Learning from the Care Quality Commission pilots for principal social workers

Principal social workers (PSWs) have a key role to play in the Care Quality Commission (CQC) local authority assessment process. We've commissioned this publication to summarise the experiences of PSWs involved in the pilots as part of a wider package of support designed to help other PSWs to prepare.

The work seeks to draw out key learning relevant to PSWs and provides some pointers for PSWs to consider as they prepare themselves for their role in the assessment process. It is based on presentations delivered by PSWs from three of the five CQC pilots: Ian Redfern, PSW Warwickshire, who was part of the CQC team for Lincolnshire and Suffolk, and Charmaine Malcolm, Principal Child and Family Social Worker, London Borough of Bromley in the webinar. 

Follow up interviews were conducted with the pilot PSWs and director insights are also incorporated from The return of the regulator: What adult social care needs to know case studies. Feedback from a short survey sent out to PSWs in December 2023 has been used to inform the content alongside discussions with Hannah Scaife and Sarah Range, co-chairs of the national PSW network.

There is a cautionary note in that learning may not entirely translate into the live environment, because the CQC adapted their approach over the course of the five pilots. Furthermore, it is a challenge to cover all eventualities given the variety of ways in which PSW roles differ across the country. Further iterations may therefore follow as the assessment process becomes embedded and more learning comes to light.

A common theme arising from the pilot sites was the volume of work involved. This is evident in the case studies. One director described the evidence gathering as ‘a major undertaking’, with another saying that ‘councils must be prepared for the amount of work involved’.

The project team racked up more than 1,000 hours over a three-month period – and that does not include requests they made on the wider team for information and interviews. They were working full time on it – there was only time to deal with very urgent things in their day job."
Georgia Chimbani, Director of Adult and Community Services Suffolk County Council

That said the experience was also described as positive. Directors reflected a change in staff and teams during the process from something akin to nervous anticipation at the beginning, to feeling positive and uplifted towards the end.

Karen Pavey, Director of Adult and Health, North Lincolnshire Council and Professor Graeme Betts, Corporate Director for Adult Social Care, Birmingham City Council reflected on their staff’s experience.

"I think, especially for frontline staff, it is a chance to tell their story, what they do and the difference they make."

"I think it reminded them of why they do the jobs they do."

Leaders appeared keen to set the right tone from the beginning, to be transparent and to be accountable to the public. Sara Storey, Director of Adult Health and Social Care at Nottingham City Council said:

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

Charmaine Malcolm, Principal Child and Family Social Worker, London Borough of Bromley highlighted the many reasons why they welcome OFSTED inspection and underlined the importance of creating the right culture, a culture in which staff feel safe and which allows them the freedom to speak up about what is working well and not so well within the organisation.

PSWs similarly reflected on the demands of their role in the pilot process as well as the positive nature of their experience of interacting with the CQC inspectors. They welcomed the opportunity to talk about what they were proud of as well as challenges and areas for improvement. Julie Stevens and Sarah Gibbons, both PSWs at Nottingham City Council said:

The interview felt very conversational. We were able to get our passion and enthusiasm across. We came out feeling very positive.”

Mr Redfern, believed that the CQC were as keen to explore what was working well as much as the challenges and areas for improvement, that they were taking care to get the process right and that they shared the same strong values.

Mr Redfern also indicated that the CQC seemed to regard the PSW role as important though he was “not sure whether they appreciated the variety of ways PSW roles differ.” That said he questioned “how much this matters as they were looking at broad themes…” nonetheless he said it was “important to be aware of because if things are outside your role and/or you don’t know – then you need to explain this.”

The precise nature of how PSWs were involved in the pilot process varied depending on the post holders remit and position in the organisation. All were core to the project team and led on such things as case file tracking, staff support and aftercare. PSWs also contributed to the self-assessment, evidence submission and interview and focus group timetables. Notable areas of learning from involvement in the process include:

Project team 

PSWs found being part of the project team extremely helpful. They valued project and admin support so they could focus on their expert input. Backfill, clarity about overtime arrangements, along with peer and management support were referenced as key to managing the workload and maintaining wellbeing. Ms Stevens and Ms Gibbons said:

“It works best when there is acknowledgement from the organisation about how much work goes into the process including the self-assessment and there is administrative and project management support so that PSWs can focus on what they need to do rather than tracking progress.”

Case file tracking 

Case file tracking was particularly challenging and time consuming. The pilots were asked to submit 50 cases with the CQC then asking for detail, including reflective logs for 10. Six were followed up by the CQC for interviews with four in reserve. The people selected or their families needed to be willing to speak to a CQC inspector during the on-site visit, either face to face or virtually. Selecting cases that met the criteria along with finding people who were willing to speak with inspectors proved challenging.

Amanda Takavarasha, Principal Social Worker and Quality Assurance and Practice Development Lead at Suffolk County Council was keen to highlight that the focus of case tracking was on the person’s journey and outcomes rather than on any system of case file audit. Also to note, the CQC did not routinely speak to practitioners involved in a case and have indicated they would only do so if they needed to seek clarity.

Ms Stevens and Ms Gibbons advised that where necessary, councils should commence a review of their quality assurance processes as soon as possible.

“The more work you can do on your quality assurance the more confident you will feel in selecting cases.”

Ms Takavarasha found value in creating a timeline with key milestones to manage the process. She also spoke of learning from the process of selecting cases. In other words, understand issues and identify remedies as you go through the process of case selection. Consequently, the quality of case recording and therefore the process of case selection will improve over time.

