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Reporters recorded vulnerable people left unattended, including one left on a bedpan for 40 minutes, an out-of-date prescription supplement relabeled for use by another service user and the threat of morphine being used to silence a resident.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