By Debbie le Quesne

Posts Tagged ‘Joseph Rowntree Foundation

Paperwork nightmare: The JRF way forward

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I love solutions much more than the challenges presented by problems and yesterday’s blog outlined many of the paperwork difficulties that beset the care industry.

The Joseph Rowntree Foundation research – ‘Is excessive paperwork in care homes undermining care for older people?’ – thankfully offers proposals to cut back on the current workload.

The report suggests a number of, what it calls, “limited steps” to improve regulatory paperwork in the short term. Here we go                     . . .

oAdoption of a single incident reporting form. Fabulous idea!

oAlignment of national inspection criteria across agencies such as the Care Quality Commission, NHS and local commissioners. Also good.

oSharing and use of information across inspectors of care. Is that not what the Government want us to do with streamlined care?

oGeographical alignment (improving consistency of approaches to inspection taken by commissioners and regulators in specific local areas). We’ve been lobbying for this for years.

oOrganisation of paperwork for different audiences (organising a set of paperwork that can be owned and used by the resident and organising paperwork that is used more by staff on a day-today basis). I think in some homes this already exists.

As for a long-term approach. . .

o      Providers and residents should play a greater role in defining the criteria for high-quality care. At a care home level, consultation should be used to identify the ‘moments that matter’ to residents, relatives and staff. This bottom-up vision of care quality should form the basis of how that care home is judged by inspectors and commissioners. And I agree.

o      Care home inspection should involve observed assessment of care, giving real weight to choice, participation, dignity and respect. These are observable in the day-to-day interactions between residents and staff and should be at the heart of any inspection and regulatory regime. Don’t CQC inspectors already do this?

o      The primary role of risk management should be to enable residents to live their lives in a way that they value as opposed to defending the home from potential litigation or reputational loss. This requires additional training and a better understanding of risk and enablement among regulators and commissioners. Care homes, commissioners and regulators should generate more collective approaches to accountability to reduce defensiveness and improve shared learning and calculated risk-taking across the care home sector. The primary focus should always be the residents and not a defence policy. Quite how we change this culture, I’m not sure, but if we could there would be a lot more people looking for careers in caring.

As ever with the JRF, the report is balanced and thorough. I love the ‘solutions’ but there will need to be a massive shift in thinking to make them a reality anytime soon.

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.

Highs and lows of the passing year

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I have been thinking (dangerous I know) of what to blog on New Year’s Eve. There has been so much miserable news over the last 12 months that has both shaped and scarred the care industry.

But there have been some incredible triumphs and opportunities too where as an association we have been able to bring influence to the movers and shakers.

In recent months we have been able to respond to the Telegraph article on ‘the scandal of secret mark-ups’ and correct the over-generous figure of £486 a week quoted for the average care bed price paid by local authorities for a realistic £384.99. And we have argued also that self-funders are indeed to the difference between many home closure and survival in these difficult financial times.

Let’s take a look at the care sector highlights over the last year . . .

  • In January we had the so-called revelations on the Dilnot report where the long-awaited capping of care costs for individuals was set at a far higher £75,000 than the recommendation of £25,000 t0 £50,000. We were hoping for clarity and certainty and we got neither.
  • Domiciliary care agencies had been saying it for years, and in January the NHS Confederation adding to the chorus: GP and community services should receive a higher proportion of NHS spend to enable more care to be carried outside hospital, said the Confederation chief. Mike Farrar said in his New Year message that he would like to see ‘more investment in primary, community, mental health and social care services as a proportion of the total spend’. And wouldn’t we all?
  •  We also saw our MPs in confessional mode on dealing with mental illness – a brave and laudable move and one that could only help the funding issues around this care specialism.
  • In February the Lords Committee investigation into the growth of the section of society above retirement age tabled some scary facts, prompting calls for a proper plan to cope with the dramatic increase in those aged over 65.
  • The Care Quality Commission (CQC) and the Patients’ Association also joined forces in a move to speed up action on concerns over poor elderly care.
  • And there was a groundbreaking social media project, which aimed to trigger past memories in people with dementia, is to be piloted in Scotland. The Memory Box Network is a charity which aims to use online reminiscence therapy to increase the quality of life of those who live with dementia, which affects around 84,000 people in Scotland. The team developed a website where users can view and upload content to act as a talking point between the person with dementia their carers and loved ones.
  • In March the Joseph Rowntree Foundation encouraged care homes not fall victim of negative stereotypes. Critically, in conclusion, the report says: “With greater levels of staffing and investment, care homes will be better placed to understand and act upon the wishes and aspiration of older people.” So much of this report was based on the need for extra money and more staff and at the sharp end of care and still we need both like never before.
  • I loved the newsbreak on the care home where charity Magic Me was holding cocktail nights specifically aimed at bringing in new faces to residential care settings and establishing a larger friends network. Sadly, I never did receive my invitation.
  • The chancellor also announced that a modified version of proposals laid out in Dilnot report would be brought forward by a year to . . . wait for it, 2016.
  • April gave us Good Care Week Good Care Week, a national platform to be show off excellence in care and a fantastic initiative.
  • Also in April was the announcement that the Care Quality Commission (CQC) would be introducing bigger, more expert inspection teams to police the industry.
  • May’s centre stage event was work by pupils in Sandwell who created visuals to help understand dementia. It was a real privilege to be part of The Sandwell Dementia Friendly Event.
  • June came with a new buzzword – integration where NHS and social care funding pots combine. Hmm . . . My abiding concern in the ‘real world’ of caring is that there are huge divides still between social care and the NHS – not an easy fix; inadequate funding – CCGs are being asked to give two per cent of their budgeting to this cause and already cash is tight; there’s the political issue of who gets priority; and frankly, I don’t believe the initiative will fix the billions of pounds shortfall politicians are speaking of.
  • July – When you don’t know the way ahead, ask a care worker on the frontline. Well, at least that seemed exactly what the government was doing. Care minister Norman Lamb called for everyone in the care mix – service users, carers, managers and directors to submit ideas on how to make the home care system work.
  • August came with more agendas on the Care Bill, this time with a Prevention Matters initiative where investment into first-line social care was being sought as a way of saving NHS treatment costs.
  • Author Sir Terry Pratchet was in the news in September after going public with an update about his particular dementia condition and a memory lane street created at care home near Bristol. Great if you can afford this kind of therapy.
  • October saw headlines stating there was a RGN crisis in nursing homes. Burt there was joy for the National Care Homes Open Day with 2,500 care providers taking part.
  • Also in this month Health Secretary Jeremy Hunt found the solution to an ageing population and poor funding: Adopt the Asian culture in caring. The British way was deeply flawed, he maintained, so we must look overseas for sustainable answers. Hmmm . . . I’ve been privileged to travel a lot and what has struck me most in these cultures is the poverty, sickness, neglect and chronic conditions.
  • November saw The Work Foundation suggest that social care apprenticeships could “strengthen the pipeline for future talent.” The flouting of the minimum wage law was also highlighted this month with investigations by Her Majesty’s Revenue and Customs finding that of the completed 183 investigations, 48 per cent of employers had paid workers below the national minimum wage, set at £6.31 for adults. And so to December: It’s still Bah, humbug! Over funding from government but good will to the elderly from the young all over the country was in evidence. One very good piece of news in this month was Mr Cameron calling for an international summit to address the global problems of Alzheimer’s disease.