Quality Improvement in Social Care

• Summary
• Background

  • Focus from central government

  • Development of national standards

  • Professional development and regulation

  • Organisational commitment to quality

  • Satisfying clients, prospective clients and commissioners

  • Meeting the requirements of regulation, inspection, registration and accreditation

• Drivers and enablers
• HQIP's work

Building a shared approach to improving quality in social care - Summary

Whilst clinical audit is universally used within health services in the UK to improve quality and outcomes, the social care sector has no nationally agreed framework and wider system of quality assurance and improvement. 

In addition to a genuine desire within the sector to improve quality and professionalism, there is a convergence of drivers and enablers to support the sector in establishing such a system, including: pressure on services to meet the requirements of regulation, inspection, registration and accreditation; pressure on services to demonstrate their quality within an increasingly competitive marketplace; the extension of NICE's role to developing quality standards for social care; and new guidance from The Social Work Reform Board and the Health Professionals Council both explicitly supporting the clinical audit approach. 

The clinical audit methodology - suitably adapted for social care -  is a recognised and evidence-based process that can provide a simple but effective shared approach to quality improvement.  HQIP is progressing work in partnership with SCIE to develop guidance and support to social care organisations on implementing the approach.

Background

In healthcare, clinical audit is well established and is a fundamental building block of clinical governance, assuring the quality of services and driving continuous improvement.  In contrast, the social care sector, despite serving a large and often vulnerable client group, has no nationally agreed framework and wider system of quality assurance and improvement to mirror that in health.  Whilst there is a genuine commitment to assuring and improving the quality of services, in the absence of a central approach, local providers often develop ad hoc systems responding to local needs and commissioning requirements.  Not only does this create challenges for providers and their commissioners, but it limits comparability and usability from the perspective of someone using services.

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Drivers and enablers

The social care sector is currently experiencing a convergence of drivers and enablers to establishing a shared approach to quality improvement.  These provide additional impetus to the genuine desire within the sector to improve quality and professionalism.

• Focus from central government:  Social care is high on the Government's agenda, with a focus on the integration of health, social care and education to reflect the overlap between these areas of life.

• Development of national standards: Evidence-based quality improvement requires quality standards and guidelines against which practice can be measured and the findings used to develop and improve practice. As NICE starts to fulfil its extended role in developing quality standards for social care, these will provide a building block to support the social care sector to review and benchmark performance.

• Professional development and regulation:  Professionals in social care want to be able to show that their work is effective and leads to real changes for service users and society.  This desire to assure the quality of their work is now being incorporated into professional regulation.  The Social Work Reform Board has emphasised the importance of learning from clinical audit in its recently published proposals for implementing a coherent and effective national framework for the continuing professional development of social workers[i].  The Health Professions Council (the  UK-wide regulatory body responsible for setting and maintaining standards of professional training and skills and health) has adopted the key messages around clinical audit near wholesale from healthcare guidance into its regulatory framework for social care[1].

• Organisational commitment to quality:  Our work with leaders in the social care sector has underlined how practitioners, teams and services want to ensure that they provide the best possible care, and that the service they offer is in line with best practice standards. This helps to ensure better use of resources by improving the effectiveness and efficiency of care, potentially saving money.
  

• Satisfying clients, prospective clients and commissioners:  In an increasingly diversified and competitive environment of care delivery and personal budgets, providers need to be able to demonstrate that their services are high quality, meet the expectations of consumers, and demonstrate commercial edge.

• Meeting the requirements of regulation, inspection, registration and accreditation:  Service providers at every level, from individual practitioner through to whole organisations, are increasingly required to provide evidence of the quality of what they do and that they have processes in place to ensure the quality of care they provide.

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HQIP's work

Whilst several of our national audits already operate at the interface of health and social care (particularly those focused on care of the elderly), HQIP has been conscious that the social care sector as a whole needs support to develop a shared approach to quality improvement.   

During 2011, HQIP systematically engaged with key social work and care providers, commissioners, sector skills bodies, regulators and professional bodies to discuss how best to develop such a shared approach.  We received strong support for this initiative from the Department of Health and have also established a joint working agreement with the Social Care Institute of Excellence (SCIE), which is our partner in this work.

Development work to date has included several focus-group seminars held in both May and October of 2011, which have shown unanimous support for ways and means to drive up quality.  We are in the process of developing written materials, in the form of a ‘service manual' designed to be used at operational level. In the coming months we hope to promote the agreed approaches, to pilot these in suitable settings, and to find early adopters to trial, test and refine the methods.  Over time there will come an education and training programme, and possibly national review projects that mirror those in healthcare.

If you would like to contact us about this work, we would be pleased to hear from you. Please email Eve Riley in the first instance: eve.riley@hqip.org.uk.

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[i] http://www.education.gov.uk/swrb/about/b0074393/social-work-reform-board-publications