Essential insights for effectively communicating your narrative in the adult social care CQC self-assessment

CQC local authority information return guidance says that in the self-assessment the council should:

• assess and judge your own performance in relation to the quality statements 
• use evidence to support your judgements  
• highlight key successes, risks and challenges 
• identify actions needed to address the most pressing risks.

The insights are based on discussions with adult social care colleagues at councils that have already experienced the CQC assessment process. They also draw on learning from colleagues who have been supporting councils to prepare for CQC assessment. All councils emphasised the importance of actively involving social care leaders, managers and frontline staff in the process.

Each insight has several examples, drawn from different regions, which have helped councils to plan for, write, evidence and communicate their self-assessment and its main messages.

Councils which are awaiting contact from CQC regarding their local assessment are invited to consider these ideas to help them to refine or communicate their draft CQC self-assessment narrative. Colleagues who have already been assessed emphasised the importance of regularly updating the self-assessment to reflect new data, changes in services and new insights.

Thanks to all councils and colleagues who have given their views and shared examples of their self-assessment preparation.

Although it may be tempting to tell a complete recent history of adult social care, the self-assessment is not the place to do this. Use the assessment framework as your guide. 

The focus of your narrative should be to concisely demonstrate that: 

• you know your place and its population, including the people who are currently drawing on adult social care and the likely future demand for your services 
• you have a strong sense of what you are doing well and showcase those successes and highlights 
• you understand where progress still needs to be made, any barriers to improvement and you have a plan to move forward 
• you have identified your most significant risks and have effective operational and strategic governance in place to monitor and manage them. 

Councils had different starting points for developing their narrative - some began with performance and data, whilst others started from a clear leadership steer. Other methods were to co-produce the self-assessment using more reflective and discursive approaches with leaders, staff and in some cases, adults and carers. 

Many councils are using the four assessment themes and their sub-themes and/or the nine ‘we’ quality statements to structure their narrative, creating a line of sight between their self-assessment and what CQC colleagues will be making judgements about when they arrive onsite. A clear self-assessment can help to set the agenda for CQC’s on-site work. 

It is also a good idea to introduce your self-assessment with a short overview of your place, your population and adult social care, which should include the council or adult social care vision, values and strategic priorities. Including some key activity data and performance indicators will also help to set the scene. Infographics and data represented visually in graphs or charts work particularly well here. 

Self-assessments vary significantly in their length, typically ranging from a minimalist 25 pages to more than 60. There is not a right number of pages to tell your local narrative effectively, but it is worth reviewing the content of draft self-assessments that exceed 50 pages. This will help to ensure that the most important content and messages are not lost. 

Finally, whilst there will be many contributions to the self-assessment, ensure there is a single style or ‘voice’ throughout the document to give it coherence. 

Summarise your strengths and improvement story resources

Adult social care colleagues who shared their experiences of self-assessment said that using evidence and examples to support their narrative was an essential part of the process, particularly to demonstrate strengths. The advice is to be creative and use what might be overlooked as ‘routine’ practice examples, as well as eye-catching data or areas of innovation. Where national Adult Social Care Outcomes Framework (ASCOF) data indicates you are low performing, be sure to present wider evidence as a counter-narrative. 

Some councils have directly addressed the issue of evidencing their strengths by including a section called ‘How do we know’.

Evidence used by councils has been varied and includes: 

• practice case studies – anonymised real examples of working with an adult or carer, told through the eyes of the practitioner 
• individual stories – for example ‘Barbara’s Story’ which describes an adult’s journey through social care and the outcome, often told by a practitioner on their behalf 
• insights from practice audits 
• operational performance data and statistics 
• selecting relevant ASCOF performance data, comparisons and trends 
• adults, carers and staff survey data and trends 
• free-text responses from other relevant surveys, or consultations 
• compliments and complaints data or feedback 
• policies, procedures or strategies. 

Less commonly seen supporting evidence are examples of staff voice, partner or provider testimonial and first-hand feedback by adults or carers about their experiences of social care. It is beneficial to be able to reflect multiple perspectives on adult social care in your self-assessment. 

