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By Debbie le Quesne

Archive for the ‘Memory Walk’ Category

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.

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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!

On the subject of dementia . . .

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A Channel 5 News and YouGov poll has found that one in five of us fear developing dementia more than cancer.

Some two thirds of those polled also fear they may also be diagnosed with the memory-loss condition in the future.

In a statement the Alzheimer’s Society said: ‘With dementia treatments a generation behind those for cancer, it is not surprising that people are more fearful of dementia. With dementia now in the spotlight, we urgently need to turns words into action and see tangible improvements in the care and support provided to people with dementia and their carers.”

Some 800,000 people live with dementia in the UK.

And just to add to the urgency of finding a treatment or cure, I read that foods high in compounds called advanced glycation endproducts (AGEs) could contribute to the build up of beta-amyloid, a major hallmark of Alzheimer’s disease.

The findings are published in the Proceedings of the National Academy of Science journal.

AGEs are found in cooked foods and have previously been linked to health conditions including diabetes and dementia. I don’t understand any of the medical stuff here , but simply,  according to the authors, AGEs suppress SIRT1 – a protein in the body thought to protect against neurodegeneration.

AGEs are found in cooked food, particularly high fat proteins such as animal meat. Vegetarian recipes suddenly seem very exciting to me. . .

Dignity Action Day – the event that should never end

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Just incase you’ve missed the news, it’s Dignity Action Day tomorrow (Saturday) – a campaign that attempts to vastly improve the lives of those who need social, nursing and health care.

Dame Joan Bakewell, Dignity in Care ambassador sums up the goals perfectly: “Dignity Action Day highlights a more respectful way of behaving towards vulnerable people. The very old and the very young clearly need our respect, but it wouldn’t do any harm to spread the dignity message across the population then we can all benefit.”

Upholding people’s rights for dignity is surely a duty for all of us, whether in the care sector or not. To this end, events to promote the campaign have been happening all over the UK – everything from champagne and canapés afternoons to senior disco dances have been held.

Treating fellow members of our community with respect is something most of us do automatically – but sometimes in our enthusiasm to help, or just speed things along, we can steal the dignity of those who are most vulnerable.

I recall one training session where West Midlands Care Association had feedback on their workshop from carers. They were good students and some had been in care settings for many years, but one admitted to “struggling to not be in full control.”

Dignity in action is not necessarily about grand gestures, it’s about remaining aware of others’ needs and supporting their abilities . . . it’s about treating others the way we would wish to be treated.

Dignity Champions pledge to challenge poor care and act as good role models to others. They include health and social care managers and frontline staff, doctors, nurses, MPs, councillors, members of local action groups and people from voluntary groups, who believe being treated with dignity is a basic human right, not an optional extra.

There’s a 10 point Dignity Challenge we can commit to:

1. Have a zero tolerance of all forms of abuse.

2. Support people with the same respect you would want for yourself or a member of your family.

3. Treat each person as an individual by offering a personalised service.

4. Enable people to maintain the maximum possible level of independence, choice and control.

5. Listen and support people to express their needs and wants.

6. Respect people’s right to privacy.

7. Ensure people feel able to complain without fear of retribution.

8. Engage with family members and carers as care partners.

9. Assist people to maintain confidence and positive self-esteem.

10. Act to alleviate people’s loneliness and isolation.

One thing that has thrilled me during this campaign and it’s this: It doesn’t seem to have an end in sight. Dignity events are still on calendars – and long may they be so.

Have a good weekend . . . and for those who have trouble to enhance the dignity cause, a huge thank you.

CQC: A new way of inspection

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The National Care Association has been fighting the corner for care providers as the regulators finalise details for their spring consultation on their new style of inspections.

Everything will be rolled out in the autumn, but until then we can only hope that the Commission is listening to what we have to say.

The NCA attended a “re-consultation workshop” to ensure that “the voice of the smaller independent sector” is heard.

Along with the National Care Forum and UKHCA, the national team challenged CQC to ensure that any proposed changes to inspection regimes were fair, proportionate and delivered equitably across the country and across provider types.

Already plenty of debate has been aired and in the mix with the care experts are the Royal College of Nursing and advocacy groups such as Age UK. Hopefully, our voices will be heard.

Under proposals so far the CQC inspectors will focus on five key areas, known as lines of enquiry (LOE). These are: Is an organisation Caring, Safe, Effective, Responsive and Well-led?

