Director of Operations at Horizon Healthcare, Russell Leese, picks out his highlights from this year’s Outstanding Society AGM at Skills for Care’s London office in October.
Since 2016, the Outstanding Society has been holding regular meetings in London. All homes rated Outstanding by CQC are welcomed to these forums. The line-up of speakers for this year’s conference was again exceptional and included: Kate Terroni, CQC Chief Inspector for Adult Social Care; Jeremy Hughes, Chief Executive of the Alzheimer’s Society; Avnish Goyal, Chair of Care England; and the wonderfully inspirational Wendy Mitchell, author of the Sunday Times best seller – Somebody I Used to Know.
The aim of the day was again to provide a forum to share best practice and discuss the pros and cons of achieving an Outstanding CQC rating, as well as some of the trials and tribulations providers encounter on their journey towards achieving the top rating. The meetings provide an opportunity to meet with similar minded people as well as to discuss openly some of the major issues that face our profession with key representatives from organisations such as CQC.
Avnish Goyal opened the proceedings with a presentation before a discussion of the points he raised. The group spoke about austerity and the commonly reported funding gaps between providing quality support to people and what local authorities and CCGs are willing and able to pay for.
The vast majority of those present agreed funding is particularly difficult and relationships with commissioners are becoming ever more difficult because of the tensions that arise as a result of austerity. There were mixed accounts of how supportive local authorities and CCGs were with regards to inflationary increases, particularly taking into account the minimum wage and pension increases, with some commissioning authorities bridging this gap, while others were much less helpful.
The inconsistencies were stark, with one provider stating the local authority in which they operated were very open about “that they do not commission for quality at all”, despite more and more demands being placed upon providers to meet the requirements set by them. There were nods of agreement around the room and the discussion evolved into the differences experienced by providers operating in more than one area.
There was general consensus that the variation in the recording mechanisms employed by local authorities to measure quality outcomes is vast and presents a real difficulty in terms of investment in time for providers when trying to present the same data, but in a number of different formats, according to which local authority or CCG they are presenting this information to. The argument is not new but there is clearly a call amongst Outstanding rated providers for a national standardisation of quality measures.
Avnish guided the discussion towards how local authorities received the news they had an Outstanding rated provider within their area. Again, the response was very mixed, with some providers stating commissioners in their respective areas helped them to celebrate their achievements and proactively encouraged them to share best practice with other providers. One local authority in particular was very positive and posted the news on their own Twitter account and put forward cabinet members to join in the celebration event held within the home. Unfortunately, not all providers had such a positive experience, with some even experiencing what can only be described as ‘a cold shoulder’, and having no acknowledgement whatsoever, despite providers actively trying to engage and share their experiences.
The vast majority of the audience who had retained an Outstanding rating for the second time said there was an expectation from CQC to continually improve and, therefore, that the pressure placed upon them was immense to maintain their top rating. The fundamental questions presented for discussion therefore were: How can a provider continue to improve upon what it is doing consistently in order to achieve an Outstanding rating? And why is the bar set even higher for an existing Outstanding rated provider compared with a provider achieving this for the first time? The same questions were posed to Kate Terroni during her afternoon presentation and she has invited members of the Outstanding Society to discuss this within a working group and hopefully clarify people’s differing perceptions.
The discussions in Kate’s and Avnish’s presentations naturally led to questions such as: What does Outstanding look like? And do inspectors understand what Outstanding looks like? These questions have been asked repeatedly within Outstanding Society meetings and several attempts have been made to define ‘Outstanding’. However, it is generally agreed what Outstanding looks like is very dependent upon the home providing the support and in particular about what this looks like according to the individual people living there. From a truly person centred perspective, therefore, there can be no simple definition, but rather this is based on the outstanding experiences and outcomes of those people receiving care and support.
There was much discussion about innovation throughout the day and what this means within a care setting. As one of Kate’s three initial priorities, she acknowledges that technology does play a part, but there are many different ways to innovate within a care setting, particularly in relation to the second of her priorities relating to ‘Joined Up Care’: how registered managers help to link people within the community and facilitate transition in and out of hospital.
Alex Ramamurthy, who delivered a short presentation focusing upon innovation in care, summed the term up nicely as “adapting to change”, which “in a care setting is about responding to needs” (whether on an individual level, service level, or wider organisational or even national level). The third of Kate’s priorities incorporates this nicely, which is the ‘Voice of Lived Experience’. By this Kate explained that she wants to explore more about how people have a voice in their own care planning, at service development level, and in shaping the strategy of the organisation in which they live.
Kate spoke passionately about driving improvement and that it is this that stands out within Outstanding providers, as do other key factors such as effective leadership, an outwardly looking and open culture, and staff consistency.
The star of the day, however, was undoubtedly Wendy Mitchell, the author of the best-selling book, ‘Somebody I Used To Know’. Wendy’s inspirational and most intimate account of her ongoing challenges as a result of having Alzheimer’s, literally moved the audience to tears and was received with a standing ovation.
The Outstanding Society is planning to hold another conference in London in April 2020. Invites will be sent to all providers who are rated Outstanding nearer the time and it is hoped that as many as possible can join us for further discussion and sharing of best practice. For more information, you can find us at: (www.theoutstandingsociety.co.uk), as well as our own Twitter and Facebook (www.facebook.com/TheOutstandingSoc) pages. We are also in the early stages of producing a podcast. If you have any ideas or thoughts or would like to be involved please contact us on: firstname.lastname@example.org