It was perhaps last June 2010 (or thereabouts) that I first read of the Care Quality Commission’s (CQC) plan to create an ‘excellence’ award and reward for adult care homes, but I discarded the thought then – perhaps hoping it would go away!! Reminding myself then that the CQC was the Regulator of health and social care in England. True enough, that’s what the CQC thinks too:
‘We are the independent regulator of health and social care in England.
We regulate care provided by the NHS, local authorities, private companies and voluntary organisations. We aim to make sure better care is provided for everyone – in hospitals, care homes and people’s own homes. We also seek to protect the interests of people whose rights are restricted under the Mental Health Act.’
Sadly, CQC has now come back and announced plans to develop a new scheme to ‘recognise excellence in adult social care. The scheme – set to be launched in April 2012 – will be CQC-owned, but delivered by other organisations under licence. A consultation on how to define excellence in adult social care will launch in May, building on work carried out for CQC by the Social Care Institute for Excellence.‘
So, SCIE was commissioned by CQC, and SCIE has been beavering away since September 2010 trying to define excellence, with meetings arranged to discuss. SCIE’s early research suggested that an excellent care service is one that:
- makes it possible for people to have control over big decisions about their life and the small day-to-day decisions. They should also be able to play a key role in how services are run
- supports and encourages people to have good relationships with their partners, families, friends, community and care staff
- enables people to do activities that they find important, enjoyable and meaningful
- has good systems and practices in place to ensure that people achieve the three outcomes above, on an ongoing basis.
The remainder of that SCIE document explains each of these elements in more detail and suggests how they could be demonstrated and measured.
The minutes of a CQC Board Meeting held 15 September 2010 in Newcastle-upon-Tyne read as follows
20. SCIE’s programme of engagement and research will take place over the winter.
21. Under the new model providers would need to demonstrate they were sustaining essential standards over a six month period before they could apply to have excellence status.
22. In discussion Board members welcomed the dynamics of the proposed model but were concerned that an excellent service could easily fail and there was a difference in meeting essential standards and maintaining a good record. It was important the public understood the difference.
23. They felt it was also important to define excellence from a users’ perspective and questioned how far thinking had gone to define and collect outcomes.
24. The Director of Regulatory Development commented that evidence would be examined by user panel who would consider all aspects when working through the outcomes.
25. Board members asked if this regulatory activity was within current resources and were assured that of part of the field force model 10% capacity had been retained to carry out this work.
26. The Chair commented that excellence was defined by peoples’ experiences and quality of life issues. It was important that providers demonstrated they were consistently good before applying for excellence status. There was a need to engage with local authorities who have been working with a different rating system in order to provide a single system.
ACTION: Development of the ratings proposals for adult social care to be brought to the December Public Board meeting – Director of Regulatory Development
I am now totally perplexed, because I naively believed and understood that one of the main functions of the CSCI/CQC was/is to be aware of all those elements that must be seen to be present in any care home that CSCI/CQC allowed to call itself a care home. What was/is the purpose of CSCI/CQC if not to ensure that each and every care home it registered was fully equipped and able to provide an acceptable – nay, excellent – standard of care? It should be within the remit of CQC to understand already a definition of ‘excellence’, not to spend 2 more years deliberating further before introducing a reward scheme.
Quote: “Our aim is to make sure that better care is provided for everyone, whether it is in hospital, in care homes, in people’s own homes , or anywhere else that care is provided. We also seek to protect the interests of people whose rights are restricted under the Mental Health Act. We promote the rights and interests of people who use services and we have a wide range of enforcement powers to take action on their behalf if services are unacceptably poor“.
I hadn’t noticed the words ‘unacceptably poor‘ before now – much to my regret – but I’ve been only too aware of the inadequacies and failings of CSCI/CQC (the name was changed to protect the guilty, perhaps!). CSCI/CQC have willingly accepted services that were ‘poor’ or barely ‘adequate’ without actually doing anything to improve those services, without insisting on improvements, without rigorous inspection and enforcement action. CSCI/CQC have been complicit all along! A Eureka moment for me this week, with this latest half-baked scheme.
Now we are to have some kind of privatised award scheme, additionally funded – in reality – by the residents themselves, with the care providers being rewarded for doing what they are supposed to have been doing all along!!! The rationale for that escapes me totally.
It is to be a voluntary scheme, outsourced to ‘other organisations under licence’. That can only mean privatised, via the very privatised care system that is almost in place everywhere now.
The Care Standards Act 2000 expired in September 2010, and along with its departure went the National Minimum Standards for care homes for older people which came within that Act, now expired.
CQC decided to abandon the pathetic star-rating system that it had created – meaningless star-ratings they were too. I was never a fan of those star-ratings and fairly pleased to see them vanish. But ….
CQC then decided to create Essential Standards of Quality and Safety – almost like the a cheap supermarket brand. ‘Outcomes’ became the buzzword – with ‘input’ being undefined, as far as I can see. But still the CQC promised to monitor those ‘essential standards’.
CQC then made the baffling (to me!) decision to allow care homes and care home providers to inspect themselves and to submit their own paper-based assessments!
Now, we are to be treated to a kind of X-Factor of Care show, with another layer of comfort being made available to the care providers, the very people who should be providing ‘excellent care’ in the first place.
This new plan may trivialise not only care, but the CQC.
Each and every care home should be forced to provide excellent care, not rewarded for doing so. The small care home that already provides excellent care will not be able to compete with the big fat-cat care home providers who will muscle in on this one. With ease the fat-cats will lick the cream, while hiding behind a facade of caring care in the UK.
15 February 2011: CQC has told Sandhall Park Nursing and Residential Home that it is failing to meet essential standards in quality and safety and must take action to address concderns over care and welfare.
But look back to the inspection reports from 4 July 2007, then 29 April 2008, and again 28 April 2009 – and the CSCI/CQC watched Mimosa Healthcare (No 4) Limited go from ‘good’ to ‘adequate’ to ‘2-star good’ rating even though back in 2007 there were serious Statutory Requirements made following that inspection – all of which appear to relate to the reasons mentioned in February 2011 for Sandhall Park being in breach of regulations and receiving a warning notice.
Why did it take 4 years for CQC to notice a failing care home?
2 February 2011: Admissions suspended to Leicestershire care home as CQC takes action to protect people. Inspectors report 12 breaches of essential standards.
But look back again at all the inspection reports listed for Saffron House, Leicestershire – provided by Downing Barwell Ltd., and again, the question has to be why did it take so long for CQC to notice a failing care home?
24 February 2011: The Care Quality Commission has told Shelford Lodge Care Home that the care it provides is failing to meet essential standards of safety and quality people should be able to expect.
Yet again, look back at all the inspection reports listed for Shelford Lodge Care Home, Cambridgeshire – and ask the same question again. One of those inspection reports stated “There is much this home needs to do to improve its service“. And yet it took years for CQC to act decisively (if that is still possible for the CQC!).
What is the point of the CQC? All comments will be most welcome, because I am at a loss to understand it any longer.
I feel as though I am now back to Square One. So perhaps that’s where I now need to go – right back to the first square in my own experience of dementia and Care in the UK. That may give me a chance to return to the magic number – seven! But, I cannot promise to complete my mission within seven squares, seven posts, let alone within seven days – it will take as long as it takes. I’ve been very patient thus far.
I do solemnly and sincerely and truly declare and affirm that the evidence I shall give shall be the truth, the whole truth and nothing but the truth.
It will be left to anyone who chooses to challenge me to show differently.