If we continue to be distracted by Brexit an entire generation will suffer because of the lack of social care

In this the first of my blogs for 2019. I must apologise for returning to that thorny subject of Brexit which has taken up so much political time in 2018 to the detriment of everything else. Spare a thought not least for those who continue to live their lives without the care services they need, who are at the behest of politicians who have failed and reneged on their promise to publish the Green Paper on Social Care.

In addition, the delay has seen the decline in the social care industry, with increasing care home closures and fewer home care startups because of the uncertainty within social care which continues to be in limbo.

It’s right that ministers and officials focus on what is arguably the biggest upheaval in British politics since the Second World War. But with the internal mechanisms of Westminster and Whitehall snarled up by the huge task of negotiating our future relationship with the European Union, we risk losing sight of the many other issues which could have life-changing consequences for an entire generation.

According to Dr Anna Dixon is Chief Executive of the Centre for Ageing Better, near the top of this list, alongside climate change, must surely be how we respond to the seismic demographic change we’re experiencing. We are on average living 10 years longer than our parents’ generation and nearly two decades longer than our grandparents’ generation. In just 15 years, the UK will have 1.2million more people aged 85 and over than it does today – an increase of nearly 70% in this age group alone. Like Brexit, our longer lives will have colossal implications for everyone in our society.

Two of the most pressing challenges are health and care. We have waited over a year for the Government’s long promised Social Care Green Paper for it only to disappear amidst the recent Brexit blizzard. The Long-Term Plan for the NHS has recently been published, but we continue to wait for the Green Paper.

Simon Stevens made clear when he launched the NHS 5 Year Forward View – his first attempt at a strategy for the NHS – that success depended on the government meeting two further tests. Firstly secure funding for social care and secondly maintaining investment in public health. Neither of which have been met. Local authority funding cuts mean social care services have been stripped back to the bare minimum in most areas. For families struggling to fill the care gap, the NHS is the last resort in a crisis when their elderly relatives become too ill, frail or confused to manage at home.

But even if the health and care services receive increased funding to put them back on a more stable footing and transformation in service provision happens, the huge increase in the numbers of people living to very old ages means this will not be enough.

While, many people enjoy their longer lives, with wellbeing and happiness rising throughout people’s 60s and 70s, longer life also means more years managing disability and illness. At 65 men can expect to live a further 18 and half years of which about half is with some disability, while women can expect to live a further 21 years with 11 of those with disability. But disease and decline in old age is not inevitable. We can do better.

In 2019, we need to focus on prevention, stopping people from developing the long-term conditions and preventable disabilities which can reduce their quality of life. Many of the diseases experienced in old age have common risk factors. We need bold action to tackle the biggest drivers of poor health in later life – smoking, poor diet, excess alcohol and lack of exercise.

It is right that Matt Hancock, Secretary of State for Health and Social Care, has made prevention his priority. The recently announced Prevention Green Paper needs to make promoting healthy ageing a key part of its focus and propose evidence-based interventions such as regulation and incentives, as well as changes to the environment, that are more effective at changing behaviour than education. Beyond government, it will need employers, communities, businesses and service providers to play their part in enabling us to age well. For example, designing communities to be more walkable, with decent and affordable transport links, and green spaces that we can all enjoy.

To reduce pressure on our social care services, we must improve the environments in which people live so that people can remain independent for longer. Addressing the inexcusable lack of age-friendly and accessible housing in Britain means a commitment to building new homes that are accessible for people of all ages and abilities. It requires developing more affordable and attractive products to adapt the home and ensuring that people who need aids and adaptations get timely and personalised access.


No one can deny the importance of Brexit which tantamount to the biggest upheaval in British politics since the second world war. But the truth is governments of either persuasion fail to keep pace the speed of social change. Our population continues to age and if we are to take action to ensure a reasonable quality of life in later years for the many then we need action now.

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

It’s that time of year again

Let’s hope 2019 is a better year for Social Care Services

Looking back over the year 2018 I have tried to bring to your attention articles and blogs that you might find interesting in the world of social care. I have covered topics ranging from the crises in social care funding to the use of Alexa to help those suffering from dementia.

The central purpose of my blogs as always is to keep you informed of innovative practice that may improve the quality of life of people who use social care services. In addition, I bring to your attention new requirements placed on providers by the Care Quality Commission.

Overall the year 2018 in social care is ending as it began. Social care is still in crises because of underfunding, and has reached a tipping point. A number of care homes have decided to call it a day, and some domiciliary care providers have even handed back their contacts to local authorities because they are uneconomically viable. What is most disappointing is the continued delay of the Green Paper which, could you believe it, is now being blamed on Brexit.

However, as a long standing optimist I am sure 2019 can only get better. Surely, during the year, we will see at last our newly confirmed relationship with the European Union. It may also see the publication of the long await Green Paper. Regardless, of either outcome, people will always require social care services and we will need committed people to provide them.

