Community Care reports that the CQC yesterday released figures stating that 42 adult care services (that would be care homes and home care agencies) have been closed over the last year following action taken by the registration authority. A further 51 services were closed following ‘poor’ ratings.
The Guardian breaks down the figures a little more minutely. And the figures deserve examination.
Those 42 services comprised of 34 care homes and 8 agencies.
Of the ‘further 51’, that includes 39 care homes, 11 care agencies and 1 nursing agency.
The total amount of residents who have needed to move places of residence due to these closures is 1600.
How is this not a national scandal on the front page of every newspaper?
It may or may not be obvious (probably not, come to think of it) but I do haul around searches for care homes and poor practice in care homes including ones that have been forceably closed – that is active searching – and maybe 3 or 4 might have been on my radar. So that’s an awful lot of highly vulnerable people who have been subject to incredible disruption, often linked to abusive practices in these care homes that have completely slipped beneath the public radar.
The Guardian lists the reasons for these closures as being
• verbal and psychological abuse of residents;
• medicines not being managed safely, leaving people at risk of not receiving vital medication;
• lack of medical and nursing care;
• staff not legally able to work in the country;
• poor sanitary conditions;
• lack of staff training.
Unfortunately, verbal and psychological abuse of residents is always a potential danger in work with vulnerable people. Residential homes can be a rich ground for potential abuse and sometimes the ‘wrong’ people are attracted to the kinds of work which can allow for abusive power-plays. It is despicable, it should never happen, but it has and it will, unfortunately. The only way to stamp on it really is strong regulation and good management.
All the other issues though seem to point to potentially money-saving measures related to staffing – illegal immigrants will invariably be paid a lot less than ‘legal’ employees. Poor medication management points to poor training. Training costs.
Lack of medical and nursing care? Medical and nursing care costs.
Poor sanitary conditions? Cleaning up costs.
Lack of staff training? Training costs.
Do we see a theme here?
It is a very pertinent theme as we move towards an NHS which will increasingly draw on private enterprise.
This announcement and these figures are in advance of a new regulation system that comes into place on Friday. I’m fortunate to have a very good friend working in CQC as an inspector. We go back to when we worked together as care assistants in the same residential home. Now, that makes me feel old but I raise it only to show how strange it is where our careers take us – anyway, I use her as a sounding board about my day to day frustrations and equally have a neat little insight into some of the behind-the-scenes changes in the various regulatory bodies that have become the CQC. It sounds like a mess, to be frank.
I lost any faith in the regulatory system a while back – not because there aren’t good people working there – indeed, taking my friend as an example, I would be hard pushed to think of anyone with a higher moral compass as a practitioner and she couldn’t be more focussed on providing good outcomes but the constant flux in the system (and yes, retraction of staffing levels) does have an impact both on quality and on staff morale.
At the ‘sharp’ end we have abusive systems in residential homes which are able to rattle along without sufficient oversight and regulation because there aren’t the people to provide the level of supervision needed.
I don’t want to colour the past in roses unnecessarily. I know there were problems, certainly with the physical structures of homes but with private companies, the motivation to ‘get better’ and ‘improve’ is not sufficient to force their hands. It only occurs when the delivery is so very poor that they are actually losing money.
There was an interesting quote from Cynthia Bower, the Chief Executive of the CQC in the Guardian where she says .
“This is where we’ve been focusing our attention over the past year as we get the sector ready for a new registration system that will be even tougher when care is not up to scratch.
My ‘mole’ in the CQC would claim that this is a part of the problem – the focus on changing systems has taken people away from front line inspections and where I’d agree with her is that the desk-based inspection systems do not provide any protection to those the system is meant to protect.
I know the system is due to change but in my old fuddy-duddy way, I would say there is absolutely no replacement for spot inspections regularly, day and night, weekday and weekend, from inspectors.
A ‘good’ report one year is no more valid than a CRB check one day after it has been completed. Bad things can happen the day after an inspection takes place.
Yesterday I was talking to a family member about a problem that she raised regarding a residential home where her mother is currently placed. This is a ‘good’ residential home.
It isn’t an issue that could be termed to be ‘abusive’ but it shouts ‘poor staff training’ to me. One member of staff saying one thing can make a ‘good’ residential home ‘poor’.
I know it’s not fashionable and I can’t see it happening – not in the current climate – not ever, but when the staff were employed directly by the local authority, at least training, pay and conditions and supervision could be better enforced.
Of course, we can never roll back the privatisation of the care sector but it’s amazing how few lessons have been learnt from the difficulties faced. I suspect it’s because it is an aspect of people’s lives that no-one really wants to think about unless they are directly faced with it.
I suspect it is part of an ingrained fear of growing old and possibly internalised ageism which sees ‘the economically redundant’ elderly as being somehow peripheral to mainstream society and their needs, wishes, wants, desires and aspirations – even if those aspirations are about living out ones’ life with the necessary care given in a dignified and sensitive manner.
Older adults will never have the same voice as young families in drawing the attention of the exchequer.
Why aren’t we shouting about these residential homes that deliver so poorly? Why isn’t every single closure on the front page of the national newspapers? Why does no-one care about the ways we treat older adults in this society? How is this able to happen?
Money, guilt and fear, I suspect.
This is why I wanted to work with older adults initially and it remains the same ten years after qualifying. There is so much more work to be done. It can feel like swimming against a rising tide but if we don’t shout out and shout frequently, all will be lost for our futures.