The prevention of scandal in social care services

panorama-nursing-homes-undercover

I am sure that all those who work in social care services who strive to improve quality must have been appalled by this week’s report by the BBC Panorama Program. When carrying out  an undercover investigation it exposed shocking levels of neglect at two care homes in Cornwall.

Reporters recorded vulnerable people left unattended, including one left on a bedpan for 40 minutes, an out-of-date prescription supplement relabeled for use by another service user and the threat of morphine being used to silence a resident. In addition, further poor practice included, a service users bin was not emptied, the soap dispenser had no soap and the toilet seat was broken.

If you are reading this or saw the Panorama Program, I guess like me you are sitting there thinking haven’t we been here before. These scandals which often seem to be the focus of the media continue to recur. Given the undoubted damage they do to the reputation of social care services and those who work within it, the question needs to be asked can we do more to prevent further scandals. I am suggesting that those who provide social care services cannot rely solely upon the best efforts of the Care Quality Commission to police the Service. More must be done by the providers themselves.

During this article, I will suggest to readers a strategy (if followed by providers) that may go some way to preventing more scandal. The content of the strategy will include the following:

  • Culture
  • The importance of the manager
  • Recruitment
  • Positive caring relationships
  • Involvement of service users
  • Links to the community
  • Supervision
  • Person centred care plan reviews

Culture

In the Care Quality Commission, Fundamental Standards ‘Well Led’ the importance of culture is recognised. In my opinion some providers do not place enough importance on culture. It must be an essential first step in embedding into the service the recognised values of quality care and best practice. These values will then underpin all the work carried out by staff in the service. Embedding culture can be achieved in the service, through staff training and induction, supervision and staff meetings.

If care homes are to prevent scandal they need to make their best practice values known, so that staff will feel confident that they can report any concerns about poor practice without fear of losing their job.

The importance of the manager

The culture and ethos of the service stems from the practice of the manager. A good manager will look, listen and learn. They will go walk about and have an open-door policy and offer a one to one reviews of the service to service users and their families. There will be evidence of learning and action in response to any concerns. The whole approach of the manager is to gain an insight into what is happening on a day to day basis in their service.

Recruitment

When recruiting, often the main focus can be on the skills and experience of the applicant. I’m suggesting that providers should place more emphasis on the ethos and values of their service and whether or not they are confident that the applicant will gain ownership of them.

Positive caring relationships

Staff should promote positive caring relationships that leave service users feeling cared for and satisfied with the service they receive. The home can provide evidence of the level of satisfaction.

Involvement of service users and their families

A good care home should encourage family visitors and involve them in activities organised by the home. This will not only demonstrate good practice, but also increase transparency in how the home operates.

Links to the community

Service users where they are able should be encouraged to maintain links and participate in activities of their choice within the community.

Supervision

The supervision of all staff provides the opportunity for the supervisor to learn from staff if they have any problems or concerns they may have about service users, along with the services that are provided for them.

Person centred plan reviews

People should be encouraged to attend person centred plan reviews. This will provide the opportunity for the service user and the family to review the quality of care and raise any concerns.

Summary

Scandals involving social care services will continue to be highlighted by the media. Despite the CQC best efforts in policing the service, poor practice in care services continues to raise its ugly head. Unless providers adopt strategies that ensure staff are committed to best practice values, ensure services become transparent and there are mechanisms in place that encourage staff to report bad practice without fear, we will see more reports of poor practice in the future.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

Lack of training for domiciliary care staff

domiciliary-home-carer-with-elderly-man

A new report by the Alzheimer’s Society shines the spotlight on appalling examples of poor care, including dementia patients spending hours on end in soiled clothing because carers are unable to calm their agitation enough to help them change. The Society claims those living with the condition are being let down by the very people who are supposed to care for them due to a severe lack of training among domiciliary care workers.

Meanwhile, infections are going unnoticed and some people with the condition are being left to walk outside and into the middle of the road at night as their home was not left secure.

Other care failures have been highlighted in the report including: people not being supported to eat or drink, dementia patients not given a bath or shower for weeks and carers leaving sufferers to sleep in wet or soiled bed sheets.

There are now 400,000 dementia patients who receive care in their homes but very few visiting care workers have been trained on how to reduce the impact of the condition.

The Alzheimer’s Society said that the “desperate” situation must be addressed urgently.

It is difficult to comprehend how the social care sector has got itself into this appalling situation. As I have said in previous blog articles there is a definite drive by local authorities (borne out by evidence), to strategically reduce the allocation of funding for domiciliary care. The government continue to dodge the issue placing the burden on local authorities who in turn claim they are strapped for cash.

