Excellence Ratings for Care Homes

Yesterday, the government announced the unveiling of a new ‘gold standard’ or excellence rating for care homes. This is supposed to address some of the poor care that is delivered through local authority funded care.

I have my doubts. Not that I’m one to be necessarily cynical. But this time I am.

There are a number of reasons for my cynicism.

I believe the problem of poor care standards in residential and nursing care could be much more easily resolved than by a further level of ‘tick boxes’. All it needs, in  my massively oversimplified world, is more spot checks and random inspections – weekend and week day – day and night.

If a care home is doing its job and providing good care with adequate staffing, there should be no problem in well-informed inspectors and lay visitors popping in at any point and being able to speak to any resident or family member.

But this is too simple for the government.

The gold standard of excellence that they are introducing will be funded by the care homes and thus by possibly increased fees as these costs will filter down of course.

They will provide a new set of ‘tick boxes’ for homes to complete.

The Independent explains what the new system will involve

What will be rated?

* What may be included in the new excellence ratings

* Ratio of staff to residents

* Turnover of staff

* Activity programmes for residents and evidence that they are taking place

* All staff to be registered with the new Health and Care Workers Professions Council

* Minimum qualifications for staff

* Spot inspections and independent feedback from residents and their families.

Firstly, it’s important to note that these are issues that ‘may’ be included. Secondly, I thought that some of these issues were already a part of the inspection programme.  And if they aren’t they should be checked for ALL care homes – not just the ones that pay more to be part of the excellence scheme.

Basically, this ‘new’ system is a way of the government trying to add another layer of cost to what the CQC (Care Quality Commission – who are SUPPOSED to be regulating care homes)  should always have been doing.

The CQC claim that the new system will be owned by the CQC but administered ‘under licence’. Why under licence? Because it allows private companies to get their teeth in and allows more money to flow in. The CQC has proved that it is spineless, toothless and unfit for purpose.

The press release goes on to say

Chief executive Cynthia Bower said: “CQC’s role is to identify and react to signs that people may be at risk of receiving poor care. This means we can say we don’t see signs of risk at a provider, but this is not the same as saying a provider is offering ‘excellent’ care.

I say she’s plain wrong. The CQC does not identify poor care. They may react but they don’t identify. It is like pulling teeth from a dog to actually report poor care to them and the thought that they might actually, you know, physically walk into a care home and check the standards is living in a fantasy land where a community and country actually pay attention to the quality of care in residential homes. It should be a role of the CQC to define and award ‘excellence’ in care as a part of the current registration regime but under this new system, this role will be tendered out, at a price, of course – because, after all, what isn’t for sale in this country now – to private providers to ‘check’ and do the job the CQC should always have been doing –  but only for those who pay for it.

I don’t understand why the ‘star’ system was abolished (as it was last year) only to introduce another system at a higher cost. Why not judge ALL homes on this excellence standard rather than attach a higher cost to those homes that wish to ‘register’.

It all seems like a complete smokescreen to hide the toothlessness of the CQC (Care Quality Commission) and a way to garner more money from the independent and private care providers to pay for an inspection system that is not fit for purpose anymore.

Does no-one else see this? I’m amazed the government have the gall to get away with announcing this as if it is something new.

If they or anyone REALLY wanted to improve the quality of ALL people in residential care, they would fatten the CQC up with more inspectors and give the inspectors more leeway to inspect.

One of the worries of mine was also mentioned in the Independent namely that

At Christmas, the Care Quality Commission (CQC) carried out spot inspections of 234 health and social-care institutions, including nursing homes, which revealed significant lapses in standards in more than a third of cases. Ten reviews resulted in the highest form of censure, which could to lead to the commission withdrawing licences to operate.

After one review, a nursing home in Luton – run by Southern Cross, Britain’s largest care-home provider – was closed immediately because conditions were so bad. The commission found that 26 other institutions were not meeting required standards in all areas and ordered improvements.

So surely more and better spot checks are the way to unearth poor practice rather than another hoop to jump through at cost.

Why don’t the CQC just adjust some of their own criteria to include those elements raised in this so-called ‘excellence’ standard? Why does it need to be a separate and discreet system? Possibly because this way the government can raise money from it and farm out the inspections to private companies rather than relying on the toothless and frankly incompetent CQC to do.

Yes, I’m angry. I am angry because a real attempt should and could have been made to improve the quality of all residential care services nationally and it was fudged and obsfuscated. We are to be fooled by this ‘gold standard’ which is another way of saying ‘if you want our money for placements, you must pay’.

I see this system as being biased towards the large care providers. The Southern Cross/Care UK/Bupa providers at the expense of some of the small operations.

Some of the best service delivery I’ve seen has been in smaller one-man operations. I remember the care home I visited where the owner’s mother was a resident, her husband was the handyman and it felt like an extended family where the owner lived next door and spent most of the day sitting in the lounge chatting to the residents.

Would she be able to pay for an ‘excellence’ rating? Who knows – but the excellence and level of care was unmistakeable.

Should we be jumping in the air and celebrating a new excellence system? Maybe that’s what the government smokescreen wants us to do.

For me, the death of an effective regulatory system makes me sick to my stomach and makes me despair for the future care for older people in this country.

10 thoughts on “Excellence Ratings for Care Homes

  1. Pingback: Excellence Ratings for Care Homes - Fighting Monsters - Member blogs - Social Work Blog - Carespace from Community Care

  2. I (proudly) work in a care home and agree with everything you have said. The new ‘Gold Standard’ will be a total farce, paid for by those who have the funds to cover up their indifference to the very people they are supposed to care for. Money is often king.

