Co-Production Learning Disabilities & Autism Opinion

Achieving quality starts with asking the right questions

Nicholas Campbell-Watts, Strategic Director of Quality and Performance, Certitude

It’s easy to know when you provide high quality support to someone, because when you get it right, everyone feels it. It generates genuine emotions in every individual involved, and each person who has contributed grows in some way because of that experience. This is one of the unique rewards of working in social care; those moments when you connect with someone, and their family, to support them well.

Quality in social care is fundamentally about relationships. High quality happens when a person or team involved in supporting someone continually looks for ways to build and sustain a relationship. It happens when we learn to sensitively assess, anticipate and meet – or even exceed – the person’s individual needs and expectations. High quality, relationship-based support can be achieved in both routine, everyday activities, and in highly bespoke, complex and intensive support.

While it’s relatively easy to know when you get it right, the real challenge for organisations is how to achieve this high level of quality support time after time, at scale and with the resources available. As London’s leading adult social care provider, at Certitude we see quality as the key driver behind our thinking, strategy, planning and investment. Getting it right all the time is understandably a complex issue that needs to encompass various factors, including:

  • meeting regulatory and contractual requirements
  • striving to constantly improve service delivery
  • recruiting and properly training, developing and retaining high quality teams

That last factor is possibly the biggest challenge we all face in social care. There is good evidence reported by Skills for Care that those with lower vacancies and lower turnover have higher Care Quality Commission (CQC) ratings, and those with more staff and higher pay also have higher ratings. This is no surprise. Good quality support simply cannot be provided or sustained without dedicated teams with the right skills.

While we continue to wrestle with that complex set of issues with no easy solutions, there is an important and welcome shift in organisations’ approaches to quality that adopts the perspective of viewing people as active co-producers of high-quality support, rather than users. At the core of this approach should be a drive to ascertain from people, and their families, what really matters to them on a personal level that is of such high importance it should always happen when they are in contact with teams.

Our understanding of quality is then based less on asking: ‘What’s the matter with you and how can we support that?’ and instead asking: ‘What really matters to you, and how can we work together to make that happen?’

This approach is at the heart of an Always Event, a co-production quality improvement methodology which seeks to understand what really matters to people who use services.

The concept of an Always Event was originally developed by the Picker Institute and provides a person-centred approach to quality improvement. It is rooted in identifying and formalising actions and behaviours, in teams and organisationally, to deliver the quality-of-support issues identified by people and their families as being personally important to them.

At their best, Always Events are locally agreed because they are so bound up in what matters to a person and their family that they need to be understood and delivered within the context in which they have been determined. Quality improvement is a local phenomenon, best delivered by those closest to the person and their families.

At Certitude, we are on that journey in our approach to quality. We have set out a strategic intent to reinvest in local teams, co-production and strength-based approaches. Because quality is about relationships at a local level and always starts with the question: ‘What really matters to you?’

Edel Harris





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