A Focus on Equality & Human Rights Essential to Get a Good CQC Rating

The CQC, alongside a number of partners, has published a new good practice resource, Equally Outstanding, exploring how a focus on equality and human rights can help to improve quality of care.

Using case studies from the NHS, adult social care and primary medical services, it looks at how services rated outstanding by the CQC have prioritised equality and human rights and the positive effects this has had on quality of care and staff engagement. This resource also helps set out the ‘business case’ for equality and human rights at a time when the whole health and care system faces significant financial challenges.

Paul Corrigan, CQC Non-Executive Director and Board Equality and Human Rights Champion, said "When finances are squeezed, it may seem tempting to view work on equality and human rights as an expendable extra – when in fact it makes both ethical and business sense for this work to be more central than ever.

"There’s a clear link between the quality of care a service provides and whether the people who use it and its staff feel that their human rights are respected and they are treated equally. And equality and human rights will only become more important over time because of demographic and system change; research shows that money spent on reducing health inequalities is the most efficient way of improving health outcomes for a local population.

"We have developed – and will continue to develop - this work both as a practical resource that people can use within their own organisation to make the case for an increased focus on equality and human rights and to learn from providers that have used these approaches. More broadly, we hope it encourages health and social care leaders to look beyond provider boundaries to ensure the community involvement of people from diverse communities and develop broader, more holistic services that meet their needs."

Human rights principles of fairness, respect, equality, dignity and autonomy should be at the heart of good care provision .  Evidence points to a clear link between quality of care and whether people who use services feel their human rights are respected and they are treated equally:

• In the 2015 NHS Inpatient Survey, patients receiving care from Trusts rated outstanding were more likely to say that they were treated with dignity and respect in hospital and had the emotional support that they needed.  Their overall satisfaction with their hospital stay was also higher and patients at outstanding trusts who identify as lesbian or gay were more likely to give positive responses to all three questions than heterosexual patients - the reverse is true in Trusts not rated outstanding.
• In the CQC’s acute NHS hospital inspection reports, the proportion of positive comments made about the quality of care for people with a learning disability increased in line with the Trust’s rating.
• Seventy-five per cent of hospices rated as outstanding had carried out some work on equality for disabled people, but only 55% of other hospices had done so. Eighty-eight per cent of hospices rated as outstanding had carried out some work around equality for people of different religions and beliefs compared to 65% of lower-rated hospices.
• Looking at 14,000 adult social care “provider information returns”, services rated good or outstanding were more likely have undertaken some specific work on equality in the past 12 months.

There is also a link between whether staff feel they are treated equally and with respect and the quality of patient care provided:

• CQC analysis of NHS trusts' ratings shows that staff in acute or combined trust with higher ratings are less likely to say they have experienced discrimination, bullying or harassment.
• Research looking at the NHS staff survey and inpatient survey found that where Black and Minority Ethnic staff experienced discrimination, there tended to be lower levels of patient satisfaction.
• Though there has been less work on this topic in primary care and adult social care, the case studies in Equally Outstanding show that the basic principle holds true – where organisations value and support staff equally, this will help lead to better care.
• Equally, a care setting where staff do not feel valued and respected is more likely to experience absenteeism, high staff turnover and recruitment problems – with implications for both care quality and finances.

The resource describes some common “success factors” in the case study organisations that have used equality and human rights to deliver outstanding care. These include:

• a leadership committed to equality and human rights
• applying “equality and human rights thinking” to quality improvement
• developing a culture of staff equality where staff are improvement partners in this work
• listening carefully to people using their service, including to their aspirations
• being courageous in their approaches to tackling difficult issues
• and making external links to help them progress their work.

Download a copy of Equally Outstanding by clicking here.