    ‘My’ home is one of a very small group who would not have the funds available – as the profit margins are low as fees are invested in the people for whom they are paid – to achieve this ficticious award.

    I would be interested to know what happens when you yourself report a home to the CQC? I truly wish that any visiting professional contacts the CQC if they have any concerns.

    In the old system ‘my’ home could never attain five stars – despite the care being excellent – as the home is not purpose built; so it would appear that decor is more important than care provided.

    I dread to think what this new paid for by the receiver gold standard will cover up – the whole thing sucks. ‘My’ home like all, is swamped in tick box paperwork which deflects from actual care – but a tick box is just a box ticked and no proof need be offered.

    Spot checks – yes; any time in a twenty-four hour period.


    • Hi Anna,
      Thanks for your comment. My background is as a care worker in residential care and I feel very strongly about the good work that is done at that level. Training has been something that has already been brought into standards without need for an additional ‘excellence’ scheme – that’s what’s a bit baffling to me. Why not make these indicators ‘mainstream’ and expect them of all providers rather than only those that pay to participate in a voluntary scheme. It makes no sense to me.
      About reporting to the CQC, well, first it’s about actually finding the right registration officer which isn’t as easy as it sounds – then raising concerns often via voicemail. I’ve rarely had an inspector actually call me back. On one occasion, they did go out and do a spot visit which ended up in a large scale safeguarding investigation. These are not trivial matters.
      But it has to be pretty serious for them to take action, in my experience. They want to push everything back to the increasingly poorly resources local authorities.

  3. A good concise summary of a fairly big issue. Like you I feel angry – and there are so many dimensions/directions of that anger. We’ve had a series of national regulators over the past decade, each of which arrived with the promise to bring order where none had previously existed. Each has failed – okay the last one, CSCI, became a fairly effective publishing house producing a wide range of reports on topics affecting the quality of the services they were allegedly inspecting. But just as much of the blame for the speed of current government’s changes can be laid at the door of the Blair govt (it would not have been so easy to bring forward the NHS changes if NuLab hadn’t spent years messing around with structures and aping their market obsessed predecessors) so also can the present shambles and these planned changes – the out sourcing of ‘inspection’ – be traced back to CSCI’s ill starred attempt at aping the hotel and guest house industry by handing out star ratings. Sadly they couldn’t even be as humble as to choose one of the existing scales, instead having their very own system where you could fail to secure a star and still be allowed to trade… but I digress. If I was a care provider I’d be furious that I pay to register, and each year I pay to be inspected (and by definition my users are paying too) only to be told that if I want to have some universally recognisable way of portraying the effectiveness – or ‘excellence’ – of my service I’ll have to pay for another set of people to come in. Inspection now consumes significantly more money, employs fewer people, and carries out less inspections. Is this a national scandal – is anyone talking about it? No, just a few of us on the margins – at the moment – but MPs must call this system to account (as required by the legilsation). That’s made me feel better…!

    • Thanks Les.
      I know you have a lot of experience in this area so I appreciate your comments and find it hard to disagree. I was no fan of the star rating system to be honest. I think it led to some complacency. I saw much poor practice at homes rated ‘good’ and I had families tell me they didn’t want a placement in a home that was rated ‘adequate’ when I thought it offered better care on a personal level than some rated ‘excellent’.
      I think it’s a national scandal. That’s why I keep banging on about it. I want more people to care.

  4. The spinelessness of the CQC is absolutely astonishing. That it has failed to close any care homes, despite evidence that some should, speaks volumes. A law lecturer who works closely with CQC spoke to us today. He stated that the CQC lives in perpetual fear of being sued by the big providers if they make any intervention that might be detrimental to their business. This is not the actions of a robust regulator but a body that gives undue validation to a sub standard system through spurious rating systems. If everything is going down the privatisation route and away from a direct democratic oversight of Local Councils, surely regulation needs to be strong enough to take on big business.
    Also, does anyone actually assess how much the introduction of these new policies and programmes will cost, and if they will have the desired effect? Minimum qualifications etc are important points. But having completed NVQs in this area I feel that they are often next to worthless and just extra sheets that need to be filled in. The way to go should be spot checks as anyone can put on a façade for a couple of hours or create wonderful activity rotas without this representing what actually happens in the service. But also I doubt many people in care homes even know what the CQC is. If residents and families really were encouraged to write regular feedback on their experience, the CQC would get much useful information. They wont though because this information cant be easily quantified into gold star ratings etc. The CQC needs to stop using these star ratings to create warped reality of what good care is to deflect criticism but create a regulatory system that is accessible, to residents and family, with the power to intervene. There also needs to be an effective whisteblowing policy that will offer protection for staff that are really concerned.

    It is quite simple in one sense: The care system needs to care. It needs politicians who care about the people and not “efficiency” or privatisation; it needs regulators to care about the best interests of residents and not just being sued; it needs managers to care about their staff and residents, and not spurious league tables; and it needs staff who care about their clients even if they are overworked.
    The saddest thing is that I feel nothing will change. The current system reflects what society accepts and I for one feel deeply ashamed and frustrated.

    • Thanks Humanitas
      I agree about the spinelessness of the CQC. The problem is they are relying on council quality assurance teams and those teams are being cut now. For me it seems so obvious that more spot checks are the answer.

  5. Makes interesting reading, I’m not a Care Home professional but have visited plenty over the last two years and sometimes the smaller, slighty shabbier ones seem to provide the most caring, compassionate, interested care. It does of course vary massively and I agree spot checks are the only way to check that no-one is ignored, isolated or not being given the top care they deserve.

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