Happy New Year!

I hope that everyone has had a happy and restful break. I certainly did, but have had to cram a couple of weeks work into five days in order to catch up!

Hence the lateness of the greeting.

One of the things that makes Christmas for me is the BBC.

It all starts with the Christmas Radio Times, and then Carols From Kings, The Reith lectures, The Royal Society Christmas Lectures and delightfully this year Terry Pratchett and Neil Gaiman’s Good Omens!

The Reith Lectures by Professor Atul Gawande were a huge pleasure this year and I can highly recommend them.

Click here to go the BBC website to listen to them

The first lecture explores the topic of why doctors fail, and explores the factors which affect medicine, Ignorance (lack of knowledge) and Ineptitude (failure to use existing knowledge).

The second lecture is titled the century of the system,  and interestingly describes some simple systems that care and nursing homes would do well to copy.

Lecture three is about the problem of hubris and looks at the issues of aging and death and how society has a problem recognising the limits of what professionals can do.

The final lecture the idea of wellbeing is for me the highlight, and explores ideas around end of life care and assisted dying.

If nothing else, for me, the whole series re enforces the importance of the fact that people providing care need to care. A simple concept,but one that’s often overlooked.

Registered Care Home Managers

Here’s a story that’s close to my heart. Having been a Registered Manager for several years, managed the work of a group of Registered Managers as Responsible Individual, and having gained the qualification as a Registered Manager (RMA NVQ4) I feel my opinion comes from a well informed stand point.

I often say to clients that the Registered Manager accounts for 90-95% of the quality of a home. So it is important to-

1-Make sure the home or service has one.

2-Check on their qualifications and experience.

3-Find out how long they have worked in the home or service.

It’s good to see the issue being debated nationally, the headline story being that a proportion of services providing care do not have a manager registered with CQC.

This despite recent efforts by CQC to improve this figure.

Here is what the piece in the Telegraph of 10th October has to say-

More than 2,000 care homes looking after elderly or disabled adults have no registered manager, according to figures to be published this week.

The results mean that 12 per cent of all care homes in England lack the leadership required to ensure that vulnerable people, including frail pensioners with dementia, are cared for properly, according to a study to be presented at the Liberal Democrat conference on Tuesday.

Paul Burstow, the Lib Dem MP and former health minister who obtained the figures, said the figures showed that “a revolution” in care homes was needed.

There are a number of factors underlying these figures and I would like to unpick them here.

The main one in my experience being turnover of managers. The position has changed over the last decade or so, and the focus of the job is diluted by the various stakeholders that the registered Manager finds themselves pulled between. A clear example is the needs of owners to run a profitable business weighed against the needs for care. On the surface one would expect owners to be in care business out of altruistic motives, indeed this was more the case in the past. However more and more the ‘owners’ are venture capital companies more interested in the bottom line. Care decisions are overidden by financial constraints. This leads to the high turnover of registered Managers in the sector, the majority of whom come from a caring background as opposed to a business background.


Lack of support
for registered managers is another factor that influences the lack of candidates for the sector. The old saw ‘it’s lonely at the top’ is never more true than it is now for the Registered Manager. As well as the pressures from divergent stakeholders as outlined above, there is the lack of peer support due to the business model of care provision. How can one go to another registered Manager locally for support when they are in fact business rivals? The same is true of the sharing of good practice in care throughout the sector.

Finally where do these managers come from? The skill set required to be successful in these posts is quite unique. A mix of care professional, business manager, HR professional, diplomat, carer supporter, pharmacist, CQC inspector-I could go on! There is a case for the industry taking along hard look at where it recruits from, what skills and knowledge it’s looking for and how these are developed and accredited. Yes I know Skills for Care do a good job of this, but they do it from outside the industry with one foot in the political camp of the current government regulators. Does anyone tell Costa where to get their manager from and what qualifications they must have? No the market decides that, however in the market of care, the qualities needed to manage aren’t clear.

Here’s The Telegraph piece on the story

Listen to the You and Yours item here.

CQC Sandwich Generation Survey

I covered this story briefly earlier in the month when it was featured on BBC Radio Four’s You and Yours.
It’s a really useful piece of work though, so I thought I would cover it in further depth.

CQC commissioned Mumsnet and Gransnet to carry out a survey of the users of their sites. They were in particular looking for those that are described as the Sandwich Generation.

These are people who described as juggling caring for children and older relatives.

Eight out of ten people surveyed identified choosing care as major source of stress. Going as far as describing it as more stressful than divorce, separation, choosing a school, getting married or buying a house!

I have always described the process of finding good quality care as minefield. This survey clearly re enforces this.

