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Steven Weeks

Steven Weeks, policy manager and the lead on staff engagement at NHS Employers discusses the recent updates to the well-led framework. 

On 14 June the Care Quality Commission (CQC) published a new and updated well-led framework for assessing NHS organisations, which includes an updated set of questions on staff engagement.

The CQC inspection regime provokes mixed feelings for the NHS and the process of going through inspection can be challenging. It is nevertheless positive that within the framework the CQC places strong emphasis on issues of leadership, culture and staff engagement, which are assessed as part of the evaluation on whether an organisation is well-led.

Earlier this year the CQC consulted on a number of changes to the well-led framework as part of wider series of changes to the inspection model. Planned inspections of whether an organisation is well-led will continue to take place on an annual basis. However, inspections of individual service areas would be based on an assessment of risk or following concerns being raised.

The new framework will be used from autumn. The main area of change to the assessment is to the overall leadership and culture of an organisation. We hope it will lead to greater recognition of the staff engagement work that organisations have been undertaking.

Time for change

Following work with The Kings Fund the CQC will now look at whether an organisation demonstrates inclusive and compassionate leadership. This will include the visibility and approachability of senior leaders. Under the assessment of culture the CQC will now ask:

Do staff feel supported, respected and valued?

The NHS doesn’t score well on staff feeling respected and valued in its annual staff survey, although staff do generally feel supported by managers and colleagues. Organisations may need to focus more on this area in future. Organisations have addressed this issue in range of ways including though awards ceremonies and schemes. It will also ask:

Do staff feel positive and proud to work in the organisation?

The CQC is likely to look at data from the survey on whether staff would recommend the organisation as a place to work as well as any local surveys and direct discussions with staff. The NHS does reasonably well on the organisational pride indicators in the survey but there are considerable variations between and within organisations and employers may want to look at how best to encourage positivity and pride.

There has been a lot of work around encouraging staff pride in organisations through locally developed values. 

There is also a specific section that looks at the involvement of staff and in particular asks:

Are staff actively engaged so that their views are reflected in the planning and delivery of services and in shaping the culture?

The overall score for the NHS on staff feeling involved in decisions are good at team level but levels of involvement for overall organisational decisions tend to be lower. This question looks at involvement at service planning level, so organisations may need to look at how they involve staff in this area. The CQC will also look at staff involvement in quality improvement, which many organisations have already been addressing, and examples are highlighted in our latest briefing.

What is expected?

There are no major changes to the descriptions of what is expected at each level, although the descriptions should now be much clearer. By the end of June under the current framework the CQC rated 18 organisations as outstanding and 14 as inadequate. We hope this balance will improve over the next year to better reflect the efforts of organisations across the NHS.

NHS Employers is keen to get feedback on how the new framework especially once it is applied to inspections. Please email StaffEngagementNews@nhsemployers.org or send me a tweet @NHSE_Steven

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