CQC and the 'So What?' Question

How to demonstrate the positive impact care services have on people's lives and aim for an outstanding rating.

CQC inspectors are trained to pose the ‘So What?’ question when they make judgements on compliance and ratings. But what is the ‘So What?’ question? How can you answer it effectively as a care provider, particularly if you believe you are providing an outstanding service and want CQC to recognise this?

Let’s use two examples. If a care service has a detailed and up-to-date policy on person-centred care that’s great, isn’t it? Well maybe, but what if people tell you that the home is run for the benefit of the manager and that they don’t feel they have a voice? Or what if a wide choice of meals is available each lunchtime in a care home? Again, that’s got to be good, hasn’t it? However, what if a person reports that they have coeliac disease and that the chef doesn’t understand their intolerance to gluten? Well, that’s not so good and could provide evidence of neglectful care. 

These examples show that the ‘So What?’ question refers directly to the impact on individuals receiving care. It doesn’t matter how good your intentions, records or policies are. What matters is the impact on the people you support. 

So how can you strengthen your evidence of positive impact on people’s lives and improve your CQC rating?

Focus on people’s lived experience in care planning and reviews

All care planning should take place in partnership with people. Recording what people tell you is important to them, and keeping a document of what they want to happen is vital too. When you review care plans and record whether people have taken notice of this and how they feel about it, don’t be put off by thinking statements are too simple. It’s good to spell it out and make the evidence clear. For example, how did Mary feel when you worked on a detailed risk assessment and care plan with her for self-medication?

Did she feel cared about, more confident, fulfilled, educated, and empowered, could she rely on the nurse call system? Was she listened to? If so, write this down in the care plan and review records using her words wherever possible. This is evidence of the positive impact you are having on Mary’s life. 

Of course, people’s comments won’t always be glowing. If a person tells you the impact of your care is not so good, this provides an important opportunity to put things right straight away.

Mental Capacity

When people have difficulty telling you about their experiences then be sure to record how you have done the most to improve their ability to communicate with you. A person may have limited capacity, however, there will be ways to gather their views. If people are feeling positive, they may use sign language, smile, reach out, interact, hold eye contact or appear content. All these should be recorded as the person’s response to the care they receive. Key workers, advocates, Lasting Power of Attorneys, family and friends may also be consulted and their comments recorded. You may need to provide accessible information to help people to understand what is being asked and communicate their views. Evidence of supporting people like this will help inspectors recognise you are going the extra mile to address the ‘So What?’ question.

Quality Assurance

All good and outstanding rated care services should have a well-developed quality assurance system. This will include audits where areas for improvement will be identified. A good way to improve the evidence of a positive impact on people’s experience is to record what difference your changes have made to an individual’s quality of life. For example, you identified through your falls analysis that David was regularly falling in his bedroom at night and you fitted a sensor mat with his consent. So what? If you then report that David’s night falls reduced by 80% and that he now feels more confident, this is really good evidence of the positive impact on him. Or, your social activities audit identified that Denise would like to try assisted cycling in nearby woodland. You supported her to arrange this and she now proudly reports on her growing cycling skills in the home’s magazine. This is great evidence of the positive impact of a planned activity on well-being. 

Case Studies

The examples above show the power of using case studies to evidence your positive impact on people. You may have noticed that CQC often use anonymised individual case examples in their reports. CQC panels that decide on whether to award an outstanding rating often asked inspectors to give them extra examples of the positive impact on individuals to help them make a rating judgement. If you are proactive and provide your own detailed examples for CQC, they are much more likely to recognise that the care you provide is outstanding and award you a rating to match.