CQC assurance regime should be seen as an opportunity for the council's adult social care, says North Lincolnshire Director of Adults and Health Karen Pavey.

"I see the new regime as a great opportunity to showcase the full extent of adult social care to bust the myth that all we do is hospital discharge – 75 per cent of what we do is prevention and enabling people to live their best lives we should embrace it and see it as a positive."

The evidence gathering

Ms Pavey said going through the assurance process was “uncharted territory”. “Apart from me, no one else in my team has any experience of an inspection regime.

“We are not a big authority so all my senior team had to get involved. I had my three assistant directors working on it. They each took responsibility for a different part. We called on the heads of service to provide us with the information we needed. I found myself becoming directive due to the timescales.

“It was an incredible amount of work – especially in those first three weeks when we were gathering all the evidence we needed. In the 11 weeks to the fieldwork each of us were doing the equivalent of one day extra per week minimum. That is unsustainable and placed a big toll on all of us. 

You have to look out for each other and be very aware of the wellbeing of your team at such times.

“At the start of the process, we were having catch-ups every day to see how it was going and to keep across it all. We did ask for an extension – but got just two days, which ended up being over the weekend, so I am not sure it was really worth it. In many ways, an extension just draws out the process longer.”

Ms Pavey said the council submitted 164 different documents across the 48 categories. She said the case tracking was particularly challenging. “We gathered 50 individual cases for the CQC to consider. You have to make sure all the individuals you are putting forward are happy to talk to the CQC.

“Many were not. They had moved on with their lives or were suspicious about talking to people on the phone about personal things to be fair we tell them not to do that. The CQC then comes back asking for more detail on 10. We had to do reflection learning logs and in the end they spoke directly to seven.”

The fieldwork

Ms Pavey said once the evidence gathering had been completed, attention then turned to the fieldwork when CQC assessors visit the council to interview staff, providers, people and partners.

“There is a lot of preparation that goes before their visit. Simple things like making sure you have rooms booked and car parking sorted are important. You want to give them a warm welcome.

“But there was also lots of back and forth with the CQC too. They asked to speak to staff and used job roles that don’t exist. We were also surprised how heavily weighted it was towards frontline staff. They did not want to speak to team managers, council leaders or service managers.

“We had some very senior people setting aside time to speak to the CQC, but we only got notification very late of the days and times they were needed. In fact they had to do some of the interviews outside of the three days they were here.”

In total the CQC interviewed 120 people - 16 focus groups of six, seven one-to-ones and a drop-in session.

Lessons learned

Ms Pavey believes it is important for councils to embrace the new process. “We do not want it to be seen as burden. I really believe it needs to be seen as a positive experience.

“But for that to happen we need the CQC to credit councils that are aware of their areas for development as well as their strengths to encourage openness. You should get credit if you know what your weaknesses are. It can then be a vehicle to support improvement and to get help.”

She said one of the early decisions she took was to refer to it as an inspection regime to corporate colleagues and the rest of the senior management.

“I know it is not called an inspection – but that is what it is really. If you say assessment, people do not see the urgency of it and do not appreciate it for what it is. The term inspection means much more.”

She said this helps prepare the ground for the process. But she also recommends councils spend time preparing their staff for the interviews with CQC assessors during the fieldwork stage.

“We had workshops and mock interviews and brought in children’s services staff who are used to an inspection process to help us. We had to help staff to think about how they would tell their story. We also had Partners in Care and Health support some external sessions for practise”. 

“At the start we had lots of staff who did not want to be involved. But gradually with practise they began to come round – and by the end we had them putting their hand up asking to speak to the CQC. 

I think, especially for frontline staff, it is a chance to tell their story, what they do and the difference they make. It is something they don’t often get to do – so from that point of view is a positive.”

Ms Pavey said it is also important to be ready for the first experience to be tough. “It was really difficult, hard work. I am sure the CQC will streamline it for others. But the first go is always going to be the hardest. Like anything, it will get easier the more you do it. I think there are some parts – such as the self-assessment document – that will become something you regularly update, maybe every quarter. CQC is for life not just for Christmas.”