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By Debbie le Quesne

Archive for April 2014

Ahead of Panorama: Secret abuse that must be rooted out

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Understandably, the care sector is a little twitchier than usual today as it braces itself for tonight’s shocking report by Panorama.

HC–One, which features in the ‘Behind Closed Doors: Elderly Care Exposed’ report have already gone public by responding with the announcement of introducing a camera-watch system in its homes.

The Care Quality Commission also has a response on its website which has been picked up by a number of publications.

Clearly, we still need the Panorama approach to expose rotten care, but it makes me feel ashamed that we still have not cracked an effective screening to ensure rogue employees are kept well away from the care business.

This evening’s Panorama investigates what life can be like inside the world of elderly residential care homes and asks if parts of the system are letting down our elderly.

Secret filming uncovers what can happen away from the eyes of relatives and Commission inspectors and shows the lives of some elderly and vulnerable people blighted by poor care.

I read that since the episode care workers have been suspended and others convicted of assault.

We struggle so hard over years to present all of the good care that hundreds of homes deliver and in a brief hour all of good work is undermined. I am not for one moment suggesting that such abuse is silenced or ignored by the media, but hope the public understands that all care is not bad. Sadly, I feel this morning that such wishes are just a dream.

On it’s website, the CQC posted: “CQC carries out an unannounced inspection of every care and nursing home in England every year – more often if we believe people may be at risk. This system of regulation can and does identify poor care which CQC then takes action to tackle.

“However, what it cannot do is to identify and stamp out deliberately concealed abuse. By its very nature, concealed abuse takes place away from the eyes of managers and inspectors and can even take place, as in this case, in a well-run care home. Abuse of vulnerable people is a criminal matter, and is rightly handled by the police and the courts.

“CQC has taken action against a number of providers where a current risk to people has been identified. In this case, the risk had been dealt with by the removal of the care staff involved by the home. CQC’s role was to make sure residents were protected once police and social services had acted to deal with the abuse shown in the hidden camera footage. CQC acted quickly and appropriately in this regard.”

My sympathy is extended to the people affected in this case and I have no words to express my anger that fellow human beings can do such cruel things to vulnerable people. Yes, I know that there have always been ‘bad eggs’ and that some have no conscious about wrongdoing. I guess I want the culprits to understand the full extend of the damage they do, firstly to their victims and the victims’ families . . . and then the wider care arena.

Get ready to man the phones Debbie!

New arrangements for CQC inspection intervals

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Care businesses scoring well with the CQC will be inspected half as frequently as they are now under plans to take a more “risk-based” approach.

The new arrangements will come in from October this year.

The commission plans to ditch annual inspections and introduce a system under which services judged ‘outstanding’ under the new performance rating system are generally re-inspected within two years and ‘good’ services revisited within 18 months.

Logically, services judged to be ‘requiring improvement’ will be seen within a year and those rated ‘inadequate’ re-inspected within six months.

The CQC will also carry out responsive inspections where there are concerns and inspect 10 per cent of ‘good’ and ‘outstanding’ each year to ensure its ratings system remains valid.

The proposals have been published in a new – yet another – CQC paper.

We must do our best to keep abreast of how the inspections are going, as we all know the bar is getting higher. However, currently we have a good relationship with the Commission and it’s something that I wish to explore more.

CQC says its latest reforms would strengthen the regulation of adult care services. The key aspects of the reforms are:

  1. Setting a higher bar for registration, including ensuring that directors of providers meet a “fit and proper persons test” before their services can be registered
  2. The introduction of a four-point ratings system, with all adult care providers rated by 31 March 2016
  3. Focusing assessment on five questions – whether the service is safe, effective, caring, responsive and well-led
  4. Ensuring inspectors specialise in adult social care, rather than cover health services as well, and increasing the numbers of service users and carers involved in inspection teams
  5. Taking tougher action against poorer performers, including being able to prosecute providers for serious care breaches without issuing a warning notice first.

The Commission has stated that it is planning to increase its focus on how well providers are complying with the Mental Capacity Act 2005 and, where relevant, the Deprivation of Liberty Safeguards (Dols).

I am already aware that some members of West Midlands care Association have been caught out on Dols issues regarding bed rails. Just remember your paper trail and a proper risk assessment needs to be in place, otherwise the devices can be seen as restrictive rather than something for personal safety.

