What the CQC’s State of Care report tells us about leadership in adult social care

Each year, the CQC’s report, ‘The state of health care and adult social care’ prompts us to reflect on some of the challenges facing adult social care. This year's report highlights familiar themes around workforce pressures and increasing demand, but also that care arrangements becoming more complex, with more care being delivered in people's homes and communities and a growing number of organisations involved in supporting individuals.

As a regulatory lawyer, the finding that stands out is that Well-led was identified as the area requiring the greatest improvement across adult social care ratings published under CQC's current assessment framework.

In many respects, this feels different to some of the other challenges highlighted in the report. Providers cannot control labour markets, demographic trends or wider system pressures. Leadership and governance are not immune from those pressures, and creating a positive culture, maintaining effective oversight and developing systems that identify and respond to risk all require significant commitment. However, unlike many of the wider challenges facing the sector, they are areas where providers can often exercise a greater degree of influence and are not entirely dependent on external reform.

The finding is also particularly relevant given the wider themes running through the report. As more care is delivered in people's homes and communities, responsibility for supporting an individual is often shared across multiple organisations, healthcare professionals and family members. That can create more opportunities for things to fall between the gaps unless there is clear oversight and accountability. Good leaders need to understand what is happening across their service, identify emerging risks, ensure information is shared appropriately and satisfy themselves that people are receiving safe and effective care

It is also worth remembering that governance of care quality and safety extends far beyond inspection outcomes. Inquests, safeguarding investigations and enforcement action frequently raise similar questions. Often, the focus is not only on what happened, but on whether systems were in place to identify concerns, whether risks were recognised and escalated, and how the organisation responded when issues came to light.

Perhaps the greater challenge is not simply being well-led, but ensuring that good leadership, oversight and learning can be evidenced when they are scrutinised.

Many organisations are operating in difficult circumstances, balancing workforce pressures, increasing demand and competing priorities. Leaders will often have a clear understanding of the decisions they have taken, the risks they are managing and the improvements they have introduced. The challenge can arise when those decisions need to be explained to someone outside the organisation. That might be during an inspection, a factual accuracy process, an inquest or enforcement action. 

Providers will often have the information to answer those questions. The difficulty is often articulating them effectively, providing the right context and ensuring that regulators and coroners are able to appreciate the full picture.

That is where specialist support can add value. As expectations around leadership and governance continue to increase, the ability not only to deliver good care, but also to evidence and explain effective leadership, is likely to become ever more important.

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