Here at Bettal we have seen a continued growth in providers subscribing to our Quality Management System Policies and Procedures which are used for registration purposes at the start of new businesses. We can take this as a positive light at the end of the tunnel.

All the best to you and yours for 2018.

Happy Christmas

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

CQC guidance on surveillance technology in care services

CQC in December produced guidance on the use of surveillance technology. The commission suggests that it can help services:

  • protect people’s safety, for example from the risk of unsafe care or treatment
  • keep premises and property secure
  • help people stay safe without restricting their activities.

Open surveillance

Care services are more likely to use surveillance openly (overt surveillance). Which requires the provider to tell everyone that it affects. You can do this by talking to them before you start using surveillance or by putting up clear notices. In some circumstances, you may need their consent.

Covert surveillance

This is when you use hidden cameras or microphones people are not aware of. This is only likely to be appropriate in rare circumstances, if you have a pressing reason and only plan to use it for a short time. For example, you might decide to use it to identify a specific incident or allegation.


If the provider uses surveillance to help keep people safe or monitor their wellbeing, CQC will treat it as part of their care. This means it must meet the regulations under the Health and Social Care Act.

But any recordings made of people also count as information about them. Collecting information about people is regulated by the Information Commissioner’s Office (ICO).

Things to be carried out before commencing surveillance

Before they start providers must be able to identify the purpose for using surveillance – the thing you want to achieve. The provider should:

  • Carry out an initial assessment
  • Check the right regulations
  • Fill in a data protection impact assessment
  • Carry out a needs assessment
  • What you should record

Records to be kept by the provider

The provider must keep a record of:

  • your purpose for using surveillance, including how it supports people’s needs
  • your initial assessment
  • your DPIA, if you’ve completed one
  • what alternatives to surveillance you’ve considered.


The provider should tell people:

  • why they are considering surveillance (your purpose)
  • what type of surveillance they are thinking about using
  • where they are considering using it
  • what information they will collect
  • where and how they will store the information
  • who will have access to the information and how long will they keep it.

It’s best to keep a record of the process when people are consulted, along with their responses. Providers are reminded that initial consultation with people is not the same as getting consent.

People raising concerns

People who use your service or their families may raise concerns about privacy. If they do, the provider must take steps to address them. The aim is to make the impact on people’s privacy as small as possible.

Equipment and staff training

When choosing equipment, the provider must ensure it’s fit for purpose. For example, it may need to capture video at a high enough resolution that you can recognise people.

Staff training and record keeping

Staff must be properly trained in handling information gathered by surveillance.

To protect people’s information providers must make sure:

  • staff are properly trained in handling information gathered by surveillance
  • they have clear policies and procedures for when people ask for access to recordings, about sharing information and for complaints about surveillance
  • they keep a record of who has had access to the information, when and why
  • they have a clear policy about keeping information and recordings secure, how long you keep them for, and when and how you destroy them
  • if someone else (like a security company) is handling personal data on their behalf, their contract with them must set out clear rules on how they process it.

Use of hidden cameras

People sometimes worry about a loved one and their care. They might use hidden cameras or microphones to give themselves reassurance. If the provider finds that surveillance is being used in their service, it’s important to put the interests of the person first.


The appropriate use of surveillance technology will be a cause for concern for many providers.  The requirements of the GDPR have added another dimension to the importance of correctly handling people’s data. Before contemplation of its use providers would be well advised to refer to the CQC guidance on their website.

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

CQC is driving social care services to make more use of technology

According to CQC technology is changing the way people provide care and treatment. It suggests that there are huge benefits to be gained for people who use services, families, carers and providers. But it’s important technology and innovation never come at the expense of high-quality, person-centred care.

Benefits of technology in care

Technology can:

  • give people more control over their health, safety and wellbeing
  • support them to be more independent or feel less isolated
  • link them to services which are important for them
  • enhance the care or treatment providers offer
  • help them communicate with families, professionals and staff
  • help staff to prioritise and focus their attention on people who need it most
  • capture and compare data and share good practice with peers.

If providers are to make the best use of technology then people’s safety, dignity and consent must be at the centre of decisions about their care. This applies to decisions about the use of new technology. Being clear about people’s rights, privacy and choice must always come first.

Questions to ask before using technology

CQC ask providers to consider the following question if they are thinking about using technology to deliver care.

  • How will you involve people who use your service in your plans and putting the new technology into use?
  • What do the people it will affect need to know to make an informed choice? Do they fully understand the implications of the new technology?
  • Who will the technology affect and how will it affect them?
  • What outcome do you want to achieve? How will you measure it?
  • Will the technology fully meet the needs of the people using your service? If not, what else do you need to provide?
  • Are there more appropriate ways to meet these needs?
  • What are the practical and legal issues you need to think about before you introduce new technology?
  • What are the risks and how will you manage them? Particularly during transition and early implementation of the technology or system. What is your contingency plan to keep people safe?
  • How have you involved your staff? What information and training do they need so they can be confident and competent? This includes understanding their responsibilities and         how to respond to associated risks.

