A Brief Guide to Outstanding

The Outstanding Society was formed by a small group of providers who had at the time all recently achieved ‘Outstanding’ ratings following the introduction of the CQC inspection standard ratings in 2014. There was a general consensus between this groups that it would be beneficial to the adult social care sector if ‘Outstanding’ services were able to share their expertise with other providers and support the driving up of quality across the whole of England.

In order to achieve an Outstanding rating a registered service provider must demonstrate at least two areas of Outstanding practice within the following five Key Lines of Enquiry (KLOE’s): 

• Is the service safe
• Is the service effective
• Is the service caring
• Is the service responsive
• Is the service well led

One of the most common questions that people ask is: ‘What does Outstanding actually look like’? To which there is no simple answer. This is because of the differences in types of services and different client groups, but most importantly about the individual differences between the people that are being supported and what is important to them, or important for them. 

The culture of a service or organisation is therefore really important, particularly with regards to how person centered planning is embedded within practice and the understanding of individual wishes and needs. Effective leadership is therefore key. If care and support is delivered consistently in a manner that is focused upon the individual, which maintains the safety of the person, their support is effective and caring, as well as being responsive to change / wishes of the individual, then it is likely that each of the five KLOE’s will have been successfully evidenced and therefore the service might expect a ‘Good’ inspection rating. 

To achieve Outstanding, there is a requirement to evidence practice that not only achieves all of the above, but rather goes the extra mile in order to obtain the most effective outcomes. Many of the areas of Outstanding practice recorded within CQC inspection reports refer to innovations introduced to help overcome a particular problem, or an achievement that is out of the ordinary, or exemplary practice that has made a significant difference to the life of an individual or group of individuals. 

There is a broad spectrum of examples of Outstanding practice contained within CQC inspection reports and it is well worth reading through some of them to fully understand what makes the difference between Good and Outstanding. Examples might include: 

• Bespoke adaptations to the environment in which people with Autism / Learning Disability live, which minimizes the impact of light and sounds where people may have heightened sensory processing
• Innovative and creative ways to train staff, which included the role of a ‘Champion’ in dementia. This meant they actively supported staff to make sure people experienced excellent care.
• Introduction of a bespoke method of involving someone in decision making where they have severe communication difficulties.
• Specialist training to public service personnel such as GP’s, ambulance crews, police officers, leisure service staff, such that more is understood about the impact of some conditions and therefore better able to respond or support when needed.

These few examples provide an idea of how diverse Outstanding might present and how this might only be applicable in a specific context, or with a specific individual. 

For those service providers aspiring to achieve Outstanding at their next CQC inspection, there are a few simple tips below, which may help, though again this is not always obvious and very much dependent upon the consistent delivery of high quality care and support that is making a significant difference to someone’s life: 

• Be prepared for inspection by knowing what to expect and by fully understanding the quality of the service that you are providing. Robust QA auditing systems are key in understanding the health of your service.
• Ensure all standards are met and each of the 5 KLOE’s are rated ‘Good’. If there are any areas that require improvement then clear action plans should be in place to bring that area up to standard.
• Think about the points above relating to what does Outstanding look like: is there a positive and proactive culture in your service / organisation in which staff are motivated and possess the knowledge and skills to deliver highly effective person centred care and support?
• Managers should be motivated, skilled and effective in leading the service.
• There should be a reasonable level of investment in the service to allow for adaptations and resources to be made available to deliver highly effective care and support, as well as responding to changes or individual needs
• Get to know what Outstanding looks like by reading Outstanding CQC reports and identifying those elements that stand out
• Identify what is felt to be Outstanding within your service – remember this is not always obvious to others, particularly if they do not know individual service users and the small but hugely significant changes that make such a difference to individual lives.
• Produce an evidence file or some other system of cataloguing those areas of practice that are felt to be Outstanding so that this can be used as a reminder for staff and managers, as well as for CQC inspectors.

There is a very useful and much more detailed guide which has been produced by Skills for Care entitled, ‘Good and Outstanding Care’. This can be downloaded at the Skills for Care Website.