Background to quality improvement in social care
All social care practitioners, teams and provider organisations want to ensure that they deliver the best possible care they can, and that the services they offer meet best practice standards. Excellent practice already exists in many care settings, confirming the sectors' on-going commitment to quality. There is a long tradition of quality improvement in the sector and there are many examples of inspiring and imaginative practice, within individual organisations and at the sector level.
However, as the process of continuous quality improvement is still a developing field in social care, although there is a well-developed tradition of QI, as yet there is no systematic and sector-wide approach to quality improvement. Quality Cycles, used in comparable settings such as healthcare, where they are known as clinical audit, offer the potential to provide such a sector wide approach.
In the coming months we will look to promote the agreed approaches - changing the language and process as needed- through consultation, to pilot these in suitable settings, and to find early adopters to trial, test and refine the methods. Over time we will develop an education and training programme, and possibly national review projects that mirror those in healthcare. We will work with key organisations to develop sector specific ‘audit' tools for specific care environments.
We are pleased to be working in partnership with the Social Care Institute of Excellence (SCIE) as we take this work forward.
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Background and rationale
Quality matters in care services.
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.
Care audit is a means to showcase excellence across the sector, to identify unmet need or unacceptable variation in care, and to drive improvement where necessary.
We have to prove the quality of the care that we deliver and account for the resources that are allocated, to verify that people who use our services are receiving the best possible care in relation to these resources. We also need to be prepared to compare them to other models of care.
People who use services, family members, carers and advocates all want care to be of the highest quality and to be able to make meaningful choices based on clear, transparent and comparable information.
Increasingly providers want and need to understand how they can improve care, and demonstrate the quality of their services in a competitive marketplace.
In turn, commissioners need robust evidence of the quality of a provider's practice and the ability to compare services across the sector.
With a shift towards achieving high quality outcomes for people who use services and an increasing focus on value for money, there is urgent need for these goals to be supported by high quality intelligence and information systems.
Care audit is aligned with the expectations and requirements of government policy including departmental aims around personalisation, dignity, integration of health and social care, end of life care and dementia strategies as well as the requirements of statutory regulation.
The benefits of care audit - care audit can help to:
- Work in partnership with people who use services to prioritise local concerns
- Provide a check for care providers i.e. "are we actually doing what we think we are doing?"
- Implement and sustain improvements in services
- Provide evidence of current practice against national guidelines
- Provide evidence about the quality of care in a service to establish confidence amongst stakeholders
- Deliver a return on investment.
A person-led approach
High quality care services equal a high quality experience for the person using the service, carers, advocates and family members. Good care services put the people who use them at the heart of improvement work, and measure the things that are meaningful and important to the person in receipt of care.
Ultimately, a good outcome in social care will be determined by the person in receipt of that care, and delivered in partnership with the responsible professional organisation, team or individual. Much time has been given to thinking about how the essential process of care audit can best be utilised to make sure that the care people receive is not only competent in technical delivery but also that it meets the subjective needs of each individual.
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:
- 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 service users 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 the people who use services, 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.
- 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 remit 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. For example, 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.
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