On Failing Care Homes

Today, the BBC report on a statement by Unison, who represent the inspectors who work for the CQC (Care Quality Commission), explaining how failing care homes will be able to thrive under the ‘cost-saving’ exercises which are the utterly despicable ‘desk based inspections’ that I’ve been railing against for over a year.

This is one of many areas that I don’t want to be right. I don’t want to be a ‘Cassandra’ type figure but I do want people to care and know that elderly and vulnerable people are not being protected by the current regime of inspection and that things are going to get worse unless there is a massive change in the way the CQC is run – remember the Chief Executive is Cynthia Bower, the same woman who was responsible for the West Midlands Strategic Health Board – which covered the Stafford Hospital whose problems we have become all too aware of. Hardly a glowing CV for someone appointed to a regulatory body.

The BBC article explains

Unison says the new system of written self-assessments will mean thousands of homes will avoid inspections altogether if they look good on paper.

But the Care Quality Commission, which introduced the system, said it would let inspectors focus on failing homes.

Which would be fine if they DID focus on failing homes. I  am, for the record, currently in the middle of a really unpleasant safeguarding investigation at a so-called ‘Good’ residential home. It only takes one day or one person for a ‘good’ home to turn into a really bad home. This is the point that is utterly and comprehensively missed by the ‘new’ system.

The BBC go on to explain

The new system replaces yearly automatic inspections for all homes.

It came into force in October and now means that homes which provide a good written self-assessment may not be inspected again, unless there is a serious complaint made about them to the commission (CQC).

For me, this is a horrific institutional abuse and dereliction of the duty of care that the state has towards adults who rely on us to provide high quality care for them. Firstly, I know for a fact this has been the system for way before October, as I have spoken to an inspector directly about care homes that I am worried about and have been told that they haven’t been ‘visited’. This is NOT a system that ‘came into force’ in October’.

And sorry, but when it takes a ‘serious complaint’ to trigger an inspection, we are setting such a low baseline for the standards of care that we expect. If they MUST move down this route and, if it wasn’t very obvious, I think it is a cruel and horrendous path to tread – then surely only those homes which provide faultless and outstanding care would be able to produce self-assessments, not ‘only those that don’t have serious complaints made about them’.

The CQC is not able to manage the work that is being generated for it – that’s the problem. It is purely and simply about cost-cutting.

According to the BBC article

Unison, which now represents about 700 inspectors, claims that the workforce numbers have halved since 2004.

And there we have it. The key to why the systems have had to change. It is not about providing a better service, it is not about more tailored inspection regimes – it is purely and simply about cost and cutting back the number of inspectors. They can’t spend two days inspecting every residential and nursing home because they don’t have the time to.

Paper-based self-assessment is as valueless as the paper it is written on. It is a completely inadequate system that produced poor quality care.

Can we rely on whistle-blowers? Perhaps but remember the people who often work in residential homes who we might rely on are often very poorly paid and this is a sector that relies very heavily on transient staff on minimum wages. Particularly the worst homes.

What about council’s own Quality Assurance teams? This is what I was told, informally, in conversation with an inspector. On the other hand, someone I know who works in our own council’s monitoring team tells me of potential job cuts they are being subject to. This is leaving a monumental gap in the checks and balances of the care home system.

Care is a big money business in this country.

Just last year, Andrew Lansley, the Secretary of State for Health under whose auspices the care sector lies, was given a donation to his private office of £21,000 by Care UK – one of the largest care ‘industry’ operators whose poor quality of care has been highlighted in the past in Panorama.

However this is not a party political issue. The previous government showed little care or interest in the proper regulation of residential and nursing care services but the further erosion of local authority budgets will lead to a worse system of regulation than we have ever had in this country.

This is scandalous in the extreme. Anyone from this government (and the last, to be honest) who claims they are protecting the vulnerable need only look to both the decimation of proper and thorough regulation of the care sector which has left the way open to abusive practices and the crushing of local authority budgets without ring-fencing which will lead to any back up checks and balances being slowly (or not so slowly) eroded.

No-one seems to care enough about these changes and what it means for quality and the CQC management seem to be able to get away with reassurances that ‘paper based’ inspections will be ok.

They won’t and they aren’t. I know. I worked in residential homes for years before I qualified. There is no such thing as over-regulation in this sector because the power imbalances are enormous and in some of the care homes, the residents, due to issues of capacity or through fear of consequences are not able to speak up about what is going on. We cannot rely on family members to be whistleblowers, it isn’t fair and it should be accepted that we can provide a good standard of care.

And, you know, not everyone has family.

And we can’t necessarily rely on social workers, like me, who go and review. Yes, I can and do pick up some aspects of care but we don’t have the powers to look at records about people we are not primarily involved with (quite rightly). We can raise concerns about individuals when we notice them but that is no replacement for a proper and stringent regulation regime.

We need inspectors, we need inspections and we need more of them. But they cost and it isn’t a price the government is willing to pay. But it should be.

9 thoughts on “On Failing Care Homes

  1. “The CQC is not able to manage the work that is being generated for it – that’s the problem. It is purely and simply about cost-cutting.”

    This seems to be a theme with the present government.

  2. When this issue arose on your blog last year I described some work I and a couple of colleagues had done – randomly accessing inspection reports on 1 star (‘adequate’) homes. These homes ought to have been the beneficiaries of the ‘extra’ time available from a more targetted approach (and less frequent inspection of ‘good’ and excellent’ homes).
    Sadly, but all too predictably – and remember this was before the God of Deficit Reduction was being used to justify all cutbacks – these adequate homes were being inspected no more frequently or, it might be argued, rigourously than any other type.
    The Brave New World (ring any bells?) of inspection, introduced by CQC in line with the new “essential standards of quality and safety” will mean that inspectors set foot in homes, and other services, much less frequently and instead will become increasingly reliant on information provided by service managers. Self assessment – isn’t that as discredited as market economics and so-called target culture?

