Panorama — challenges facing home care

Andrea Sutcliffe, Chief Inspector of Adult Social Care at the Care Quality Commission

It’s almost six months since we published our State of Care report that warned adult social care was approaching a tipping point, and last night’s Panorama programme once again brought many of those well-documented challenges (this time focusing on the home care sector) into sharp focus.

Thousands of people across the country are experiencing good quality care from the majority of organisations registered with CQC to provide care in their homes. But the problems we identified last autumn persist and it is clear we are not out of the woods yet by any stretch of the imagination.

Last week Panorama interviewed me to ask about CQC’s views on the quality, fragility and sustainability of the home care market based on our latest inspections and analysis. At the time of writing I am clearing the decks in the office ahead of a week’s holiday in New York, so when you read this, you will know better than I do which bits of an hour to camera actually ended up being used! But here is a short precis of what I said.

Insight

The quality of care we are seeing is mostly good and we must not forget that. But very often this is down to amazingly dedicated care workers going above and beyond to support the people despite the current system, not because of it.

Updated from State of Care for Panorama, CQC’s most current ratings analysis shows that 1 in 5 home care services are not providing high quality care, with concerns about leadership and safety continuing, and this has a direct impact on the health and well-being of people who are using those services.

We have highlighted before that too many providers are struggling to turn things around. This is still happening with around half of home care services originally rated as requires improvement staying the same or getting worse on re-inspection.

What is just as worrying is that we are now returning to home care services we originally rated as good, and although this is based on small numbers (123 inspections), our early assessments show that 20% of these services have fallen to requires improvement and 5% have deteriorated to inadequate. This just reinforces our concerns about the sustainability of quality services.

Impact

I understand money is tight for local authority commissioners and providers, but there can be no excuse for cutting corners on quality. When that happens, it is the people relying upon care and support, their families and carers who suffer the consequences and can experience:

• Poorly trained staff not knowing how to care for someone with complex needs;
• Sketchy care plans that do not give staff the information they need to care for someone properly;
• Rushed visits leaving someone living with dementia even more confused and bewildered by the whirlwind that just came and went;
• Increased isolation because staff do not have time to sit and chat, to make that human connection that means so much;
• High turnover of staff so the continuity of care that people value is not possible;
• Missed calls that mean people are anxious about what will happen, may miss crucial medication, go hungry or thirsty or be left in degrading conditions because the assistance they need to go to the toilet just isn’t there.

None of us would want our loved ones or ourselves to experience care like this and it is crucial that the organisations commissioning or providing services work together to make sure it doesn’t happen to anyone.

And we know it does not have to be like this. There are services that invest in their staff and systems to ensure that care is reliable and provided by staff who have the time and training to care for people properly and with compassion.

We need to value and nurture these services and make sure they are sustainable. Please don’t overload them with more work than they can cope with — some of those services that deteriorated have done so because rapid expansion was not matched by the necessary resources, recruitment and system improvements and the subsequent impact on people is dreadful.

Quality Matters

Adult social care has secured a spot at the top of the agenda that I have never seen before. The additional resources announced in the budget are welcome and the promise of the green paper and the potential for a longer-term solution even more so.

But we cannot talk about the money without focusing on quality and what this means for people using services. We need to make sure we keep quality firmly on the agenda too and staff, providers, commissioners and funders, regulators and national bodies have to work together to make good quality care a reliable reality for everyone.