Whilst I take no satisfaction in the fact that finding good care is so hard, clearly all care should be good! It is refreshing to see the CQC tasking steps to gain views and improve the information they provide. The infographic they provide shows what people want to now about care providers. All of which are included in one of my reports.

www.scotting.org/services.html

If you need some help and advice call my freephone line 0800 0016694 always happy to help .

sandwich-generation-survey-infographic-011014

Heres a link to the report on CQC website.

http://www.cqc.org.uk/content/sandwich-generation-carers-say-choosing-care-one-lifes-most-stressful-events

 

 

 

You and Yours 7th October 2014

You and Yours have been producing some good coverage of the care sector for some time now. I particularly liked todays episode as it repeats one of my key messages to people. Always get good advice when looking for care. Odd to see CQC taking this position, but also refreshing to see them taking a real world view of the whole picture.

How easy did you find it to get good quality care for your elderly parents or relatives? The Care Quality Commission says it is one of the most stressful things we’ll face in life.

We’ll ask why is it so difficult and what can be done to make it better.

Guests will include the Care Quality Commission and Carers UK.

Web users click here for full story

For those reading in print the programme can be found at- http://www.bbc.co.uk/programmes/b04kbjhx

And don’t forget advice, help and information is available on my website-www.scotting.org

Union Supports Poor Care Provision!!!!???

Whilst one has sympathy with the people affected, it’s odd to say the least to see a union taking this stance. In effect asking CQC not to close a home providing poor quality care.

Surely they should be supporting their people, who have been part of the failed service, to find other employment?

 

Is it me?

 

http://www.bbc.co.uk/news/uk-england-kent-28874174

The News at Ten

Actually it was eleven when I started typing, but i thought the title might get your attention.

I was just updating my news stories, when it occurred to me that there are a limited amount of subjects that are reported on, when it comes to care.

I monitor the news on a daily basis for stories about care, that will inform my work, and help to advise people looking for good care.

Stories tend to fall into a few categories-

1-Care scandals, these are the ones that make national news, and usually involve criminal behaviour. Orchid View being the lastest example.

2-Failing care service. Usually reported in local papers with the a headline like-“Care Watchdog slams poor care” These are the stories about CQC inspections of services.

3-Stories promoting services. Again usually promoted in local press, but occasionally national when there is a special event on, such as National Care Home Open Day. Local stories tend to be of the Garden party/100th birthday variety.

4-Good care stories. These are the hens teeth ones, and are so few and far between that it’s not possible to spot a trend.

5- Finally there are the Government Policy type stories, such as the recent Care Act/Care cost Cap.

So what can we conclude from this?

Is the lack of good news stories a result of media bias, or a drought of good news in care?

I would like to think it’s media bias, but sadly I think the Bad news stories outweigh the Good.

There is clearly a need for the providers of care to pull their fingers out and focus on care quality and promoting the benefits of good care.

Listening to The Archers last night, I wonder if part of Peggy’s current unhappiness isn’t the worry about going into a care home.

Many people in later life that I speak to worry about care. Part of this worry is well founded, but part is also due to the media delight in reporting bad care.

As always I would say get some sound advice before buying any care service.

www.scotting.org/free_advice.html

BBC Panorama, Behind Closed doors:Elderly Care Exposed, 30th April 2014

Okay I confess I chickened out.

I didn’t watch it.

The plan was to read all the comment and debate, watch the programme, and then make a post from an informed point of view.

I have seen the clip of a lady being slapped as she was being changed, and that was more than enough for more me.

It makes my blood boil and I see red, so yes I didn’t watch the whole programme.

However I have read a lot and thought a lot and here is my tuppence worth.

Disclaimer-whilst I think the people who did this, or allowed others to do this, are despicable and deserve punishment, I do think there are wider systemic, social and political issues that need to be examined.

 


Why do people like that work in care?

Let’s be clear, in my experience, it’s a small minority of people.They are very difficult to spot in an interview situation, and can usually hide their behaviour long enough to be seen as credible. Even when colleagues start to have suspicions, they are skilled at manipulating teams of people and rationalising their behaviour.

As we see on the video, and have seen before in Winterbourne view, when they do wrong they are easy to spot and catch.

In the last 28 years I have sacked two of these people, and reported another two.

I dislike the medical model in describing social behaviour, but I can only describe these people as having a Personality Disorder.

They enter the care sector to have control over people who are reliant on them. They feel justified in treating people like they do.

I would also point out that the other 99% of people working in care, enter the sector because they care. Indeed that was my motivation as young man, and remains so.

However the environment and systems in which we work make this increasingly difficult.

I’m sure you know the mantra-Low pay, long hours, working nights and weekends. etc etc

Yes its a tough job, that has never changed.

What has changed is that care has become a commodity.

And so people who came to care aren’t allowed to because-

  • Its not in the budget
  • Health and Safety
  • HR won’t allow it
  • No time
  • Doesn’t tick a box
  • Not one of our targets
  • We won’t get paid for it
  • It’s not good business
  • Can’t afford enough staff
  • Can’t afford equipment/repairs/maintenance

I could go on but I best not.