These enquiries will be judged taking into consideration personalisation, care, staffing, premises and equipment, quality and management, nutrition, health, involvement and infection control.

Central to everything is user engagement in designing the right framework for inspection and provider engagement is fundamental to improving quality, the workshop heard.

This all sounds good and a viable alternative to the tick-box inspections we currently go through.

I despise the ‘us and them’ culture that is so endemic regarding the relationship between CQC and care providers. Thankfully it is slowly changing. Let’s hope we can build on this with the inspection charter.

Thunderbirds legacy: Mission Alzheimer’s cure

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If you’re of an age you will probably remember television’s Thunderbirds which charted the adventures of an international rescue team with Tracy brothers Jeff, Scott, Virgil, Alan, John and Gordon.

The puppetry was poor by today’s computer generated imagery standards, but the space-centred storylines were gripping even ten years or more after the programme was launched.

The man who created this fabulous fantasy was Gerry Anderson, who died just over a year ago aged 83 after suffering from Alzheimer’s disease.

To mark his death a documentary about his live with dementia was launched on Boxing Day.

The documentary, commissioned by Fanderson – the official Gerry Anderson appreciation society – began filming in the summer before he passed away and features Mr Anderson and his son Jamie talking about the condition and how it was affecting their lives.

It tells the story of Mr Anderson’s dementia journey, from mistaking the early symptoms as ‘old age’, through to how they coped as a family and what it felt like for Jamie when his father no longer recognised him.

He also reflects on their work supporting Alzheimer’s Society, and Mr Anderson’s decision to donate his brain to dementia research.

To see the film in full, and hear more of Gerry Anderson’s reflections on his condition and his son Jamie talking about his father’s deterioration over the last few years, visit http://fanderson.org.uk/gerryandersonnews/

The footage offers another insight into this terrible affliction and adds to the growing chorus that action is long overdue on research.

Alzheimer’s Society research shows that 800,000 people in the UK have a form of dementia, more than half have Alzheimer’s disease. In less than ten years a million people will be living with dementia. This will soar to 1.7m people by 2051.

Mr Anderson’s famous line in all of his Tracy brothers’ adventures was “Thunderbirds are go!”

And it seems to me they’re still going, but this time on a ‘rescue’ mission far closer to home and much more pressing than any other intergalactic task they have tackled.

‘Eight million hours of care time lost to subsidising drinks industry’

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Councils could have paid for eight million hours of home care visits and filled almost three million potholes with money they have been forced to spend settling a £1.5 million monthly bill subsidising the drinks industry.

Can this be true? Yes it can and I am fuming!

The facts have benn released by the The Local Government Association, which represents more than 370 councils in England and Wales and quite rightly it is calling for an end to nationally-set licensing fees as part of its Autumn Statement submission.

The Home Office has not made any progress on its commitment to introduce locally-set fees, set out in the 2011’s Police Reform and Social Responsibility Act, the LGA says.

In simple terms it means that town halls remain unable to recover the actual costs of applications from pubs, nightclubs and off-licences. These include paying for site visits, public consultation, liaising with police, committee hearings and investigating and taking action on breaches.

It is costing councils almost £1.5 million a month with the current bill at £150 million since the system began in 2005.

LGA analysis reveals this money could have:

Provided 8.9 million hours of home care or 24.8 million Meals on Wheels.

Filled 2.8 million potholes or paid for one fifth of total council spending on street cleaning.

Funded the annual running costs of 520 libraries.

Paid for 8,430 care workers or 11,290 lollipop men and women.

Reported in the Care Industry Neews online magazine, Councillor Mehboob Khan, Chair of the LGA’s Safer and Stronger Communities Board, says: “With council budgets, on average 43 per cent less than they were, councils are having to find £20 billion worth of savings. At a time when councils need every penny for vital services, it is totally unacceptable that councils are being forced to subsidise the drinks industry to the tune of £1.5 million a month.

“With our road network crumbling and social care budgets being stretched to breaking point, this ever-rising bill would already fill millions of potholes and help councils provide more than eight million hours of home care.

“The Government must act now to reform the system so councils are able to recover the actual costs of applications from pubs, nightclubs and off-licences and not divert taxpayers’ money in such a needless way.”

Come one, Mr Cameron, this may even be an election platform worth standing on.