Self-assessment 

PSWs found that being integral to the production of the self-assessment, coupled with taking regular stock of the current position and ambition with colleagues, gave them a new level of insight into the wider context that they otherwise would not have had.

They were keen to highlight the value of this in developing their confidence for the interview with the CQC. While they might not have known the detail of everything, they were better able to reference and contextualise wider work. Ms Stevens and Ms Gibbons commented:

“For the first time we really had a helicopter view of the directorate.”

Chris Erskine, Principal Social Worker, Lincolnshire County Council echoed the importance of “taking the time to become familiar with the self-assessment and improvement plan as well as taking responsibility for sharing it with teams.”

The CQC will tailor the focus of their on-site work based on anything identified as an area for closer examination once they have reviewed national data, the self-assessment, the information return, and case tracking information. They will also adapt their lines of enquiry as things come up in interviews and focus groups.

Lines of enquiry for each assessment and each interview are therefore likely to differ and this was evident in the PSWs' experience. There were some common themes however with a mix of broad and more focused lines of enquiry. For example:

Broad

• the role and remit of a PSW
• what they were proud of, what was working well and what part did the PSW play in any successes
• what were the pressures, challenges, and plans to address?

Focused

• workforce (for example recruitment and retention, learning and development career progression, pressures and how well the workforce felt supported)
• quality assurance processes and governance
• practice
• case loads
• waiting times
• the voice of people
• equalities, diversity, and inclusion

Mr Redfern pointed out it that is helpful to start with some scene setting so that the CQC understand the specific remit of the role in that organisation.

”Be prepared to talk about areas covered in the assessment themes in a way that is relevant to your role.”

Ms Takavarasha suggested that the broader lines of enquiry provide a good opportunity to "think about the main points you want to get across relevant to the role and the impact it is having." She expressed caution about being overly focused on understanding from others the specific questions that the CQC ask because they will differ. What she did find helpful was to have a gap analysis in her head.

“Where there are opportunities for improvement, it’s important to be able to articulate where things were previously, what you have done to get where you are now and where you are going.”

Ms Malcolm’s presentation indicated that one requirement of leadership in the process was to "seek comfort in identifying areas for improvement and commit to learning what is needed to make it better, to prepare timely action plans and to ensure there is oversight." In other words, "SHOW GRIP."

Importantly, PSWs reflected the extent to which they were asked to qualify their responses in terms of evidence, experience, and outcomes.

What have you done, what difference has it made, how do you know?

This is demonstrated by a discussion Mr Erskine had about waiting times. He said,

“Inspectors wanted to understand how the council was engaging with people while they waited, what those people were saying, what impact the wait was having on them and how risk was being managed.”

While each of the PSWs had different levels of exposure to detail, they agreed it was helpful for them to:

• Know enough about what was happening across the directorate, and about data, performance, and benchmarks.
• Be able to give an account of plans for improvement and understand the impact on quality.
• Accept they couldn’t know everything but to do what they could do to help the CQC find answers to questions they could not answer themselves.

Mr Redfern spoke about the importance of “learning to articulate what you are good at”.

“…don’t undersell yourself”. “Make sure you focus on outcomes and experience, what makes a difference for people and how you know. Don’t forget the day-to-day things like how you talk to people in supervision.”

When it comes to areas that the CQC did not focus on there was less in the way of common themes.

There was some surprise that the CQC did not probe more about the role of the PSW itself and there seemed to be less of a focus on safeguarding than expected. If something had been declared as an area that needed further work in the self–assessment there was a sense that the CQC did not feel the need to explore further. Others noted that they may not have been probed in areas where CQC were sufficiently satisfied with what they had seen or heard already.

Equality, diversity, and inclusion (EDI) did not surface repeatedly in exact terms in discussions with the PSWs, but we know that EDI is integral to the CQC’s new assessment framework and is inherent in their key lines of enquiry. For example, impact and outcomes, waiting lists, workloads, staff support and wellbeing.

We also know from the published reports that three of the five pilots were judged as having ‘some shortfalls’ in their evidence relating to the quality statement equity of experience and outcomes.

The confines of this work do not allow for a full examination here, however it is worth touching on the CQC’s updated approach to human rights and how EDI fits within it. Furthermore, there is some helpful learning in Ms Malcolm’s presentation in terms of embedding EDI in children and young people services.

CQC’s updated human rights approach 

Here the CQC work from a premise that "care that does not promote human rights is neither safe nor high quality."

When the CQC refer to the general scope of human rights in their approach, they say they are describing "human rights related risks and issues rather than formal legal thresholds for human rights breaches. When people tell us about what is important in their care, issues of human rights feature strongly – such as dignity, respect and fairness…"

The CQC go on to highlight the "particularly close links between human rights and inequalities in experience in health and social care."

One of the core ambitions underpinning the CQC’s new approach is "tackling inequalities in health and care by pushing for equality of access, experience and outcomes from health and social care services."

Also contributing to the CQC’s focus on human rights are their equality objectives. For example, their equality objective on "amplifying the voices of people most likely to have a poorer experience of care or have difficulty accessing care", they say will help them to "identify and respond to human rights risks."

Children's services and OFSTED

The main point to note about Ms Malcolm’s presentation is how equality, diversity and inclusion is integral throughout. Here are some examples:

The social work profession is guided by the values and principles of anti-racist and anti-oppressive practice and advocating for equity in society.

Feedback from the survey to PSWs shows the extent to which they want EDI, values and ethics, co-production, and anti-racist and anti-oppressive practice to feature highly in accounting for the work they do to promote and improve the quality of social work practice.

This according to Ms Malcolm “is an area where leadership needs to be intentionally shown”.