Some councils acknowledge that it can be challenging to evidence adults’ and carers’ lived experiences of drawing on social care and the positive impact it has had on their health, wellbeing and ability to remain independent. One council recognised this early as a gap and developed a feedback pilot in some services, which has continued to be rolled out.

Resources and examples of effective use of evidence

The self-assessment is an opportunity to highlight the human narrative as well as process and practice. Understanding lived experiences of adult social care and the impact social care support has on the lives of adults, carers and families is central to CQC’s judgements. Whilst including examples of lived experience can be challenging if adult social care does not already have well-established feedback mechanisms in place, the self-assessment can provide an impetus to think about how to routinely gather direct ‘first-person’ feedback from adults and carers. Where councils realised this was a gap in their self-assessment, they tapped into existing processes and also piloted new ways of generating adult and carer feedback. One council reported collecting wellbeing measures.

Some other suggestions include:

• seeking direct feedback at different points of the care journey, for example, following initial contact, after a Care Act Assessment, at case closure and so on 
• use feedback from adults through ‘Making Safeguarding Personal’ 
• ensure you can collectively articulate or evidence how you support equality and inclusion and can meet diverse social care needs 
• provide insights from practice audits, for example, where the adult or carer has been contacted directly for their views 
• provide video-logs made by adults themselves 
• provide comments made as compliments or during complaint resolution 
• provide insights from satisfaction surveys or consultation exercises 
• work with providers to gather feedback from adult and families drawing on commissioned services – regulated providers should already be doing this.

One council has used the case-tracking process as an opportunity to summarise and evaluate positive practice with adults, highlighting the person and their outcomes.

Show in your self-assessment that you understand the concept of co-production and have plans to improve the voices, representation and agency of adults and carers within social care decision-making – in decisions about their own care and support, and wider social care issues that affect them.

Resources and examples of focusing on experiences of adults and carers

Councils highlighted the importance of encouraging staff to reflect on their practice and achievements and ensure that these examples are celebrated and shine through in the self-assessment. For some adult social care leaders this was an explicit priority in their preparation for CQC assessment, with the intention of building workforce confidence and positivity, motivating teams and reducing anxiety.

Several councils used the self-assessment process as a tool to reflect and engage widely with social care staff, drawing on their practice wisdom and day-to-day working relationships with adults, carers, providers and partners to shape and support the adult social care narrative. This also involved coaching staff to notice and appreciate their own good practice – in one council this helped to highlight strong peer support and informal practice development in front-line teams, which would not have been recognised otherwise. Engaging with social care staff is particularly important to evidence how Care Act principles are being delivered in practice, in other words, strength-led and person-led approaches, promoting wellbeing, reducing and delaying need, offering choice, and how this is formalised in duties like Care Act Assessment and safeguarding processes.

Ideas and methods to support staff involvement and confidence-building include: 

• principal social worker-led drop-in cafes to create informal opportunities for discussion 
• bite-size learning sessions recorded 
• Care Act refreshers 
• running practice CQC focus groups 
• practice reflection sessions 
• regular e-mail updates from the principal social worker 
• weekly newsletters 
• FAQs.

Some councils have developed a six to12 month communication plan to prepare for CQC assessment. These have included mapping stakeholders and putting plans in place to share relevant information from the self-assessment with different audiences - including staff, voluntary, community and faith sector partners, adult social care providers and NHS partners.

A good-practice feature of these communications has been to distil the most important content from the self-assessment into bite-size messages and regularly socialise this information using various communication techniques.

There have been a wide range of approaches, including:

• creating a condensed, visual PowerPoint summary of the self-assessment 
• one-minute written briefings for staff that summarise must-know information straight to their inboxes 
• staff roadshows 
• lunch and learn webinars 
• weekly blogs by the director of adult social services (DASS) 
• A video-log by the DASS immediately prior to CQC arriving on site. 

Several councils said that their approach to communications changed once they received notification of their assessment date, becoming more targeted both in terms of messaging and audience.

Resources and examples of communications with staff and partners