By Debbie le Quesne

Archive for the ‘Dols’ Category

Failings report: The other news behind the headlines

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The BBC has picked up on a media release from the Care Quality Commission, reporting that nine sites have been rated inadequate across the north of England.

Some 41 visits in that region had taken place at the time of the newsbreak (April7).

It all makes depressing reading with incidents of faeces on a sofa and a window sill, walls and furniture stained, damp dining chairs and sliding bolts found on the outside of doors. What!

You may think that this news (see www.bbc.co.uk/news/uk-england-32204389 ) is CQC flexing its muscles to sends out a very clear message to those homes where standards are not so good.

Perhaps, that in part, is true – frankly, neither myself or the West Midlands Care Association which I head would ever condone substandard care – but the cases highlight for me another issue and probably a bigger one.

For too many years care providers delivering residential packages have been deprived by local authorities of realistic rates for beds.

Some councils have pegged fees, some have offered minor increments, a few in more affluent areas of the UK have dispensed better deals, while others have been challenged in the courts over chronically poor payments.

This financial deprivation has effectively forced the hand of many providers to keep their quality mark at a safe level, but not at the excellence that many would wish. Safe, indeed, not exemplary . . . it’s what’s being paid for, and has been paid for even in the years of plenty when LAs saw fit to spend budgets on other items they deemed more important tan caring.

With fiscal restraint continuing to look bleak even post-General Election, there appears to be no money left for the poor care provider who must continue to maintain safe care with no extra resource.

Of course, I’m not defending the failing homes, but I would like to think the Commission really did understand the root cause of many of the problems that its enthusiastic diligence will disclose.

I wonder too just how many homes will fall at the new CQC hurdles because of bad paperwork and poor audit trails. Ironic, isn’t it, that this Government body is fast uncovering the results of its own master’s policies.

Add to this the top-heavy procedures of implementing DoLS and safeguarding, we have a growing pool of homes where ratings are bound to plummet.

I’m not surprised with the emerging outcomes, especially when the standard required to achieve ‘good’ has significantly shifted upwards.

Like most things in life, you get what you pay for.

Here’s a snapshot of the West Midlands picture:

Good  Requires        Inadequate


Dudley Care Homes                         3               8                             2

Sandwell Care Homes                    12              10                           0

Wolverhampton Care Homes        4                   5                            1

Walsall Care Homes                        2                 3                            0

Birmingham Care Homes                35            17                             2

Worcester Care Homes                  13              5                              0

Totals                                              69            48                              5

lease note well: Worcestershire, with its better figures, pays better than the other Midlands authorities and there are also more privately funded service users in that region to subsidise those whose care is paid for by the local authority.

Rocketing Dols demand means timescales breached

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Deprivation of Liberty Safeguards (Dols) are rocketing to new highs with many still breaching legal timescales for completion.

A landmark Supreme Court ruling last March triggered a nine-fold rise in monthly referrals to councils, a Community Care online magazine investigation has found.

The ruling’s extension of human rights protections has been welcomed by social workers, but they warn more resources are urgently needed to help frontline teams cope with demand.

Under the Dols, local authorities must assess whether people who lack capacity to consent to their care arrangements are being deprived of their liberty in care homes or hospitals and, if so, whether this is in their best interests and necessary to protect them from harm.

The legal landmark was set with cases involving Chester west and Chester Council and Surrey County Council. The outcome was a revised test that has lowered the threshold for deprivation of liberty in care.

Six months on from the ‘Cheshire West’ judgment, a Community Care investigation, based on data obtained under the Freedom of Information Act from 103 local authorities in England and 19 councils and health boards in Wales, showed a massive impact it has had on the adult social care system.

Community Care notes: “In 2013-14 councils received 8,455 requests for Dols assessments; since April this year they’ve already had 32,988 referrals. The figures mean average monthly referrals have risen from 713 in 2013-14 to 6,643 in 2014-15. The effect of the dramatic rise in cases is clear. Last year 2.2% of cases breached timescales; so far this year 50% of cases were not completed in time.”

The investigation also found “that the shortage of trained staff in councils means local authorities have already spent £1.4m on independent BIAs (business impact analysis) in 2014-15. That’s almost three times the £550,000 spent across 12 months in 2013-14.”

Predictably, the chorus of complaint is one of more resources required. I know that the teams have had to divert much of their safeguarding resource to getting as many fulfilled in the times scales as they can. In some areas that means they are having to priotise.

However the Department of Health has not passed this message onto CQC who feel that it is there duty to punish Care Homes very severely if they have not put everyone through for a DoLS that they can. We talked to the DOH when we saw them in January and asked them to help CQC understand the problem.

It seems it is understandable for local authorities to fall behind with their timescales but not care homes!