Andrea Sutcliffe, Chief Inspector of Adult Social Care at the Care Quality Commission.
The BBC Panorama programme Behind Closed Doors: Elderly Care Exposed was awful. I watched, like so many others, as secret filming revealed neglect, verbal abuse and physical violence against people who were frail and vulnerable.
Such care, or more accurately, lack of care is totally unacceptable.
Watching the programme, and particularly Joan’s daughter weeping at the footage, upset me as I am sure it upset you.
The programme has provoked a lot of reaction and comment. Social care leaders wrote to The Guardian to rightly highlight that the “vast majority of residential care providers provide good, if not excellent care.” Others have condemned the staff, the managers and owners, the commissioners, the Care Quality Commission and the Government. Some have shared their own stories of both good and bad care. Still, more have asked what more needs to be done to stop this happening.
I am glad that exposing poor care provokes a reaction — but immediate outrage and indignation can be short-lived and fail to deliver the change we want to see. Already the news agenda has rolled on to other topics and the blind-eye that society often turns to the issues that matter most in adult social care will take over again.
Ahead of the programme the CQC issued a statement and I was interviewed on radio and TV. After the programme I tweeted that “no-one should experience such awful care. Staff, owners, commissioners, CQC, Government, society — we all have a responsibility to sort.”
So, what does that mean? No — I am not recommending another concordat or more public hand-wringing (as some of you will be pleased to hear) but real, concerted action building on foundations already in place.
It starts with providers delivering on the promises their sector leaders have made to champion “the excellent care they provide and to use this as a driver so that excellence becomes the default standard”.
It continues with local authorities delivering on their commitment voiced by ADASS President David Pearson to ensure “that many thousands of people are cared for properly in secure, safe and stimulating environments… [where] only the highest standards are applied”.
And it means that Government and society reflect upon the true cost of social care and how that can be properly funded so that sufficient staff are recruited and trained to deliver high-quality care.
Role for us
But what does it mean for the regulator, the Care Quality Commission? I do not pretend that we are the sole solution nor that inspection is the only way to guarantee safe, compassionate and effective care (and I am encouraged that some of the commentary in the last 24 hours has recognised that). But neither are we spectators standing idly by. Our focus must be to:
- Be explicit about our expectations of services making sure these are focused on what matters most to people using services and a sound evidence base
- Monitor what is happening, listen to people using services, their families and others and respond when concerns are raised
- Carry out rigorous and robust inspections which are person-centred and alert to warning signs
- Focus on leadership and culture of services and hold managers and owners to account
- Share information clearly so that we can celebrate good practice for others to learn from
- Encourage services to improve when that is required
- Take firm action when necessary.
On this last point — it is worth remembering that since 2011 we have issued 2,438 warning notices to 1,260 care homes; 158 of those homes are now de-registered so are no longer operating; 696 locations still registered are now fully compliant demonstrating improvement. That means, though, that 406 locations issued with a warning notice are operating but are still non-compliant. The new powers in the Care Bill will put us in a much stronger position to take additional action which is welcome — and one way Government can help us to be even more effective.
You have your chance to have your say about what we do as we are consulting on our new approach please do!
Making a difference
Every day I know our work makes a difference. An inspector shared her experience with me yesterday about a recent inspection where last year we had served a warning notice and identified necessary compliance actions for poor staffing practice. She told me:
“This service has turned around and I was so pleased to find everything in place and people being treated very well. Everyone sang the praises of the service. The manager has worked hard to make this happen and it has reminded me why we do this.”
We are not the only solution, but we are definitely part of the solution.
Originally published at www.cqc.org.uk.