HC-One to install care watch cameras

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So what’s making the news today in social care? CCTV – not necessarily for security as one would expect, but as an ever-watchful monitor in residents’ rooms to stop abuse, neglect and theft.

And where’s the dignity in this, I wonder? To their credit, HC-One, the company introducing the system, are presenting the monitoring as an opt-in package.

The operator, which runs 227 homes across the UK, has conducted a public opinion survey which it says shows 80 per cent support for the move.

According to the Guardian, the newsbreak comes ahead of a BBC Panorama programme on Wednesday due to feature secret filming of residents of two homes – one operated by HC-One – being neglected and mistreated.

I’d prefer to think there is a better way that the George Orwell Nineteen Eighty Four approach, but I can’t. I’m saddened that this is the only option left.

Dr Chai Patel, HC-One chairman, being quoted in the Guardian, says the filming revealed “shocking and distressing failings.”

And I can understand that HC-One has little option but to respond in this way.

He argues that the cameras will actually “protect the wellbeing and dignity of those we support.”

I’ve blogged about this kind of monitoring before when the CQC floated out the idea last year. It forever frustrates me that poor carers managed to get through interviews and abuse those who are most vulnerable.

In the survey carried out by HC-One 2,000 adults were questioned and 36 per cent strongly supported the installation of visible cameras in care homes and a further 44 per cent “somewhat supported it.” Just 14 per cent said they opposed the idea.

The figures speak for themselves: We have a lot to do to change public perception about the care we give.

The HC-One home to be featured by Panorama is Oban House in Croydon. Seven members of staff were involved and all were subsequently dismissed.

NCA survey to help strengthen fee negotiations

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Our colleagues at The National Care Association want our help to strengthen the case for better local authority fees.

The aim is to harvest key information about settlement trends over the last five years in in each area they represent.

It’s emerged that last year when the NCA was meeting with a group of care homes about local authority fees in the South East, homeowners there were able to pinpoint exactly what the increases had been over the previous four years and the proposal from April 2014.

  • In this five-year period the breakdown was:
  • For two years, an increase of 1 per cent each year
  • For one year an increase of 0.5 per cent was agreed
  • For two years no increase at all was offered

Clearly over a five-year period they had therefore received an increase of 2.5 per cent in total. 
 Inflationary increases in care homes have risen at 3 per cent each year, according to the NCA.

With an effective inflationary drain at 15 per cent, in real terms the care home operators in that region had suffered a 12.5 per cent loss.

Fired by this financial cameo, the NCA has asked members to take part in a survey to identify key fee increments in operational costs against the local authority settlements.

Filling in the form is a five-minute job and anything that strengthens our arm in negotiation a more prosperous future must be worth our time.

I’m sure chairman Nadra Ahmed OBE and Sheila Scott OBE, the chief executive, will appreciate our cooperation.

Please click here for the survey.

Human Rights Act now to include care at home

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Those receiving state-funded care in their own homes will now be given additional protection by the Human Rights Act.

Government ministers have agreed to the move following pressure from the Liberal Democrat side of the coalition.

An amendment to the care bill in the Lords will be tabled to make sure the Human Rights Act covers people receiving care in their own home, whether from the state or a private body under contract to the state. However, it will not apply to self-funded, privately provided care.

The announcement, which I applaud, comes after a six-month campaign by pressure groups for elderly people, as well as by the Lib Dems.

Let me quote a national newspaper: “The issue of protecting vulnerable elderly people has been pushed back and forth between the Commons and the Lords, with the Ministry of Justice arguing that previous case law did not mean there was any ambiguity about the extent to which human rights legislation covered state-funded social care.

“There has been cross-party pressure to extend the protection of the act beyond those currently covered – mainly those receiving care in care homes.”

Previous Liberal Democrat care minister, Paul Burstow, led the charge against the Conservative stance, to ensure that people who receive care in their own homes should be covered by the Human Rights Act.

It makes a lot of sense to me . . .Why on earth should people’s rights be lost for having care delivered into their homes!

The change of heart has been welcomed by Age Concern and the Labour Party and no doubt a raft of other organisations too.

Wheels turn for charity as Skills for Care seek high-flyers

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You’ve heard the expression “on yer bike” and that’s just what residents and staff are doing in a Newcastle care home.

