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By Debbie le Quesne

Archive for April 2015

Ratings posters edict seems heavy-handed

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With downloadable options for rating posters now on the CQC website, this is a gentle reminder not to forget the obligation to display inspection ratings.

Under requirements to display, these posters must be “conspicuous” at premises and websites.

Breaches of this regulation can move directly to prosecution – there’s the big stick – without a warning notice being served.

For split or multi-site providers, the posters must also be displayed “from each and every premises where a regulated activity is being delivered.”

Okay, I know people need to know the ratings, there’d be no point in having them if they were secretly squirreled away from public gaze, but no warning prosecution!

The feedback I’m getting is that for such a minor ‘offence’ – remember this nothing to do with the wellbeing of those receiving care – it’s heavy-handed.

It’s worth noting that providers will be able to defend themselves against such wrongs where they are able to show they took all reasonable steps and acted with all due diligence.

One element of the new enforcement policy does offer a glimmer of hope to providers as the CQC’s aim to take only action that it deems to be “proportionate”.

Granted, we have heard this before and providers on the receiving end of such action are unlikely to agree that the Commission is a proportionate regulator. However, in the light of appeals representations, this assurance should be at least a guide to the central pillar of evidence.

Written by debbielq

April 23, 2015 at 10:17 am

Food for thought

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In a recent blog, Editor of the Caring Times Geoff Hodgson writes about the reliance on national corporate suppliers – it’s cheaper and more amenable to head office control, he observes.

In an ideal world it would be lovely for care homes to favour their local suppliers, thus engaging more with community and supporting the neighbouring economy, a sentiment Geoff supports. Business sense, however, must prevail and the trend to shop cheaper is not only with care homes. Take a look at the Aldi supermarkets explosion driven by a canny public.

The regulatory burden of audit trails on food and the possibility a story being true about a home that wanted to ‘think local’ and was prevented from doing so by the administrative box ticking, really does highlight the impact of too much government control, says Geoff.

Hmm . . . it’s just the tip of the iceberg I fear.

Written by debbielq

April 22, 2015 at 8:23 am

Duty of candour – exploring the real cost of legalities

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Duty of candour – exploring the real cost of legalities

Like all computer users, the Google search engine is never far away from my fingertips, but I was amazed at the rash of links I found when I typed “CQC duty of candour.”

Page after page popped up – mostly because of some comprehensive work by the Commission search engine optimisation techy geeks. Clearly this is something CQC is going big about.

But these top of the pile listings were followed by law firm information articles, sinking in legal jargon and promoting their compliance services to avoid big trouble.

Some care observers branded the new regulation, introduced as ‘live’ at the start of the month, as “the rebirth of the CQC.” Indeed, the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 makes important changes to health and social care standards which now being regulated with fresh zeal.

They represent one of the main ways in which the Government is responding to the Francis Inquiry that recommended the enforcement of fundamental standards to prevent problems like those at Mid Staffordshire, Winterbourne View and elsewhere.

Lets get legal (promise I’ll be short): The new Fundamental Standards of Care replace the 2010 regulations and are a response to the Second Francis Report into events at Mid Staffordshire.

Whilst the 2014 regs cover, in broad terms, the same subject matter as those dealt with under the 2010 regulations, the ‘Standards’ are now much more focused, the language is more direct and they set out clearly the higher bars which all health and social care providers must adhere. This dovetails with the requirement in the newly- enacted Health and Social Care (Quality and Safety) Act 2015 which “will in the future require the Secretary of State to make any regulations considered necessary to secure that services cause no avoidable harm to those that use them.”

As part of that raft of change, the new duty of candour has been implemented. This provides that where a notifiable safety incident – basically those that cause harm –occurs within a service, there are certain notification requirements which must be followed.

Already emerging is confusion over the definition of ‘a notifiable safety incident’ and it’s critical all care workers are up to speed with this knowledge.

Under the Health and Social Care Act 2008 (Regulated Activities)(Amendments) Regulations 2015 the definition of ‘harm’ for independent sector health and social care providers is as follows:

  • Death of the service user, where the death relates directly to the incident rather than to the natural course of the service user’s illness or underlying condition;
  • An impairment of the sensory, motor or intellectual functions of the service user which has lasted or is likely to last, for a continuous period of more than 28 days;
  • Changes to the structure of the service user’s body;
  • Prolonged pain or prolonged psychological harm;
  • The shortening of the life expectancy of the service user;
OR
  • The service user requires treatment by a healthcare professional to prevent death or any of the above injuries.

Already the lawyers must be rubbing their hands at the potential money-spinning services they can offer providers to ensure the procedural steps in satisfying the duty, and evidencing it to demonstrate compliance, are in place.

It’s early days, but the impact of this new legal duty already appears to be looming as an extra training cost for managers and their staff. Who could possibly afford the consequence of getting this wrong?

