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Personality questionnaires and aptitude tests have long been used when recruiting in the business world, but social care providers are increasingly turning to psychometric testing in the pursuit of quality frontline and management staff.

The recruitment method emerged as an option either already in use or under consideration at a recent roundtable event held jointly by the Voluntary Organisations Disability Group (VODG), a body of over 50 leading voluntary sector pan-disability organisations and the English Community Care Association (ECCA), a leading representative body for independent care services in England.

The debate, entitled Assuring Quality in Learning Disability Services, was held at the Westminster office of law firm Radcliffes LeBrasseur under the Chatham House rule to allow for a frank discussion without attribution. The aim was to share ideas on how to boost quality in care, explore the barriers to this goal and how to overcome them. The 17 speakers around the table included senior staff from the UK’s leading private and not for profit providers.

In the wake of the Winterbourne View scandal and renewed focus on regulation and inspection, discussions about quality in the care of those with complex needs are timely. As one roundtable participant said: “With the most recent issue of Winterbourne View, the challenge is how you ensure the delivery of consistent quality - not just on front line but from the top to the bottom of the organisation?” Another member of the debate added: “With all the best efforts to get recruitment right, we sometimes get it wrong – so how do you go about recruiting people with the right values?”

One speaker, whose organisation supports around 1,500 people with learning disabilities in the south of England, revealed that the group started using psychometric testing in the last year to hire staff with the “right” qualities. “We use a tool that scores people as ‘carey’ or ‘non-carey’ and also scores them on how flexible they are. If someone has an overcaring, stifling approach but are flexible and can adapt, then we can work with that.” Two other organisations said they were considering using psychometric testing for front-line staff.

There was some concern, however, that applicants whose personalities did not fit the bill but who were well-qualified might consider employment tribunal if they were not hired after a psychometric test. The answer to this dilemma, as one contributor said, is “to be clear about why you think that person fits the values of the organisation – and that is all you need to say in terms of justifying your decision”.

Psychometric testing alone, of course, does not guarantee success in creating high quality care. It is one means to an end, as the roundtable heard, but has to be used within a management structure and ethos that drives and supports improvement in care.

The voluntary sector provider that currently uses psychometric testing embarked on a management re-structure three years ago. Its new structure established a network of locality managers or “quality champions”, whose job it is to act as entrepreneurs in their areas “developing people to address quality issues in their services”.  Each manager undergoes a coaching programme and has access to a team of specialist coaches in areas ranging from finance to human resources. “They are after all responsible for all those agendas in their services,” the speaker explained.

The restructure also clarified the role of the executive directors, now responsible for sharing best practice across the organisation, and driving quality. If they see standards slipping, they call in the locality mangers to work on a recovery plan. To ensure that an understanding of “quality care” trickles down to the frontline and, most importantly, to service users, the individuals supported are asked about issues like what privacy means to them or how they want people to share information about them. Everyone, as the speaker from the organisation stressed, should be “owning quality”. A quality ethos has to permeate the whole organisation, so that quality is the word on everyones’ lips.

Line managers supervising support workers collect evidence demonstrating how well staff are complying with someone’s preferred support plans. The contributor added: “We coach line managers to find evidence of compliance so we can audit it and find it, so in turn CQC inspectors can audit and find it easily.” Good internal auditing processes “makes for a better inspection experience as inspectors can get hold of information more easily”.

The issue of internal and external audit and inspection of services brought the roundtable to the sector’s perennial challenge; the need to rationalise inspections and audit. As one member of the debate put it: “If we are all making enormous amount of effort to collect data, does that align with what our external auditors are asking us or are we just duplicating things?”

There was condemnation of the amount of data collected by local authorities and CQC – some of it through tick-boxing exercises rather than with any subtle analysis of quality outcomes - and multiple inspections. “It is an inept way of monitoring quality and adds costs to the social care system,” one speaker said, while others called for “rationalisation of inspection and monitoring” suggesting that at times regulation seems to be “a stick to beat providers with”.

One care provider recalled how an inspection of a care home was followed a few days later by one from local commissioners: “They were all looking at the same things, just with slight permutations.” Separate visits in short spaces of time from inspectors, and commissioners looking at very similar issues was described as inefficient and disruptive.

There was agreement that duplication and bureaucracy distracts people from the job of caring and, ironically, improving quality for service users. One debate member said: “If someone [at a government level] had the courage – although it doesn’t win enough votes – to say ‘let’s knock all this together, you’d save money not paying people to do the same job.” Despite the criticism of the inspection and regulation regime, it was stressed that the answer is not to keep inspectors away, but for them to build their understanding of services and start being consistent in their judgements.

On the subject of regulation, there was a concern that the personalisation agenda would be harder to pursue while staying on the right side of risk and the regulators. While social care watchdog the Care Quality Commission (CQC) does not regulate services bought by individuals using direct payments, some voiced concerns that regulation might have to get tighter as more people got personal budgets in order to ensure safety and wellbeing. The personalisation drive, argued one participant, might affect care quality in another way as it demands that staff, usually expecting to work shift patterns, have to work much more flexibly. “Where are your motivated, happy, well-balanced staff if you’re asking the unreasonable – where’s the quality for them?”

Inevitably, the roundtable debate moved on to the impact of funding pressures on the quality agenda. “Local authorities are cutting fee levels in an arbitrary way,” pointed out one speaker, “but expecting a Rolls Royce service – it’s as if they live in a parallel economy.” Another speaker added: “It’s not going to get easier for the next two to three years, maybe longer, what can be done to protect service users?” One participant advised that providers should have courage to “walk away from the contract we cannot do it at that price - the external [economic] context will get chillier, so what is your own bottom line around quality?” This attitude would be harder for smaller providers to adopt, it was acknowledged.

The onus, the roundtable was told, is on providers to “think creatively about the business model”. Outcome-based commissioning, the discussion heard, is one relatively new concept that allows funding to be aligned to results.

Continuing the debate on overcoming the challenges to quality, the roundtable heard that leadership and ownership of “the quality agenda” is vital and should be “everybody’s responsibility” in an organisation. “This is not just about the chief executive or middle managers but it is also about the frontline,” was one comment. Leadership is vital, another speaker stressed, because sometimes if you change the mangager “you can get a very different approach out of the same staff – and that is amazing to watch.” If good quality is really to get embedded throughout an organisation, it also means placing greater responsibility on boards and trustees to embrace the concept of raising standards and monitoring the experience of the service user.

The roundtable also discussed driving and monitoring quality through service-user involvement in assessing and auditing care and support. The  “service user voice” and influence are vital, speakers said, as it allows people in receipt of social care to act as “quality champions”, in the way the CQC uses “experts by experience” alongside traditional assessors. Unfortunately, one participant pointed out, many such service-user led assessment schemes are threatened by the cuts and tight operating margins. Local authorities, are keen on service user led audit processes but are increasingly unable to pay for their cost. It was agreed, however, that the voice of the social care user is absolutely crucial to improving quality: “Independent advocacy has got to be part of the quality agenda.”

Ultimately, however, there was unanimous agreement that assuring quality is “now more important than ever” given the cuts, a post-Winterbourne focus on risk, regulation changes and an all too often inconsistent inspection regime. The onus, the roundtable concluded, was that social care providers must themselves steer the debate on quality. “Do not think someone from outside is going to come in and drive up quality,” said one provider, “this is our responsibility. Another added: “Too bad if CQC is only interested in compliance and no longer focuses on quality improvement,” “we should be doing something ourselves and fill that gap.”

As one member of the roundtable concluded, “the only people who can really deliver quality and assure it are those responsible for delivering the services”.