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“A bad CQC report can help to improve a suboptimal service”

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I was sad to see comments of outrage, anger and sadness on my Facebook news feed this morning after publication of the Care Quality Commission’s report into a trust at which I used to work. I haven’t yet read the report - in fact, this isn’t about the report but about the way we feel and respond to “perceived” poor reports.

Gemma Davies

What saddened me was reading comments left by others who work on the front line in clinically supporting roles angrily saying how hard they work, that they miss breaks and what a wonderful team they work with and in. Of course this is all true. The sad fact is that many, many workers in the NHS go above and beyond the call of duty each and every day. We do it to give our patients the best we can and to support each other. It is commendable. But it is wrong.

We should not miss breaks or leave late - this should only happen when there are additional unexpected pressures. This is what the CQC’s inspection system aims to identify, and publication of the report should help management refocus on where these constraints are and which processes aren’t working or need adapting - in essence, how we can make each service deliver the highest standards of care, safely, and in a well-led, responsive way.

I have worked in trusts that have been in special measures and those deemed to be “inadequate” or rated “requires improvement”; I have been a part of teams whose focus becomes about improvement and driving up standards after CQC inspections. Like the five stages of grief, the initial reaction from many working in the midst of organisations in cohesive teams start with denial (“But we work so hard”, “I love it here”, “This report is wrong”), then anger (“We should dispute it”, “The CQC is useless”) through to bargaining (“Well we do it this way but, if we could, we would do it differently”), and depression at the thought of the immense amount of work that may be needed as well as how the media portray the report. The final stage is acceptance - once reached, this should be the start of the improvement journey. This is also when you accept that this isn’t about you or the team but that it’s about the failure of processes that should allow you all to do your jobs with optimal effect.

This is when management need to use the report to refocus and review the areas identified by the CQC as needing improvement. It needs to have those honest, transparent conversations that say: “We didn’t get it right but how can we fix this?”

No one goes to work to do a bad job and no report will say that. If staff identify areas of deliberate, intentional or unintentional harm through poor standards they will step in. Reports say: here is what we saw and what you need do to improve.

When we had a poor report I said to my nursing staff: “This isn’t about you not caring - you care passionately about your patients and each other. This is about you not being able to deliver that care due to pressures in the system that make it harder or more complex for you. Remember that.”

I hope my former colleagues remember that as they pick themselves up, dust themselves down and, instead of seeing this report as a bad thing, see it as potentially a very good thing. Because no service should be operating at a suboptimal level that leaves staff exhausted and despondent, and could be detrimental to patient care and safety, when there are ways to improve.

I urge staff working in these systems to speak up with ideas for improvements because it is often those at the coalface who come up with the best and most workable solutions. This could be an exciting time for my former trust and I wish everyone well as they start this difficult - but potentially incredibly rewarding journey.

Gemma Davies is matron at Mid Essex Hospital Services Trust

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