Recently in Inspection and regulation Category

There are just two days to go until this year's Community Care Live - the best free event in the social care calendar (in our humble opinion!). If you haven't booked your place, this is what we've got in store - and, in particular, here's the line-up of adult social care sessions.

Plug over (well, sort of), so let's return to the ever live topic of the future of personalisation, which will be in focus at Thursday's session to launch Making it Real, the new way councils, providers and others can measure their progress on personalisation, against 26 markers devised by users and carers to spell out what an ideal service means to them.

Produced by sector coalition Think Local Act Personal, its key principle is that users and carers should not only help decide organisations' priorities but also judge how far these are being met. But after blogging on this the other day, I was left with questions on how Making it Real would work in practice. Today I spoke to project co-ordinator Shahana Ramsden, who has provided some answers.

Given that it is a voluntary system based on self-reporting, how confident can we be that organisations are measuring progress honestly and fully involving users?

There are a variety of checks and balances in the system. Organisations signing up to Making it Real must tick a box on its web-based application form to confirm they have engaged with users and carers in deciding priorities. They must then carry out a six-month review of their progress and fill in a box demonstrating how far they have involved users and carers in assessing progress. Users and carers must also explicitly sign off on the six-month review report.

Over time, TLAP wants to see groups of Making it Real signatories grow up in different parts of the country who will challenge and support each other to improve. So, say, in Birmingham, you could have the council, several care providers, user-led organisations and charities working together to implement the system.

What encouragement/incentives will there be for organisations to sign-up to Making It Real?

TLAP is confident of getting significant extra sign-up in the coming year. Almost 300 organisations have expressed an interest. But beyond that, it will seek to convince those organisations that do not have a culture of engaging users and carers in what they do that Making it Real is for them.

The central TLAP team will put out examples of good practice and also hold events around the country to sell the idea. In addition, it has teamed up with other membership organisations - including the Dementia Action Alliance and the My Home Life movement to improve residential care - to reach out to as many organisations as possible.

How does Making It Real tie-in with all the other systems of performance monitoring and management in social care?

For councils and providers, it's important that Making it Real doesn't appear as yet one more initiative that they need to comply with. TLAP says it is working to ensure that its markers are compatible with the various other performance frameworks in social care. So:-

• It has compared the markers against the government's outcomes framework for adult social care, which councils are expected to make progress against, and there is something like a 90% overlap.
• The Towards Excellence in Adult Social Care programme, the local government-led initiative to help councils improve their performance through peer reviews and other measures, has implementing Making it Real as one of its main priorities.
  
• For providers, the Care Quality Commission is looking at how far the markers overlap with its essential standards, which providers are regulated against.

So that's what I learned, but I'm sure there's plenty I haven't thought of. Do come along and pose your own questions at Community Care Live on Thursday 17 May at 2.30pm.

(Image: John Behets)

Tonight's Panorama programme left those of us watching it aghast at the abuse and poor care received by Maria Worroll. The images were graphic and either shocking or shockingly familiar, depending on your point of view.
But the programme left unexplored the causes of the scenes it depicted - either in the individual case or more widely.

Cynthia Bower's resignation as chief executive of the Care Quality Commission was not unexpected, but it seems unlikely that it will prove sufficient to end the climate of criticism surrounding the regulator.
Critics are already calling for more heads to roll, and three highly critical reports about the regulator (from the public accounts committee, the public inquiry into the Mid-Staffordshire hospital scandal, and the serious case review into Winterbourne View) are due in the next couple of months.

Bower's announcement coincided with the publication of yet another review - a Department of Health capability review into the CQC - and while there are some positives in this, it is worth noting the significant criticisms it contains.

Adult safeguarding - lack of clarity on roles

"There remains risks of a lack of clarity on safeguarding roles, and risks that responsibilities are not clear between CQC and local authorities," says the review, which calls on the CQC to clarify respective roles with councils.

This is pretty striking to me, as the respective roles of CQC and councils should have been settled by a protocol published in 2010 setting out the limits of the regulator's role in this area. This was the latest in a series of protocols on this issue (see this one from the CQC's predecessor, the Commission for Social Care Inspection).

Disappointingly, the review doesn't present its evidence for this lack of clarity, but the fact that it draws this conclusion is a concern, as a lack of clarity about roles can easily translate into increased risks for service users.

Inspections (and inspectors?) must be tailored to the service in question

After inheriting inspectors from health and social care-specific regulators, CQC instituted a generic model in which the same people inspected hospitals and care homes. However, the review find that CQC's confidence in the generic inspector model is not shared by providers who feel themselves on the receiving end of inconsistent judgements.
Hence, the review calls for inspectors to have more access to sector-specific expertise and for the CQC to ensure that it adjusts its approach to the different risks presented by different health and social care settings.

Totally missed this but a thoroughly damning report was published last month into adult social services at Wirral Council.

It was into the events surrounding the council's overcharging of several learning disabled service users, which was exposed by social worker Martin Morton, who was later forced to resign.

I've stuck a bit more on the report at the bottom of this post, but the man on my left was quizzed about it at prime minister's questions yesterday by Wirral West MP Esther McVey.

Cameron accepted McVey's call to look into the report (or, rather, to get care services minister Paul Burstow to do so).

But what's interesting is what he went on to say about the Care Quality Commission:



"The Care Quality Commission, which has had a difficult birth, clearly has a really important job to do in ensuring that its inspections are thorough and targeted in the areas where they are most needed."

The Wirral report concerns a local authority adult social services department's failings. In November 2010, Cameron's government took the decision to end CQC assessments of local authority adult social services departments, replacing it with a sector-led assessment system led by the Local Government Association and the Association of Directors of Adult Social Services, among others.

So while we might all agree that the CQC has an important job to do, it's unlikely to be in ensuring Wirral responds to this report. So the question is, does Cameron know what he's talking about?

Damning CQC inspection

Ironically, Wirral's adult social care failings had been exposed by the CQC before Cameron's government stripped it of these powers, following an inspection in 2010 that found it was performing poorly on safeguarding.

There is an exception to what I've just said, which is if the LGA, Adass and the CQC decide collectively that problems at Wirral Council are so serious - and that sector-led intervention cannot make a sufficient difference - that an emergency CQC  inspection is warranted.

But somehow I don't think Cameron was opening the way for such an intervention with his comments. I think he was just a bit loose with his tongue and not very well briefed. (Apologies prime minister if I'm wrong).