Checklist: Having defined the notifiable incident, care providers must:

  1. Notify, and support, the relevant person as soon as reasonably practicable after becoming aware of a notifiable safety incident
  2. Provide an account of the incident as known at the time
  3. Advise what further enquiries the provider will be taking
  4. Offer an apology
  5. Follow up the above in writing, and provide an update on the enquiries
  6. Keep a written record of all communications

Guess WMCA will be running courses soon, but I promise we will do all we can in out bi-monthly member’s meetings so that no extra cost of taking people away from the workplace will be incurred.

Minimum pay: There’s nothing new to say

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More than a tenth of UK care workers are being paid less than the national minimum wage of £6.50 an hour, the BBC reported recently.

Some 160,000 are losing out on an average of £815 each a year, The Resolution Foundation think tank says.

And it added, some firms wrongly did not pay staff when they travelled between clients, on training or when “on call”.

We have heard it all before – many times before.

And we know too that minimum wage regulations say working time includes travelling in connection with work, and training or travelling to training during normal working hours.

I dearly want to respond with the beat of different drum, but I have nothing new to say,

The financial restraints of the industry are such that many employers are struggling to meet this legislation and while Local Authorities can’t pay any more for the Care Packages, I understand the dilemma of Providers.

Until such times when central Government sees fit to release its purse strings in a realistic way for the care sector, nothing is going to change. As for making more savings: That ship sailed more than 18 months ago. For my members of the West Midlands Care Association there simply isn’t anywhere else to find economies.

The Resolution Foundation, a not-for-profit research organisation, said the problem it had uncovered was “primarily down to the failure of employers to pay staff at a level that adequately covers all of their working time.”

Well, that’s one view. I’d suggest another – that an increasing ageing population’s care needs adds daily pressure on a finite pool of resources with what is essentially government-pegged budget.

The care industry sector, which employs about 1.4 million people in the UK, has long been associated with low pay, while funding cuts and an ageing population is creating an additional strain on wages, it added.

The Resolution Foundation, says the Beeb, is calling on national and local government as well as social care providers to address its concerns.

Sorry, wrong place to target the comment. This needs to be brought before Government ministers. Oh, how could I forget, we’ve already done that and currently government has been dissolved pending the General Election.

In an attempt to balance the narrative, Colin Angel of the UK Homecare Association, was approached. He’s reported as saying that care providers operate in a market where purchasers, largely local councils, “face unprecedented spending constraints.”

He goes on to add that commissioners need to “take the actual costs of care services into account when letting contracts to the independent and voluntary sector . . .”

Oh yes, but as he points out local authorities are under the financial cosh.

Will it get better soon? No. Perhaps there’s hope on the horizon with the General Election, but I doubt it very much.

Our work empowers and really does make a difference

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Today, as I’m often inclined, I scanned online the social care section of the Guardian newspaper and was attracted to the headline ‘Our work makes the lives of older people better’.

I confess to rarely reading day-in-the-life-of features, but the heading alone had a resonance with the work of the West Midlands Care Association where I’m the CEO.

Sue Ash works for Age UK’s national advice line, a free, confidential service that supports older people as well as their families and friends. In her story, she simply outlines the contents of her day.

The type of calls she receives make interesting reading, though there’s nothing in them that surprises me.

I quote: “We speak to all sorts of people, from those who are struggling to receive practical support at home, to people who don’t know what funding is available to help them to pay for care. We specialise in advice regarding care rights and regulations, and are able to support people to get the services they need.

“We recently helped a man who needed to move into a care home and thought he needed to sell his property to pay for this. He was extremely worried, but we reassured him that this was not correct for his situation, providing him with advice on the best action to take. He told us he and his wife slept better that night than they had in weeks!

“We regularly deal with calls from older people who feel lonely and want someone to talk to. Age UK offers a number services that can benefit older people who feel they have no one to turn to; our local Age UK partners offer a range of hands-on services such as lunch clubs for older residents living nearby.”

Sue then adds “we are often able to help people claim pension credit or benefits they were unaware of and regularly hear how valuable this extra income has been.”

Care, rights, benefits, regulations, worries over fees, loneliness and social engagement. These are huge issues and just like Sue, WMCA encounters many of them on a daily basis.

It’s an agenda that should be up there with the NHS, taxes and national debt in the General Election political debates. Perhaps I’ve missed it all, but I doubt it. Potato too hot? Perhaps.

I applaud the work of Age UK in empowering our older people. Like Sue, who feels proud to be part of the work that helps so many, I too feel privileged to play my part. We’re in a business that can change the quality of life for the better, it’s about hope, it’s about winding up the clock of old age and keep going with as much quality of life as possible, it’s about high standards, innovation and securing the very best for society’s greatest treasure – our elderly.