  3. I think another issue here is that councils will no doubt ease their budget pressures by keeping increases in their maximum funding levels below inflation leading to more pressures on staffing.

    Now certainly isn’t the time to be easing off regulation.

  4. I worked in social care for years, and whistleblew several places to both CSCI and the local authority. They took years, and many more complaints, to act. In some instances, they didn’t act, because the institutions I was working in were not regulated, as they were for adults with learning disabilities who didn’t need personal care – that didn’t stop them being vulnerable to abuse though.

    Where were the whistleblowers in Cornwall, when hundreds of adults with learning disabilities were abused by staff at Cornwall Partnership NHS Trust? Where were the doctors and nurses and care workers who we are supposed to rely upon then? In the end it was Mencap who blew the whistle. Many residents didn’t have families, and those that did may not have directly witnessed much of the abuse because it took place behind closed doors – these are people deprived of their liberty. Not a single prosecution followed one of the worst and most widespread cases of institutional abuse in the last decade, in part because (apparently) all the police could rely upon in evidence was documentation supplied by the NHS trust themselves. And for reasons unknown the CSCI failed to prosecute for the only crime they had evidence for – the illegal, and criminal, failure to register a care home. Presumably, then, those managers still continue to practice somewhere in the country.

  5. As so often happens, we’re up against a history of vested interests, special pleading, elitism and self-regarding ignorance contaminating the way inspection was designed . . . from the start. And now we’ve got extreme touchiness and aggression emanating from the guilt that the comes from colluding in something that they knew was wrong.
    All the training organisations lobbied for inspection to be based on giving them work. So they change the rules and the formulae as often as possible and make trainees jump through new hoops. It’s all good income.
    ECCA, NCF and RNHA (I’m not sure of NCA) all want to retain some sort of “quality ratings” (now providing another absurd quango – SCIE – with some more work for their impractical professionals). This is a commercially competitive mind-set. Fair enough – let them do their own and pay for them, if they’re so keen. They want to demonstrate for commercial purposes that their homes are better than others’ homes. It’s like schools being rated on exam results – the schools that are most effective in drilling their students to pass exams are regarded as the best, but it’s not got much to do with education.
    Even some care home managers like self-assessment and star-ratings (if they’ve got 2 or 3 stars) because once you’ve cracked how to succeed, it reduces the anxiety and exposure involved in having someone coming to see how the home REALLY works for residents.
    When you look at the whole care home “industry”, you can see how helpful this sort of formulaic, bureaucratic approach to inspection has been. Go to any care show and look at the vast array of lucrative businesses that are based on succeeding in inspection. They are quite open about it: “Buy our product and you won’t get any trouble from CQC.” Then look at the crowds of people who throng to the CQC presentations to be told what to do to pass inspections – they don’t let on that there aren’t going to be any inspections!

    Once you put RESIDENTS AND THEIR CARE at the heart of inspection, everything becomes much simpler and clearer. We can have good, regular, inspection (once a year minimum) and responsive inspection (whenever needed) for £100+ a year. (That’s what residents are paying at the moment – for nothing!) It’s not difficult. It’s a matter of clear thinking and principled commitment to the “primary task”: residents and their care before everything else.

  6. The CQC is not able to manage the work that is being generated for it – that’s the problem. It is purely and simply about cost-cutting.

    That’s my concern, too. The CQC arguably is no longer fit for purpose. We have overarching strategy meetings about care homes where there were loads of Safeguarding referrals, with care homes known to be frankly dangerous. The CQC failed to turn up to two meetings arranged with/for them.

    People have died and referred to the coroner with neglect, been shouted at, been forcibly restrained, been repeatedly bruised, not been fed, become biochemically dehydrated, not been given prescribed medication and the CQC didn’t attend and certainly didn’t act.

    I’m not at all comfortable that the CQC is resourced to ensure standards are acceptable.

  7. Thanks for all the comments. I think it seems to hit a common nerve and I wish I could think of something more hopeful to say rather than just keeping banging on about it again and again. My experiences with the CQC and CSCI haven’t been all that positive but I know some of the inspectors who are equally frustrated by the way they are being directed. I guess we just keep shouting..

  8. As a career, I used to quite like CSCI – never ran up against it, but it gave a warmish feeling when it did inspections and you felt someone else was looking out for our son’s welfare. I don’t get the same feeling with CQC. They have box ticking rules that aren’t appropriate for his care and seem far more concerned about getting these filled in than looking at what actually happens. Their change to registration has been implemented so ‘one size fits all’ that it temporarily (until we fought it) stopped critical parts of his service being delivered at all. The impression I get now is of a large beurocracy that relies on trying to frighten providers into submission while being only really interested in the paperwork – a sort of not very effective, badly organised secret police force.

  9. Thanks for that, Ned Ludd. You struck on a massive point that I didn’t include – namely that when the change to registration is/was taking place, the CQC stopped delivering critical parts of its service. I don’t know how well known this was. I know as you do, it was an absolute fact.
    Just as another aside, yesterday, I tried to contact the CQC to raise some concerns about a care home that I had visited. If you go to the ‘contact us’ part of the CQC site for social care (health is updated :p) there is actually no telephone number at all to call!

    Hardly attracting ‘whistle-blowers’. I had to call a central call number in Newcastle only to be told that the person I needed is away (that’s fair enough – everyone has annual leave/sickness) but there USED to be regional offices that I could just call and people would know about each others caseloads… ahh.. I never knew we had it so good.

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