This situation is even more grave when one considers a recent Health Authority Report which showed that there are now more people dying from Alzheimer’s / Dementia than there are from heart disease.
A survey of care workers, conducted in partnership with the union Unison, found that 38% of care staff had not received dementia training. Given the current funding situation the lack of training cannot be laid at the provider’s door. A Department of Health spokeswoman said “Over 100,000 social care workers have already received dementia awareness training. But those of us who work in the care sector know there is wide difference between awareness training and the equipping staff with the skills to provide a quality service for people with dementia.

In my opinion the situation will not change until the Government sees the importance of social care in a similar light as the health service and an acknowledgement of their interdependence. If people with dementia are to receive a proper service, then realistic funding should be made available to providers with ring fenced money for dementia training of staff.

If the most important benchmark of any civilized society is how it cares for its vulnerable and needy, then the governments needs to take stock of how it funds domiciliary care services for people who suffer from dementia.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

Domiciliary care – the growing movement from public to private fee paying care

A recently published survey by the United Kingdom Home Care Association highlights the growing concern of providers about the stability of the domiciliary care market in the UK.

The survey focuses upon data that confirms the decline in local authority take up of domiciliary care. The survey found that between 2009 and 2015 the number of people receiving local authority funded domiciliary care in the UK decreased by 20%. Over the same period the hours delivered decreased by 6.8%. There is evidence that not only are fewer people receiving care funded by the local authority but they are also receiving less hours of care and support at home. It would seem then that there is a local authority funding strategy to restrict access to domiciliary care to those with the greatest levels of care and support needs.

domiciliary-cre-piggy-bank

Confirmation of this approach to funding can be seen in local authority funding for domiciliary care. Gross expenditure by local authorities on domiciliary care continues to decrease. In 2014/15 gross expenditure on domiciliary care by local authorities was £3.9 billion. Gross total local authority expenditure in 2013/14 was £4.05 billion. This is a 3.7% decrease.

There does however seem to be somewhat of a contradiction in the domiciliary care market trends. On the one hand, we have seen a marked decline in local authority funding but on the other there is evidence of growing numbers of domiciliary care providers. In March 2016, there were 10,176 regulated providers of domiciliary care operating in the UK. This is a 3.6% increase compared to March 2015. There was also an increase in the workforce. In 2014/15 it increased by 8.2% to 631,000 people.

The survey of providers shows that 93% of those trading with councils had faced a real-terms decrease in the price paid for their service over the last 12 months, and 20% reported a decrease in the actual fees paid.

There is strong evidence that the funding strategy of local authorities of domiciliary care is leading to a major shift towards private fee paying domiciliary care. Many providers are now considering handing back care packages to commissioners, because they are financially unsustainable.

The survey found that 74% of those providers who responded said they would reduce the amount of publically funded care they delivered, and this is estimated to affect 50% of all people for whom they provide care and support.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

Recruitment of Carers

recruiting care workers

There is no doubt that providers of care services will be very concerned about the recruitment of care workers prior to Brexit and when we finally agree our exit of the European Union. Adam Pike, a former policy adviser at the Cabinet Office and the Treasury argues that if a points system is introduced to control migration, care workers must be given priority. His view is that we should not only be concerned about tariffs for our trade but we need to recognise that the workforce and workers’ rights are more important.

Pike emphasises the importance of four things if a points system to control immigration is introduced.

One: We need to prioritise the migration of care workers and nurses.

Two: We should be encouraging foreign students who want to train in nursing and social care.

Three: We need to train a massive number of new carers and attract workers from other industries who have the skills applicable to care, but are not attracted to the industry. If we promote social carers as a worthwhile profession with terms and conditions and better pay, we will attract more people to the industry.

Four: We need to cut the spending on critical conditions and spend more money on prevention rather than waiting for people to be suffering from critical conditions before local authorities offer care services. We should be spending on prevention now and if we are to accrue the benefits 25 years down the road.

If we do not take any action there is likely to be a shortage of 600,000 carers by the year 2025.

It may well be that a points system is not introduced. Never the less we still need to recognise the importance of foreign workers to the industry. Given the current difficulties in recruiting workers to the social care sector, and especially if the economy continues to provide full employment. Who would argue that it will continue to be difficult to recruit workers from other industries, unless the Government gives providers more realistic funding that will enable the provision of training for new care workers, better pay and the promotion of the carers profession.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy