By Debbie le Quesne

Care home paperwork – the balance is all wrong

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My desk has been overflowing with reports – there seems to be more than ever telling us that the financial cuts are crippling care sector businesses, and worse, warning that care is being compromised.

The latest offering I read comes from the Joseph Rowntree Foundation, underpinning what most of us already know that care home managers are spending 20 per cent of their time on paperwork rather than on leadership activities that could improve residents’ care quality.

In the ‘Is excessive paperwork in care homes undermining care for older people?’ report, research identifies more than 100 separate items of paperwork that must be completed regularly in care homes. All are responses to regulatory and commissioning requirements, so there’s no way to dodge the work.

Perhaps most damning is report’s conclusions and recommendations which begins: “The balance between prevention of poor care and promotion of good care is out of kilter.

“Care homes spend an inordinate amount of time attempting to cover themselves against potential blame or litigation for poor care. Instead of being an addition to care quality, paperwork can lead to ‘subtractions’ – literally taking away from the delivery or management of care.”

The latest edition of Caring Times sums up the findings admirably:

  • Poor co-operation and co-ordination between agencies responsible for regulation, monitoring and purchasing care results in information being duplicated, often several times with a slightly different emphasis each time. This effect is referred to in the study as a ‘composite burden’.
  • Staff see some of these information demands as bearing little relation to an assessment of the quality of care a home provides for its residents.
  • In the care homes visited, about half of the paperwork produced was used infrequently. Some staff felt that paperwork was inefficiently designed or implemented. Providers’ interpretations of the value of regulatory paperwork also varied widely.
  • Some staff felt they were judged more on an ability to produce quality paperwork than an ability to deliver quality care.

Research was conducted in two care homes in Birmingham and one in York and involved residents, relatives, volunteers, frontline staff, managers, commissioners, providers and regulators.

A summary of the report says: “Paperwork has limited our ability to quantify and measure the quality of interactions between care staff and residents.

“Paper offers false assurances in this regard and yet it is these interactions that are of ultimate value to residents and their relatives. Care should be provided in a way that is ‘human’ – focusing on the creation and maintenance of meaningful relationships between care staff and residents.”

Interestingly, essential responses cover 28 standards of quality and care. Are we over-regulated? I think so.

Additionally other agencies require completed paperwork with varying emphases across the country. My head is already in my hands.

The report also highlights that some requests made by inspectors and regulators are seen by care homes as bearing little relation to the quality of care provided. And then there’s the issue of duplication because there is little co-operation or co-ordination between different regulators and commissioners.

I think I’ve heard this before . . .

The report speaks of the “composite impact is often what homes are describing when they complain about a ‘paperwork burden’.”

In a nutshell the report finds that leaders’ time spent on paperwork could be better spent as a visible, leadership presence in the home; that the value placed on paperwork was too high compared to the value placed on providing high-quality care; thatstaff are judged more on their ability to complete paperwork than on their ability to deliver good care; that paperwork does not drive providers, commissioners, contractors and regulators to higher levels of co-ordination; and that regulation has the dangerous potential of undermining staff autonomy or be a substitute for professional judgment.

All of this information we know, but many of us only in an intuitive way. The JRF study has brilliantly articulated my own feelings and has given another useful tool for care sector lobbyists.

I’m aware this blog is far too long, so I’ll address the JRF proposals to cut back on the paper burden hopefully tomorrow.

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