Social care and quality improvement
Introduction and resources
Excellent practice already exists in many social care settings, confirming the sectors’ on-going commitment to quality.
However, 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.
Following a series of consultations and a pilot programme carried out in dementia care homes HQIP produced a suite of care audit guides which set out this approach in three comprehensive but practical documents. The guides are free and available to download from this website.
- Social care audit in practice
- Social care audit for leaders
- Social care audit in practice – Summary guide
Download a copy Social Care audit guidance here
Contact Kim Rezel, HQIP Patient and Public Involvement Lead.
Background to quality improvement in social care
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.
Dementia care audit: pilot in care homes
In 2013 the government described its plan to change the care and support system in its White Paper ‘Caring for our future: reforming care and support’. As part of quality-related plans for care and support, it stated the government’s intention to ‘pilot a new care audit in 2013 to highlight how well residential care providers are delivering dementia care, encouraging them all to improve their care’.
Audit in social care – Frequently asked questions
- What is outcome measurement?
Outcome (noun): A final product or end result; consequence; issue Outcome measurement is a way of measuring the change in a person’s current or future status that can be attributed to preceding social care intervention. Outcome measurement can be used for clinical care, social care, audit and research purposes. Outcomes are at different levels – national, organisational, local community, individual user. Whilst there is a general desire to move away from a narrow focus on the outcomes of specific services and towards user-focus, there are associated challenges. Our forthcoming resources address these challenges in more detail.
- Will care audit lead to additional costs to my organisation?
Many changes that improve services can be made at little or no cost. However, the care audit may well identify some training needs or other developments to support the service which have a cost attached. The investment in these is likely to be offset by the improvement in the service leading to better outcomes and potentially leading to cost savings or improved business performance elsewhere.
- Is care audit expensive to carry out?
Care audit can be undertaken by existing staff, so organisations do not need to invest in external consultancy. However, staff time will need to be released to undertake the work, and staff, particularly those leading the work, are likely to need some training and support when they first start undertaking care audits.
- Does this mean more paperwork?
Care audit is not care audit if it is an exercise in pointless box-ticking. Data rarely speak for themselves. This is why the next steps in the audit cycle – taking action and making adjustments – are of fundamental value: where audit is properly conducted it is about change. The whole cycle has to happen, not just the review of existing practice, but also the next steps taken by a professional or team to ‘close the loop’ and take action to improve things next time around.
- Where does care audit fit with statutory regulation and CQC requirements?
Care audit helps to showcase and promote excellent practice where it exists and look at actions for improvement where care can be bettered. Where practice meets and exceeds compliance with CQC’s Essential Standards of Quality and Safety, care audit is a means to demonstrate this.
- Is care audit another term for performance management?
Care audit is about improving care, not monitoring performance and most audit has nothing to do with any external review process; it’s an internal self-review process. Care audit differs from performance monitoring or research because it is focused on making improvements to the service. These can be quite small changes to things you do every day that make a difference to the people using the service. Care audit is not about finding faults or blaming individuals, it is about sharing responsibility for improving the service. Such a discussion preferably requires an atmosphere of trust to encourage an honest, open and constructive dialogue.
- Can care audit support health and social care integration?
Providing high quality, integrated services is a shared goal across health, community and social care services. Through use of a systematic approach, audit can provide a consistent means for services to work together to provide the highest quality of care for recipients, especially where care services interface and overlap. Several of the national audits that HQIP supports, including Falls and Bone Health in Older People and Continence Care, collect information from social care settings, and illustrate some of the challenges of supporting people and providing joined up care, across multiple care environments. However, challenges remain, including whether it is valuable to develop measures that reach across the whole care service journey, and if so how this could be approached.
- How does care audit differ from clinical audit?
Clinical audit is an approach that is ‘part of the furniture’ in healthcare, used for many years in the NHS as a means to drive up quality. In turn, care audit takes place in social work and social care settings, and as a result, is intended to improve the quality of social care services.
Although the principles of a care audit cycle – review and action – are very similar to a clinical audit cycle, the method has been adapted and enriched in consultation with the sector to ensure it is fit for purpose. Improving outcomes in social care presents a different challenge as this type of review often starts from a different point.
Social care work seeks to start with the person as the determinant of how their needs are assessed, rather than in healthcare where the starting point is the clinical perspective of what their problems might be. Healthcare quality improvement has tended to focus on procedures, interventions and conditions without looking at the whole person.
Care audit can place a greater focus on a person’s whole journey rather than looking at specific interventions for specific parts of their body! Healthcare quality improvement can usefully learn to focus on patient experience and the sense of the person as a whole being. In turn, social care could benefit from the tradition of systematic quality improvement, with all the gains it could bring in suitably adapted form, to social care settings.
- What are the benefits of care audit for commissioners?
A huge percentage of social care services, whether directly commissioned by local authorities or through personal budgets, are publicly funded. Both commissioners and providers need to demonstrate that public funding is spent appropriately on good quality services. Care audit can provide commissioners with better information at provider level, over and above that supplied for compliance with statutory requirements and the CQC’s Essential Standards for Quality and Safety.
- What are the benefits of care audit for providers?
In a sector where increasingly people are being encouraged to ‘commission’ their own care (e.g. through the use of personal budgets) providers need to understand the quality of their services so they can continuously adapt them to reflect the needs and preferences of those people who are in receipt of care. Care audit can help providers to address quality issues systematically and explicitly, providing reliable information to confirm quality and highlight areas for improvement. Care audit can help providers to identify and promote good practice leading to improvements in service delivery and better outcomes for people who use services.
Care audit can help providers to ensure better use of resources and provide information to confirm this to others; a key benefit in terms of enhancing organisational reputation. Care audit can provide education and training opportunities through the identification of need and help staff to demonstrate competence in key areas of care. Care audit helps different organisations to match their practice to the standards of the best. Different organisations may see what standards others are working to and adopt them – if organisations publish the findings from their care audits, other providers are encouraged to ‘raise their game’ to match or exceed them.
- How can care audit demonstrate quality?
Even those who are already using a service are often unclear about what they should expect or the quality of the service they are receiving. Care audit means more transparency, which can help to empower people who are already using services.
- Why is it important to design services in partnership with the people who use them?
The perspective of those who use services is fundamental to understanding how well a service is doing and how it can be improved. Involvement is key throughout the care audit process, from identifying topics, defining standards for high quality and contributing to data collection, to suggesting improvements and agreeing action plans.
- What is meant by ‘supporting people to make informed choices'?
It is crucial that people who use, or are about to begin using, a care service have access to good information that will help them decide which service to use.
- What is the thinking behind ‘person-led improvement'?
People who use services and their relatives must be at the centre of decisions about care. Their voices and those of their advocates must be heard, and their choices and priorities known and respected.
- What are the benefits of care audit for people who use services?
Care audit is all about taking a personalised approach to care: how people who use services, their carers and the wider community can work in partnership with care professionals to enhance the quality of services provided.
- What is HQIP's definition of care audit?
Care audit is a quality improvement cycle that involves review of the effectiveness of social care and social work practice against agreed and proven standards for high quality, and taking action to bring practice in line with these standards so as to improve the quality of care, experience and outcomes for people who use services and carers.