Innovative use of technology can help answer our five key questions

When CQC inspect and monitor health and social care services, there are five key questions they ask. The following examples illustrate how technology can support good and outstanding person-centred care.


Helping ensure key information is accurate and easy to share with caring professionals in real time


Supporting effective communication and more efficient use of resources, including finances


Supporting person-centred care and helping staff to spend more time on the things that really matter

Responsive to people’s needs

Supporting providers to be more proactive and responsive to changing needs by helping to identify developing risks or needs more quickly


Supporting more effective quality assurance through more effective communication, information sharing and improved data analysis.

Bettal Quality Consultancy

Here at Bettal we have recognised the contribution that technology can make to high quality social care services. We have developed a digital audit tool to measure a services performance against the key Lines of Enquiry. Next year we will be launching our new digital person centred plan and digital risk assessment tool.

For further information on Bettal products please visit our Care Service Products section.


CQC have recognised that technology has an important part to play in social care services. We are only at the beginning of a journey that will see far greater use of technology in the future. The benefits to service users and staff are there for all to see, and I have no doubt that in time you will see less time spent with onsite inspection. The creation of digital routs which will allow inspectors to measure social care services performance off site. This will lead to a further reduction in the number of inspectors.

However, it still needs to be repeated that technology should not be viewed as a substitute for staff time spent with service users, but rather a supportive mechanism that allows more time to be spent with them.

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

Supporting service users who suffer hearing loss

Action on Hearing Loss’ have published guidance for staff in residential care homes designed to support service users who have hearing loss.

The central thrust of the guidance is a recognition that deafness and hearing loss shouldn’t stop older people living well in residential care homes.  The guide provides practical tips and advice for care staff on improving the quality of care for older people who are deaf or have hearing loss.

More than two-thirds of older people have hearing loss. Around 71% of people aged over 70 have some kind of hearing loss. It’s estimated that 75% of people in a care home have hearing loss – and that this will increase to 80% by 2032.  Unaddressed, this can lead to social isolation and an increased risk of other health problems, such as depression and dementia. There is solid that hearing aids can reduce these risks, but the problem is that too many older people are waiting far too long to get their hearing tested or face barriers seeking help because of other conditions.

People who are deaf who use British Sign Language (BSL) may be at risk of loneliness and loss of cultural identity if they are unable to communicate in a meaningful way in BSL with care staff or other people in their care home.

How care staff can help?

1.0    Care staff should be alert to the early signs of hearing loss

The assessment of service users should offer service users the opportunity to have a hearing test. When new residents arrive at the home, staff should be aware of the signs of hearing loss, such as asking others to repeat things, failing to follow conversation in noisy places and behavioural changes, such as withdrawal from social activities.

A ‘Hearing check‘ can help identify people who may need a hearing test.

2.0    Provision of support to ensure older people get the most out of their hearing aids

Where a person has a hearing aid, staff should record this in the service users  care plan and make a note of other accessories that may be needed, such as replacement batteries or tubing. When someone is fitted with hearing aids by their audiologist, they should be provided with written instructions on how to operate and maintain their hearing aids.

Staff should carry out regular checks to make sure their hearing aids are functioning and fitted correctly. If hearing aids are worn continuously, hearing aid batteries typically last no more than a week and hearing aid earmoulds and tubing require regular cleaning.

3.0    Ask older people if they need help to communicate or understand information

If older people who are deaf or have hearing loss need staff to follow simple communication tips or if they need more communication time when receiving care, make sure this is recorded in their care plan.

In England, ensuring communication and information needs are recorded and met is a legal requirement under NHS England’s Accessible Information Standard.

4.0    Make sure the care home environment is welcoming for older people with hearing loss

A high level of background noise can make it difficult for older people with hearing loss to understand what is being said and participate fully in conversations and social activities. Carpeted floors, padded tablecloths and soft furnishings should be used wherever possible to help absorb background noise.

Older people with hearing loss may also benefit from assistive technology, such as hearing loops, personal listeners and flashing smoke alarms

5.0    Take account of the cultural and communication needs of older people who are deaf

Older people who are deaf are less likely to benefit from hearing aids and they may need specialist care and support that recognises the unique language and culture of the deaf community.

They may also need support from a qualified BSL interpreter, as well as help to contact family and friends and local Deaf clubs or other community groups.


Given that there is evidence that it is estimated that 75% of people in a care home have hearing loss, it is essential that care homes adopt a strategy to support service users who suffer with this problem. The guidance provided for staff by ‘Action on Hearing Loss’ should be followed. Hearing loss should form part of the assessment process, and actions to support service users contained in the care plan. This will ensure that service users can still retain quality of life.

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