The point is even those who start off caring, are worn down, burnt out, and leave.

or worse give in.

Won’t CCTV stop it happening?

Quick answer-No

HC-One the company that owns and runs The Old Deanery, have promised to put CCTV into rooms.

CQC have floated the idea of its use.

Yes it will catch people in the act, as has sadly happened several times in the last few years.

But perpetrators of abuse will know where cameras are, how to avoid them, and how to cover up.

It would be money and time better spent looking at how a culture of care can built in a home. This will sideline the abusers and help others stand up to them and out them.

And yes let’s make caring a job that people are proud to do, pays well, and has a work life balance.

Is nationality an issue?

This one is a can of worms, and it’s a brave person who enters the minefield!

Here we go!

In some ways it is. I would point out that as many White Anglo Saxon Protestants, abuse as anyone else. I have also worked with some marvelous care staff who weren’t born in this country.

But there are issues of language, culture, and residents preferences that need to be addressed.

Language, and the ability to communicate clearly with someone who may have sensory deficits, is obviously an essential quality for someone working in care. Not just that but the ability to read and write in English, to understand instruction and training. All essential for the safety of all involved. Yet not something people are screened for regularly at interview.

Culture, politicians do like like telling us we should be more like X, as they look after family. I wonder?

I would suggest, with no research to back it up, that some cultures view the elderly as a burden, working in a care home as a stepping stone to get into a country and labour market, and people in a care home as less than human.

 What were CQC doing about it?

I have worked with the various incarnations of social care inspection since 1997, and I have never met a bad or negligent inspector. Sorry had to get that off my chest, CQC as an organisation has come in for a lot of stick in recent years. I can assure you it’s not the individual inspectors fault, they are without exception, in my experience, knowledgeable caring individuals who want to ensure the best care for the people who receive it,

What has happened is that over the years the organisation has become smaller, and further away. Systems and processes for inspection have changed, detracting from the professional judgement of the inspector. Regulations and Standards became over simplified and generic to attempt to cover too many types of service.

And of course resources have been taken away. This means that CQC spend more time on failed services, rather than working with failing services to prevent failure, and the associated human misery.

Corporate Liability

It’s a secret, but I’m going to let it out of the bag. The NHS was privatised in the 80s and 90s. Didn’t you notice? When I trained as a student nurse I worked on Geriatric wards in NHS hospitals. Those wards have mostly gone, and the people who were cared for them are now cared for in Nursing and Residential Care homes. Those homes are in the main privately owned and run. There are a few council ones out there still but few and far between. So what does this mean for care? The ownership of these homes has changed dramatically over the last twenty years. From being owned and run by small operators who may have had one, maybe two homes. Usually from a caring and/or medical background. So Doctors and Nurses. To large corporate enterprises, financed through various investment vehicles. They will all say in their blurb that care is their priority, but lets be honest, the bottom line is! Ask Southern Cross, BUPA, HC-One, all of whom have had large care scandals.

By my reckoning, each of us is worth a clear £18,000 profit during an average stay in a care/nursing home.

Those sort of profits are very attractive to large corporate investors. Quality of care is not such a priority for them.

How would you fix it Kris?

Its not rocket science! I know I’ve been there, done that, got the T-shirt! There are four key areas I would focus on-

Money-Throwing money at a problem won’t fix it, very true, but the distribution of money in the system needs to be revised. Wages for those providing direct care need to be raised above the ASDA level. By this I mean that people who are looking for work in the sector are looking for a career and fulfillment. rather than choosing between options of minimum wage jobs. Profits need to be capped, and re distributed, with minimum levels required for re-investment in the home. I would even go as far as suggesting that rules for property investment are imposed, to prevent corporate landlords siphoning off capital (Southern Cross). Finally  CQC need the resources to be effective in prevention rather than cure.

Registered Managers-Love them, pay them, support them. Yes I’m biased having been one, but the pressures of the job from so many angles make it an almost impossible task. In my mind the ideal job description for a Registered Manager is-Care for the residents. Leave H+S, property maintenance, finance, marketing etc. etc. to someone else!

Staff-Recruit for beliefs and values above all other factors. Ensure they have proper training, by proper I mean more than a DVD/online thing and make sure a proper test of learning is administered. Provide them with Terms and Conditions of employment that are attractive. Believe me care work looses its shine after your third weekend in a row on duty!

Name and Shame– Make sure that poor providers are named and shamed. with  the current Capitalist model of care provision, the best way to ensure quality care becomes important to the companies is to hit them in the wallet.

If you are worried about the issues raised please get in touch, visit my website, use my services!

www.scotting.org

Here’s what other people have been saying-

http://www.socialistparty.org.uk/issue/810/18565/07-05-2014/care-homes-abuse-scandals

http://www.bbc.co.uk/programmes/b042rcjp

http://www.cqc.org.uk/blog/andrea/behind-closed-doors