But they are not taking to the highways – just to the fitness room where they are trying to clock up some 1000 miles on exercise bikes. I love it.

The image breaks the stereotype, and indeed surprises some of us that those who need specialist care could do this kind of challenge.

The sporting participants from Pembroke Lodge will cycle the distance of the famous John O’Groats to Lands End trek in a bid to raise funds for the Cystic Fibrosis Trust and their own residents’ fund.

Reported in the online magazine Care Industry News, home manager, Joanne Bailey says: “Introducing an exercise bike was originally intended to encourage residents and staff to enjoy some light exercise.

“One of our carers mother’s is affected by Cystic Fibrosis, so we wanted to raise some money to show our support to her and the charity that helps her. We also rely on the residents’ fund for activities for the residents, which is why we are halving the funds raised between the two [causes].

But what I find interesting is how the residents have suddenly become competitive, with each person wanting to beat one another in their sessions on the bike.

The finishing line is planned to be April 29 and the home has been pledged £300 in sponsorships already, with the aim to raise as much money as possible.

Pembroke Lodge specialises in mental disability care, including neurological conditions, and currently looks after of six residents. But I wonder what could be achieved by introducing more robust physical fitness programmes in our homes for the elderly for those who are more able? With funding care now in a nationally-recognised crisis it’s doubtful this could ever become a reality in most small homes.

These stories, however, inspire me and I hope the members of the West Midlands Care Association that I lead.

For the people at Pembroke Lodge: Go for it! The finish line is in sight.

Meanwhile, I hear that the National Skills Academy’s graduate management training scheme, set up in response to the need for a new pipeline of talent to inspire a new generation of social care leaders, is looking for new students.

For a time, funding for the fifth cohort of the scheme was in doubt. But a reduced numbers course is now on track. Applications for cohort five are now open and close on 28 May. To be successful, graduates need to be passionate about social care and keen to make a difference.

Each graduate will spend a year working with a host organisation.

See http://www.nsasocialcare.co.uk/programmes/graduate-scheme-internship-programme.

‘Zombie’ comment on care plans reveal true divide

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Care minister Norman Lamb is not happy. Indeed he appears to be furious after his £5bn plan to join up social care and NHS funding was likened by a doctor to “zombie” that needed putting out of its misery.

The care and support chief was speaking at the School for Social Care Research conference and had told delegates that “great chunks” of NHS cash was going over to personal health budgets for people living with long-term conditions.

A question from the floor reminded him that at another event a show of hands revealed that overwhelmingly most health professionals were against the idea, with one medic likening the plan to an “intellectual zombie”, an “ideologically-driven dead idea still moving” that needed putting out of its misery.

Lamb’s response was brisk: “It demonstrates the cultural change that’s needed,” he snapped. “The idea that the clinician knows best has to be stopped.”

It’s a brave stance by anyone’s reckoning and though I welcome the promise of more funds, we must find a common ground with the NHS and be able to work together.

And may I add that all NHS staff are not the same. With West Midlands Care Association I have fostered some great working relationships with NHS-led care colleagues.

Lamb’s angry retort reveals the real tension over his plans, something I have mentioned many times in my blogs. If I’m honest, I can really see any movement to scrap the plan.

The coalition’s Better Care Fund (BCF) will mark a significant step forward.

According to the national media: “Lamb has confirmed that the fund, set up with a pooled £3.8bn of existing funding, mostly from the NHS, will in fact kick off next year with at least £5bn available to develop integrated care services, thanks to more than 50 local areas electing to chip in extra to that required.”

Sadly, there has always been a chasm between health and social care and the enthusiasm to join the two together I fear is only skin deep.

I quote yesterday’s Guardian: “A few months ago, when there were fears of a winter crisis in the NHS, Care England, representing private care providers, approached Downing Street to offer help. Encouraged by officials, it emailed health trusts and CCGs, among others, to make beds available in care homes for less acutely ill patients so that pressure on hospital wards might be eased.

“According to Care England, barely 10 per cent of its emails were even opened. Still fewer prompted any response. As long as such narrow thinking persists, the health and care system is doomed to remain disunited – and to fail.”

I’m afraid Mr Lamb will need more than a sticking plaster approach to fix this problem.