Joined up care?

It’s nigh on impossible to keep up with the volume of reports produced about care, so blogs by others are a valuable source of information, because they’ve often done the homework – especially if they’re salaried professionals working in the care industry in some form or other.   I read blogs and articles in the press by doctors, social workers, mental health professionals, carers, friends and families.  Alongside a few by politicians – seldom  rewarding.

Community Care is on my little list, and that’s how I came by this article by Mithran Samuel about a ‘Surveillance’ system to identify failing care providers.  ‘Efforts to identify and tackle failing care providers are being stepped up through the creation of “surveillance” groups in which commissioners and monitoring bodies will share intelligence on organisations.’ 

My first thoughts, on reading the headline, turned to some kind of CCTV system being in place, in each and every care providing facility, be it hospital or care home.  At each and every meeting between ‘human beings’ and those ‘professionals’ who are charged already with providing good quality care.  At each and every meeting when the provision of care has seen to have failed.  Not a bad first thought, but CCTV would only be valuable if those on the receiving end of sub-standard care were allowed access to it too.

My next reaction was one of amazement that commissioners and monitoring bodies aren’t already ‘sharing intelligence’ on what could be failing care providers.  You mean they’re not sharing intelligence?   Shows how naive you can be when you don’t work in the care industry.

So I had to read Quality in the new health system – Maintaining and improving quality from April 2013 by the National Quality Board.  (A draft report at present)  The report focuses on the health system, but with a view that the model described will also be central to the provision of social care, whenever/if ever our caring coalition government gets round to doing a full-time job and speeding along the reforms and changes to the social care system.  So my comments are, in the main, about the way a similar model might impact on care in general.  I don’t really mind whether it’s called ‘health care’ or ‘social care’ – I just mind about ‘care’.

  • We are clear in this report that quality is everyone’s responsibility.
  • Successful implementation will depend on the ethos, values and actions of people working across the system and at every level.

Good starting point.  I read  about ‘outcomes’  and ‘The domains of the NHS Outcomes Framework’:

  1. Preventing people from dying prematurely
  2. Enhancing quality of life for people with long-term conditions
  3. Helping people to recover from episodes of ill health or following injury
  4. Ensuring people have a positive experience of care
  5. Treating and caring for people in a safe environment and protecting them from avoidable harm

Can’t argue with that at all.  That’s what care should be all about, but I would have thought that was fairly obvious from the start.

I take issue with the report where it says  ‘Like many other bodies, CQC drives improvement in the quality of health and social care services’.  The driving seat of improvement has been empty for far too long, and the CQC, local authorities, social services, care providers, care managers and care workers have reneged on that responsibility.  The focus has all been on money.  Nobody has bothered to focus on the quality of care, or if they have, they haven’t voiced their concerns with sufficient vigour.

In theory – and on paper – these bodies and individuals, including social workers, nurses and other care professionals have been charged with all the 5 points listed above, according to their professional codes of conduct handed down by their individual regulators.   If each and every one of them had opened their eyes, their ears and their mouths many of the tragedies of care would not have happened.  But they all failed.

  • Across the system, we must be united in our responsibilities for preventing serious failure and for taking action to put it right where it does occur.

But, hang on a minute,  Joe and Josephine  Public always thought you were united in such responsibilities.  There are so many of us mere humans out here who, through no fault of our own, have had to bang our heads against the slammed doors of ‘this body’ and ‘that body’ with each in turn telling us to ‘go elsewhere’ but without providing any support or guidance, or even care and consideration.  What fools we were.  Nobody listened to us – so will a Report from the NQB open their ears, eyes and hearts?

