This is the time of year when reports and guidance are landing on us like autumn leaves. One offering stands out for me: CQC’s new guidance, created with partners across health and social care. It’s called ‘Equally Outstanding: Equality and human rights – a good practice resource’, and it’s available here:
It tackles the tricky question, how can a focus on equality and human rights improve the quality of care in times of financial constraint?
By creating an online collection of tips and guidance, with practical examples, it helps providers put equality and human rights at the heart of their improvement work so that the quality of care gets better for everyone.
The challenge of ‘doing more with less’
Your heart might sink at the thought of yet another optimistic document telling us we can squeeze yet more improvement to services when we’re facing yet more cuts to the budget. Yet the resource quotes evidence of the real financial value of a human rights-based approach to staffing, and towards those who use services.
Human rights-based recruitment and retention
The return in staffing costs is remarkable: Skills for Care found that values-based recruitment saved money by identifying the right staff and keeping them longer. In addition, an inclusive, supportive working culture pays off in avoiding absenteeism due to work-related stress. The NHS is a particular culprit here, and it is estimated that the cost to them of bullying, discrimination and harassment is, shockingly, around £1.75 billion. And when it is estimated to cost about £4000 to recruit and train a new social care worker, there are real advantages to hiring the right people and ensuring they are treated well.
Well led, unstressed staff give good care
The quality of care is undoubtedly improved when staff are happy, purposeful, and valued. Improving the quality of care makes good business sense – it enhances the reputation of the service.
And there is a business case for tackling workforce equality issues to improve the quality of care. Within this useful CQC resource is a link to a short video you might like to share with your accountants and senior managers, about the business case for a human rights-based approach:
The resource also has sections outlining the legal case for human rights compliance in practice, together with:
Practical guidance: common factors for success
The authors look at case studies and identify nine common success factors, which they illustrate with examples. The case studies range from private sector care homes to large NHS trusts. Yet there are some common factors that most, if not all, share.
These factors have helped to make the services successful in using equality and human rights approaches. But more than that, they have been crucial in developing outstanding care, without requiring large resources – they take shifts in thinking and in how people act.
I loved, in particular, the way a ‘curious and humble’ attitude is up there as an essential factor for success:
- Committed leadership: The key role of leaders who are enthusiastic and committed to equality and human rights. We need to move away from “heroes and heroines” to making this the business of all leaders.
- Equality and human rights principles into action: These principles run through as a thread from organisational values, through leadership behaviours and actions to frontline staff and their work.
- Culture of staff equality: They developed a culture of equality and human rights for their staff as a basis for quality improvement. This is likely to include both broad work to develop an open and inclusive culture and, particularly in larger organisations, work to tackle specific workforce inequalities.
- Apply equality and human rights thinking to improvement issues: They started with the quality improvement issue, created some space to innovate and then applied “equality and human rights thinking” to the issue – rather than thinking “we must do something about equality and/or human rights.”
- Staff as improvement partners: All staff were involved as partners in thinking about, planning and delivering the equality and human rights interventions to improve the quality of care. This was done within a “no blame” culture of learning and is aligned to collective leadership approaches.
- People who use services at the centre: The rule was “how do we serve this person?” They listened carefully to people who used the service and viewed them as people with a life beyond their immediate need for a service – including their future aspirations.
- Use external help: They linked to the outside – reaching out to others for help and being prepared to have a mirror shone on their work.
- Courage: They were courageous and bold in their approaches – including positive risk-taking, being honest about issues and tackling difficult problems.
- Continuous learning and curiosity: They were curious and humble – they started somewhere, learned from mistakes and were always looking for the next thing that they could improve – whether for a small service that was how to best meet the needs of the next person admitted, or for larger services what project to focus on next or service to develop.
Examples of outstanding practice
The examples of outstanding practice are a joy to see: I suggest sharing them with staff, since they bring theory to life so vividly.
You might consider using the whole resource, but particularly the practice examples, to enliven a team meeting. They show the simplicity of putting person-centred human rights into practice, and how happy it can make service users and, indeed, staff.
I enjoyed learning in the case study and CQC inspection report about the small care home providing respite for people living with dementia, where night-staff wear pyjamas and dressing gowns to help orientate confused and wakeful people to it being night-time. They also started keeping free-range hens, initially to soothe a distressed service-user who’d had a lifetime of poultry-rearing and found that the hens added hugely to the pleasure and interest of everyone. It shows how we can all be ‘equally outstanding’ – and it sounds a great place to work!