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.
- Care homes ‘gold standard’ rating (bbc.co.uk)
- Leading article: The dangers of a circuitous approach (independent.co.uk)
- Nursing homes face ‘more scrutiny’ in drive to lift care standards (telegraph.co.uk)
- ‘Excellence ratings’ for care homes (independent.co.uk)