The social care sector has undergone significant change over the past year with the implementation of the Care Quality Commission’s (CQC) single assessment framework (SAF). For some providers, the SAF has presented an ongoing challenge, particularly for those struggling to adapt their established practices to meet the new requirements. This has been exacerbated by issues identified with the SAF since its implementation.
Issues with the SAF
The SAF emphasises the importance of providing safe and responsive person-centred care and fostering a culture of continuous learning and improvement. It also aims to centre the experiences of people receiving care. While these are all important aims, the recently released Interim Report on the Review into the Operational Effectiveness of the CQC has identified several issues with the SAF and its implementation that have created additional compliance challenges for providers, including that:
- There is an expectation that providers strive to provide ‘good’ or ‘outstanding’ care, however, there is no guidance on what this looks like in practice. This makes it difficult for providers to identify how they can improve.
- Providers must comply with 34 quality statements, however, they are typically only assessed on 5-12, which creates uncertainty over how each quality statement should be prioritised.
- Not all evidence categories are assessed for each quality statement, again creating uncertainty on what should be prioritised.
The Interim Report has recommended a comprehensive review of the SAF and while this is welcome to address the issues identified, it means there is an increased likelihood that providers will need to soon re-align with a revised or new assessment framework. For providers who have been slower to embrace the changes that have come with the SAF, this will create additional challenges. The risk of falling behind is real, with low ratings limiting capacity to take on new clients, but so are the opportunities for innovation for those ready to embrace change.
Challenges of adapting to the SAF
Key challenges providers may face in adapting to the SAF requirements include:
- Shifting from a reactive to a proactive approach to compliance and quality management
- Supporting staff at all levels to understand and implement new requirements
- Demonstrating continuous learning and improvement with tangible evidence
- Balancing compliance obligations with the day-to-day pressures of care and service delivery
- Adapting organisational culture to align with the expectations of the SAF, including being able to demonstrate a culture of continuous learning and improvement
Navigating change
To successfully navigate these challenges, align with the SAF, and prepare for expected further change, providers should consider the following strategies:
- Embrace the opportunities that come with a continuous improvement culture. Feedback, and even complaints, should be welcomed and viewed as opportunities to improve, rather than threats. Make sure there are a variety of ways for service users, residents, families, and staff to provide feedback, suggestions, and innovative ideas.
- Regularly engage with service users and their families. Actively seek and act on their feedback using formal and informal channels. This aligns with the CQC’s focus on peoples’ experiences of care and can provide valuable insights.
- Invest in staff training and development. Make sure all staff understand the CQC requirements and their role in meeting them. Focusing on one key question per session can help to make training less overwhelming.
- Foster leadership at all levels: Encourage staff to take ownership of quality improvement in their areas of responsibility. This approach to leadership can drive change more effectively throughout the organisation.
- Implement robust data collection and analysis systems. Whether through quality management software or other systems, establish processes to gather and analyse relevant data. This will allow you to more easily provide evidence during assessments and demonstrate your plans for improvement.
- Streamline data collection and analysis with technology. Consider implementing quality management software to centralise data collection, automate reporting, manage improvement activities, and facilitate real-time monitoring of key performance and quality indicators. This can help demonstrate compliance and support continuous improvement efforts.
- Develop a proactive approach to risk management. Regularly assess potential risks to quality and safety, and implement risk minimisation strategies. This aligns with the CQC’s expectation of providers being able to anticipate and address issues before they escalate.
- Regularly review and update policies and procedures. Make sure your documented processes align with the new CQC requirements and reflect current best practices in social care.
- Collaborate with other providers. Share best practices and lessons learned with others through industry forums, local networks, conferences, or partnership arrangements.
- Celebrate successes and learn from challenges. Recognising achievements, however small, can boost morale and help foster a culture of continuous learning and improvement.
Adapting to the SAF is an ongoing process, as is continuous improvement. For providers who are facing challenges adjusting to the new requirements, committing to incremental change and improvement will not only strengthen their ability to meet their regulatory obligations, but enhance the safety and quality of the care and services they provide. The care sector has always been about people – both those receiving care and those providing it. By embracing these strategies and the spirit of the SAF, providers can create an environment where high-quality, person-centred care is not just an aspiration but a daily reality.
As we move forward, the most successful providers will be those who view regulatory compliance not as a burden, but as an opportunity to excel. By fostering a culture of innovation, continuous learning, and adaptability, even organisations currently struggling with change can position themselves at the forefront of care excellence, ensuring better outcomes for all stakeholders in the care ecosystem.
Ayesha Sultana, MOA Benchmarking Clinical Quality Lead