  • The quality of care provided by an organisation is dependent on the people it employs.
    How on earth can care providers justify paying little more than the minimum wage to staff who are too afraid to speak out?
  • Where health and care professionals do have concerns about the quality of care in their employer organisation, or any provider organisation with which they have contact, they should raise these with the leaders in their team, or the clinical leaders in their organisation. If they feel they cannot raise concerns with a particular individual, or where they have raised concerns which have not been acted upon, individuals should follow their organisation’s published whistleblowing procedures.
    Will the arrival of a new quango-equivalent make that a reality?  It should be happening already – so will anything change?
  • The provider leadership should recognise that quality is equally as important as stewardship of public resources.
    Quality is more important than anything and certainly more important than financial considerations.
  • The provider leadership should be able to raise concerns it may have with its commissioners, and the commissioners should work with the provider to address any quality problems as far as possible.
    True – it should be happening already, but it isn’t.  It must happen.
  • Local Authorities are responsible for commissioning social care services, managing the contracts they hold with providers of care services.
    Are they not aware of the implications of that responsibility?
  • Responsibility for the quality of care being provided should be recognised by the governance within the local authority. The local authority commissioners should use their interactions with providers to seek to drive continuous improvement as well as to identify any actual or potential quality problems or failings.
    Why have they not been doing so?
  • Local Authorities also have a particular role to play in safeguarding adults in vulnerable circumstances who are abused or at risk of abuse. Information about abuse or potential abuse should be shared with local authority safeguarding teams and, depending on the circumstances, may also require involvement of the police.
    It does not need a new ‘architecture’ for that to happen.  It should have been happening for years now.  They all failed.
  • Local Authorities will be part of the new local Quality Surveillance Groups … where they should share information and intelligence. If they have concerns about whether providers are meeting the ‘essential standards of quality and safety’ they should raise these with the CQC and with any other parts of the system with an interest through that Group.
    Why not use the word ‘must’ rather than ‘should’?
  • CQC ensures that only providers who have made a legal declaration that they meet the essential standards of quality and safety and satisfy the registration process are allowed to enter the market and provide care.
    But legal action is rarely taken against those who failed to obey that legal declaration.  That must change.
  • All regulated healthcare professionals must meet the standards set by their professional regulator and are required to ensure that they stay up to date in terms of their clinical skills by participating in continuing professional development.
    Where are the checks?  Where is the system for that which should have been happening?
  • Across the health and care system, we know that there are excellent examples of where local health and care economies have built strong working relationships between their organisations, where there is an active dialogue about quality and where concerns or risks are raised promptly and dealt with collectively in a coordinated way. But this is not the picture everywhere.
  • Different parts of the health and care economy should come together to share information and intelligence about quality as part of new Quality Surveillance Groups (QSGs).
    ‘Must’ not ‘should’.
  • These QSGs will provide a forum for local health and care economies to realise the cultures and values of open and honest cooperation.
  • The creation of QSGs should not add a level of bureaucracy to the system.
  • Any statutory organisation – local, regional or national – who has concerns about the quality of care of a provider should alert other QSG members to their concerns by triggering a Risk Summit.
  • The NHSCB (NHS Commissioning Board)  will lead the establishment of QSGs so that by 1 April 2013, there  is a comprehensive network in place across the country.   (With monthly meetings.)
  • Where the concerns in question involve a potential adult safeguarding issue, the chair of the discussion must ensure that the relevant local authority safeguarding adults protocol is followed. This will help ensure that adult safeguarding processes are not compromised.
    At last a ‘must’!  That should have been happening – will anything really change?
  • However, they (i.e. the mechanisms described to encourage different parts of the system to work together) do not provide a silver bullet. Maintaining quality requires commitment, endorsement and leadership from every part of the system, from national to local levels. It must be seen as the business as usual of organisations individually and collectively.
    Another ‘must’ – more please!
  • The model we describe will not take away the risk of there being another serious failure in the NHS.

 Then, after 53 pages, comes:

  • The patient comes first – not the needs of any organisation.
  • Quality is everybody’s business.
  • If we have concerns we speak out and raise questions without hesitation.
  • We listen in a systematic way to what our patients and our staff tell us about the quality of care.
  • If concerns are raised, we listen and ‘go and look’.

 There’s talk of ‘rewards’ for those providing the standard of care we all expect, with a statement I don’t quite see the need for: ‘payments and incentives must be structured to encourage quality improvement’.  How about serious penalties for those who fail to provide the required standard, rather than financial rewards for those who are doing what they’re already being paid to provide?

There’s much talk of being ‘open and honest’, and I agree wholeheartedly with that as a major innovation that needs to be introduced to  the culture of care.   It is immoral for anything other than open and honest communication from a care professional.

It is the arrogance of the so-called professionals that has taken more than my breath away over the last 7 years,  since I first had to involve myself on behalf of a vulnerable person in need of care.  The arrogance of every single part of the system that I had to deal with.   The arrogance that made them all untouchable.   It protected them all along the way, as they delivered shabby shoddy sub-standard care, knowingly and complicitly.

The social workers, the multidisciplinary team, the heads of mental healthcare of older people team, the NHS assessment unit, the commissioning department, the local authority, the CSCI/CQC, the Adult Protection Unit and so on.  Arrogant, challenged in the optical department, challenged in the hearing department, challenged in the protection department.   They were all challenged as caring human beings.

And finally,

This report is meant as a guide to support the system in exercising judgement and applying common sense to what will be complex situations, where the impact of the decisions made will be profound for individuals, families and communities.

That’s the bit I like most – the application of common sense would prevent many situations becoming complex.  It’s not rocket science.  A modicum of common sense would suffice in many cases.

1 Comment

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One response to “Joined up care?

  1. I agree think that “surveillance” in the context of the care industry is a key issue. This is because blind regulation is a blunt instument which often has unforseen effects. This is because regulation naturally increases costs,and if there is insufficient inspection and enforcement of the regulations this hands a competitive advantage to those willing to cut corners, thus perversly increasing the share of care services provided by the less scrupulous. Conversly more inspection, supervision, intelligence sharing and enforcement would drive quality up even with less detail in the regs.

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