The cost of care

In a funny sort of way, it’s comforting to read this BBC report about a care home provider having just opened a brand new care home providing “en-suite rooms, a hair salon, a library, landscaped gardens and a private dining  room for special occasions”.  It’s even more comforting to learn that all rooms will be equipped with sensors to alert staff if someone falls or has stopped moving.  Tht doesn’t guarantee the staff will respond, of course.

Don’t stop reading yet – because it gets better by the line.

A 12-week induction training period – including dementia care –  for all staff, and that means all staff including the handyman.  Is that 5 days a week? No, surely not.  Is that one day a week for 12 weeks?  No, doubt it.  Is that one hour per week for 12 weeks?  Sounds more likely …. but as long as that  12-week induction training period remains undefined, it may sound great but it could grate later on.  So it could be as little and as meaningless as possible.  But affordable, as far as Anchor is concerned.

The staffing ratio is to be one carer to five residents, so that customers can be cared for the way Anchor wants them to be cared for.

Residents will be able to choose what they eat and when they eat it.  So presumably they will also be able to choose when they go to bed, rather than being treated like little children and made to undress and get ready for bed at 7 pm.

This is all designed for the so-called baby boomer, property rich generation, who will be self-funding their care for the foreseeable future.  Jane Ashcroft, chief executive of Anchor and head of the English Community Care Association, says: “They have higher expectations, they have grown up in a world with all the mod cons and been to hotel rooms with all the modern facilities.

“They will demand that for themselves and also their parents who are in the system now. It is about offering a wide range of services to cater for everyone’s needs.”

So, anyone who is not in that baby boomer, property rich generation will not be so comfortable, because they won’t get a look in once the trend moves towards luxury care homes for self-funders only.  Yet, they and their relatives also have high expections of the word ‘care’ and of the world of ‘care’.

Hang on a minute!  Wait a minute!  Shouldn’t the standards of care being offered in this brand new Anchor care home, West Hall, West Byfleet, be the standards of care that every single person needing care home care should be able to expect?

Or is it only to be made available to those paying £1425 per week?  There are already many care homes charging £1000 plus per week but not providing anything like that staffing ratio of 1:5.  I know of one care home where the staffing ratio in the nursing section was one RGN plus one brand-new healthcare assistant to 28 people in need of 24/7 nursing care – neither the RGN nor the healthcare assistant knew much about the word care, though.

This all sounds great, especially when you read that  West Hall care home was only built because Anchor could largely finance it itself through its reserves.

Reserves that have already had a fair old contribution from local authority funds.  An earlier BBC report told us that Surrey County Council paid about £2.5m in 2010 to healthcare providers for beds it did not use.  The authority said then that it was “worried” by the figure paid to health firms Anchor and Care UK but was working to renegotiate the contracts.  “Under the terms of the contracts, the council pays the companies for the use of  1,000 beds. Last year, about 10% of those beds were not needed.”

How long has this been going on?

NMC to review ‘serious cases’ before the employer does so

There’s an old saying, with many variations on the same theme:  ‘everything comes to him who waits’, and my favourite variation is  ‘all things come to him who waits – provided he knows what he’s waiting for’.  I’m not absolutely sure that this next revelation is something I knew I was waiting for – but after years of waiting for the NMC to get its act together, there’s a small chink of light appearing.

The NMC (Nursing and Midwifery Council) is to review serious cases before internal investigations are conducted by the employer of the nurse(s) in question.  According to Nursing Times –

Nurses and midwives involved in “very serious cases” that pose a risk to patients should be referred to the Nursing and Midwifery Council prior to an internal investigation, the regulator has stated.

In updated guidance on referrals, the NMC has called on employers to make referrals as quickly as possible in order for it to consider issuing an interim suspension until the case has been fully investigated.

The regulator said it had “clarified its advice as a result of cases in which employers have misunderstood their responsibility to refer quickly if patient safety is at risk”.

It states: “The revised advice specifically encourages employers to refer a nurse or midwife at an early stage in very serious cases, even before they conduct their own internal investigation.”

NMC director of fitness to practise Jackie Smith said: “We would like to remind employers that if they believe the public’s health and wellbeing is at immediate and serious risk, they should contact us straight away.

“This will give us the opportunity to issue an interim suspension or restrict the person’s practice while the case is investigated,” she added.

The revised advice and information also notes that in less serious instances cases may be referred back from the NMC to the employer to be dealt with locally.

The guidance also includes more detailed information about the existing responsibilities of employers to check references, identity and competence.”

This news is of such importance, that I’ve just given you the full content of the Nursing Times article, and I trust that will be acceptable.   It’s not so easy to find the updated guidance on the NMC website, but this is the nearest I’ve found – Urgent referrals and interim orders.

As an employer you have the power to suspend or dismiss a member of staff, but this will not prevent them from working elsewhere. Even suspensions by a local supervising authority midwifery officer (LSAMO), which would prevent a midwife from practising in that region, will not prevent a midwife from practising in other regions, or practising as a nurse if registered accordingly.

We are the only organisation with the powers to prevent nurses and midwives from practising if they present a risk to patient safety. In very serious cases it will therefore be appropriate to refer a nurse or midwife to us at an early stage, even before you conduct your own internal investigation. This allows for the possibility of issuing an interim suspension or restricting the practice of the nurse or midwife concerned until the case has been thoroughly investigated.

I am shocked to discover that this has only just been ‘clarified’ by the NMC, but it goes a long way to explain to me why I’ve had such a fight on my hands for the last 4 years now. 

Perhaps I was naive and took it for granted that the onus was already there on the employer, in my case one of the big care home providers, and that the NMC would be contacted by any employer who has serious concerns about the standards of care being provided by a registered nurse or midwife.  I didn’t know then how easy it was for the employer to allow several registered nurses to resign from their employment. 

Perhaps I was equally naive to expect that the Local Authority would have a duty to follow through with all the sensible procedures, in order to protect other people who could be at risk if those same registered nurses who were allowed to resign were then ’employed’ elsewhere.  But when a care provider has several 25-year contracts with the same local authority, you begin to learn how to whistle in the wind! 

Perhaps I was even more naive to expect that the local authority’s Safeguarding/Protection of Vulnerable Adults unit would be equally responsible for ….. safeguarding others.

The NMC is a Regulator.  The GMC is a Regulator.  The CQC is a Regulator.

What is being a regulator all about if it fails to regulate in the way that most of us, mere mortals that we be,  would want and expect a regulator to regulate?