Welcome to the next in our series looking at the CQC Fundamental Standards and what they mean in practice for social care services. In this one we are going to look at Regulation 17 – Good Governance.
Regulation 17 is one of the most important and far-reaching fundamental standards. It underpins a huge amount of activity within a care service and one that frequently features when CQC identifies a wider concern with a service.
Good governance is not simply about processes and audits. It goes deeper than that and is about how services evidence that they know what is happening in the service, that they can identify when things are not right, and what they are doing to improve.
What does Regulation 17 say?
The regulation requires providers to have ‘systems or processes’ that are established and operated effectively to ensure compliance with the fundamental standards, but this general statement is refined further, and it details that providers must be able to:
- Assess, monitor and improve the quality and safety of care, including people’s experience
- Assess, monitor and mitigate risks to people’s health, safety and welfare
- Maintain ‘accurate, complete and contemporaneous’ records of people’s care, treatment and decisions
- Maintain appropriate records about staff and the management of the service
- Seek and act on feedback from people using the service, relatives, staff and other relevant people
- Evaluate and improve their own practice and governance.
- Provide on request, a report to CQC on how the regulation is being met
As can be seen, the regulation is holistic in nature, attempts to define what is meant by ‘good governance’ and is a great starting point if you wanted to establish robust systems.
What does this look like in practice – and what evidence will CQC look for?
Good governance brings together information from across the service – incidents, safeguarding, complaints, medicines, care records, staffing, audits, people’s experiences and feedback. Providers should be able to show what they have done with that information and what difference it has made.
Evidence might include:
- A range of audits and quality monitoring
- Action plans showing responsibilities, timescales and follow-up
- Analysis of incidents, safeguarding concerns, complaints and other trends showing learning and improvement
- Care records that are accurate, complete, up to date and person-centred
- Records of observations of care and staff practice
- Feedback from people, relatives, staff and other professionals on the quality of the service provided through surveys or other channels
- Meeting minutes, supervision or team discussions identifying areas for improvement and how quality will be monitored and assured
- Evidence that improvements have been checked and sustained
CQC will not simply look at whether these documents exist. It will consider whether they provide effective assurance about the quality and safety of the service. For example, if an audit says everything is satisfactory but CQC’s observations, records or conversations with people identify significant problems, this may raise questions about whether the governance system is effective.
You need to ensure that audits and other ways of providing quality assurance are not just tokenistic, or done because you think they should be done. They need to reflect a drive for quality and be clearly related to what your service is experiencing.
Governance and Culture
Good governance is closely linked to the culture of a service. A positive culture encourages staff to speak up, welcomes feedback and challenge, identifies problems early and learns from mistakes.
A service can have excellent policies and completed audits, but if staff do not feel able to raise concerns, people are not listened to, or managers do not act on what they find, governance is unlikely to be effective.
As can be seen, Regulation 17 cuts across many of CQC’s Quality Statements, particularly Governance, management and sustainability, Learning, improvement and innovation and Shared direction and culture. It is also likely to remain important as CQC develops its future assessment approach and KLOEs.
An Important Requirement
Regulation 17 also requires the registered person to provide CQC, when requested, with a written report explaining how the service is complying with the requirements to assess, monitor and improve quality and safety and manage risk. This must be provided within 28 days, together with any plans for improving the standard of services where appropriate.
This is another important reason to make sure your evidence is available, up to date and easy to share. You should not have to start searching for information or putting together a picture of your service after CQC makes a request.
Your audits, action plans, feedback, incident and safeguarding reviews, care records and other quality information should already provide a clear picture of what is happening in your service, what you have identified and what you are doing about it.
The 28-day requirement reinforces an important principle of Regulation 17: Good governance is something that needs to be happening all the time, not something you prepare for when CQC arrives.
Conclusion – Know your service
Amongst other things, Regulation 17 brings together quality, safety, risk management, records, feedback, learning and improvement and it can really be seen as a ‘bedrock’ regulation that other regulations and assessment criteria are built on. If you don’t have good governance, you realistically cannot run a quality service.
Ultimately, it is about you knowing what is really happening in your service and being able to demonstrate to CQC and others that you assess, act, learn and improve.
Look out for the next instalment in our Fundamental Standards Series, covering Regulation 12: Safe Care and Treatment