Andrea Sutcliffe, Chief Inspector of Adult Social Care at the Care Quality Commission.
Social care dominated the news on Sunday and into Monday as a result of comments I made in response to inquiries from the Observer journalist Daniel Boffey. I was a bit surprised to make the front page but enjoyed sharing top billing with England’s Ashes winning captain and actor Benedict Cumberbatch.
Daniel had asked through a Freedom of Information inquiry about the numbers of notifications the Care Quality Commission had received from regulated providers about suspected abuse. On discovering that the numbers had increased in the last four years, with 30,000 already received in 2015, not un-naturally he wanted to explore why.
Five influences on quality
While urging appropriate caution in the interpretation of the figures, I talked about the five influences on quality as developed by CQC’s Chief Executive David Behan — staff; providers; commissioners and funders; regulators; and the voice of the public and people using services (for a fuller explanation see my April blog Inspection matters). The role of commissioners and funders is a key one and this was rightly highlighted by Daniel and in the subsequent discussions on social media, in the press and broadcast media.
One of the issues I raised was that of the five key questions we ask — is the service safe, caring, effective, responsive and well led — caring is more commonly rated good or outstanding compared to the others. We can be positive about the dedication and commitment from staff this demonstrates, but it worries me that many are caring despite the system and not because of it. That can lead to burn-out and good staff leaving or worse.
The role of providers felt less prominent in the article on Sunday but is clearly our focus as the regulator of adult social care services. As I highlighted in my blog last week, there are great providers who create the right culture, support their staff well and show outstanding can be done and we continue to rate the majority of services as good.
But every week we are also rating more than a third of services as requiring improvement or inadequate. Living in an inadequate care home or using a service that requires improvement has a direct impact on people’s lives, as recent reports show — see for example Admiral Court Care Home in Hartlepool and Greenhill Residential Home in Devon.
Providers may highlight the constraints imposed upon them by commissioners, but there can be no excuse for poor care that ruins the lives of people in the most vulnerable of circumstances. I have reiterated this week the determination of all of us at the Care Quality Commission to tackle poor care and take action when it is necessary.
Our objective is to ensure that services improve and many services do. That way people can stay where they are and have continuity of care. But when providers fail to take the appropriate action, lack insight into what they need to do and allow the situation to deteriorate even more, then we have no option but to use our most stringent powers.
Old Village School
This happened last week at The Old Village School Nursing Home in Bedfordshire. The service was rated inadequate after our unannounced inspection in June this year in response to concerns about the quality of care. The provider was set clear expectations for improvement. Subsequently, local agencies advised us that the situation was getting worse not better so we went back to inspect at the beginning of last week. Our full findings will be set out in the inspection report when it is published, but suffice to say, the situation was completely unacceptable.
There then followed an intensive period of discussions with the provider, Central Bedfordshire Council and Bedfordshire Clinical Commissioning Group (CCG) to secure immediate improvements in care and to protect the people living there. The local NHS provided additional staff as an interim measure to provide care but this was not sustainable for long and the provider failed to address our concerns.
It was clear that we would need to make an urgent application to the magistrates court to cancel the registration of the service as the risks to people’s safety and wellbeing were not being managed by the provider. While that decision is clearly ours, we made it in full collaboration with the council and CCG who are responsible for the logistics of finding new placements and transferring residents. They carried out assessments of the residents on Wednesday and Thursday to ensure that new placements would be appropriate for their needs.
We agreed with the council and CCG the importance of the transfers taking place safely and respectfully and the CCG and council started moving people on Friday before the magistrates order was granted so that this could happen. 34 people moved on Friday and 16 people remained overnight with appropriate support. Of the 50 people who needed to move from the service, five were transferred on Friday after 10pm. I have discussed this with the CCG and all five were offered the opportunity to stay overnight but they or their relatives expressed a preference to continue with the move. All the residents who moved have had a follow-up telephone call in their new accommodation and each will have a full assessment to ensure their needs are being met. CQC will be kept informed of their progress.
None of us want to put people through this upheaval and disruption — an urgent closure will always be a shock for the residents and their relatives and I understand their angry reactions. But faced with such an appalling lack of care, we had no option within the powers we have but to take the action we did. I take full responsibility for that.
But the responsibility for the failings at The Old Village School Nursing Home rests squarely with the owners of this service. This situation should never have happened and would not have done if they had provided the care and protected the safety of the people for whom they were responsible.
Originally published at www.cqc.org.uk.