Nottingham City Council: Create the right environment and support staff

• Nottingham placed an emphasis on co-production of the process with staff and partners and held workshops and brainstorming events to gather evidence
• The leadership team emphasised continually that the best outcome would be one of “no surprises” - with the council constantly questioning the evidence it was presenting to the Care Quality Commission (CQC)
• Nottingham was upfront about its areas of development – setting out its headline action plans in areas where development was needed.

Following a non-statutory review, Nottingham City Council has embarked on significant improvement and transformation plans, with the appointment of an improvement and assurance board, but Director of Adult Health and Social Care Sara Storey still wanted to be part of the pilot.

“I really wanted us to be involved – and everybody in the council was very supportive of the idea. We're very much on an improvement and transformation journey so for me, and for our teams, getting that external view was important.”

The timescales were tight for Nottingham - the council had only a few weeks’ notice before it had to begin the evidence gathering process. A core team, including the quality and assurance lead and the two principal social workers, coordinated the work.

There was a big emphasis on a co-produced approach to the self-assessment, with Nottingham relying on a series of workshops with staff to populate an evidence library template they had put together.

Ms Storey said: “We brought in staff and service leads who we thought might be able to contribute. We went through each area and asked who had something that might meet this criterion and asked them to send it all in. We got a big data dump and then went through the process of selecting the best evidence for each of the areas – we ended up submitting two to four pieces of evidence for each category.”

Once evidence was collected the core team checked what had been gathered to ensure a clear and joined narrative was being presented. “We looked at whether there were any areas that were perhaps conflicting in terms of information and evidence.

“We did find some. It was not that the information we were holding was wrong, it was more that there were different snapshots in time or looking at something in different ways. It was about presenting the information in a clear way – and you can only do that when you look at it as a whole.”

For the case tracking files, Nottingham benefited from the fact that over the last year it had introduced a case file audit system. “We were reasonably confident when we asked team managers to put forward cases. Each team but forward five or six and then the principal social workers and a couple of colleagues just took a look through all of those to see what we'd got. We didn’t have much time though for reviewing cases in the end.”

Ms Storey said while the evidence-gathering was a lot of work it ended up being a “really good process of learning and understanding” for the council. 

It gives you a chance to look at things that are perhaps sat in a dusty corner of your internet. We resisted the urge to try and write bespoke documents for the assessment.

“We did, however, take the opportunity to update some of the key documents such as the self-assessment. And there were a couple of things that were in progress that we pulled forward where we could. But there just wasn’t time to be revising every document.”

Ms Storey said there was a lot of “back and forth” with the CQC before the site visit. “When the CQC told us which people they wanted to see they were not always clear as they developed their understanding of structures and teams.

“In the end pretty much every one of our frontline teams was included in those conversations because they tested out the focus-group approach with us. They also interviewed managers, senior leaders and external partners, including colleagues at the integrated care board and Healthwatch leads.

“Some staff were a little bit anxious about it. But we kept talking about it in meetings and held drop-in sessions ahead of the visit. 

We absolutely wanted to make sure that everybody saw this is a constructive and positive engagement. You have to create the right culture and atmosphere.

“We didn't want to prepare people in the sense of telling them what to say or not to say or giving them scripts or anything like that, but we wanted to properly explain what the process was about and what we had submitted.

“I think the fact the evidence gathered was co-produced in the way it was helped prepare everyone. We also asked CQC for a pen profile of each of the assessors that would be on site so that we could share that with people in advance.

"And when the CQC did arrive, do not underestimate the logistics of the visit. You have to have people meeting the CQC, meeting the focus groups and helping people move around; booking rooms, keeping track of everything.”

Ms Storey said it is important throughout the process to be constantly questioning what you are saying and what you are presenting to the CQC. “We took the approach that we did not want any surprises. We would test ourselves by saying ‘what do we think we know; and how do we know it?’

“So sometimes somebody would say ‘I think this is really good’ and then we'd say, ‘how do we know that?’ and actually we wouldn't always be able to necessarily find sufficient evidence to support that particular point as strongly perhaps as we had in another area.

“As well as getting staff involved, we took the self-assessment through our scrutiny committee and shared it with voluntary sector colleagues and partners.

"And we were always clear where we had areas for development - and for each of those we set out a headline action plan of what we were trying to do.”

Nottingham ended up being rated as “requires improvement” – something Ms Storey said was entirely expected. “What the CQC said was pretty much what we had said too. The important thing is to be prepared and ready to communicate with staff. We are doing feedback sessions with staff and plan to take the report through internal governance and then scrutiny.

“We know we are on a journey of improvement, but in truth everyone should want to continue to improve no matter what rating you get. That’s a key part of our Best Value duty and we should aim to deliver good outcomes every day, not just for when CQC come to visit.

“We've got lots to do, but we also have got lots to be proud of and I am very proud of our team for the improvements they have already delivered and their positive attitude towards the pilot. We were not far off a good – and I think that will be very motivating for staff to see. We will revisit our action plans and we can now get on with the job of improving services and delivering for our people.”