I can spend a fair amount of time in residential and nursing homes because a part of my role is about both making placements in them and reviewing ongoing placements in them.
Over the years, I’ve seen many different types and different quality care homes and there are a couple of observations I can make very broadly.
Firstly that the quality of the inspection reports (as well as the frequency of inspections) has nosedived over the last few years. This isn’t all down to the death of CSCI and the arrival of the CQC as it was a pattern that was already happening but it does seem to have got worse progressively and unsurprisingly, this is linked to job losses and a reduction of resources allocated to the CQC. The reports seem to speak their own jargon-like language and sometimes looking at one it is hard to know (unless it is incredibly good or bad) what the issues actually are.
Secondly, there are many perceptions that people have of residential and nursing homes – not helped by media (don’t get me wrong though, I think the programmes that unearth poor and abusive practice have been very helpful to the sector) – that poor care abounds. While there is much more poor practice than there should be, there are also some gems which exist out there and provide very high quality and ‘caring’ care although the impression I get is that it is sometimes in spite of, rather than because of the way that care is organised.
Often the best care is down to individual home managers, individual care staff who have a particular approach rather than large, imposed management styles.
Yesterday, Lansley announced that there would be a rise in unannounced inspections in care homes. It’s important to note that the amount of inspections carried out will not increase but the amount of unannounced as opposed to planned inspections will.
Does regulation improve an industry and a culture? Well, not necessarily. I think there is something more deep-seated in the way that the care sector has been turned into profit-making businesses where individualised care is more expensive than warehousing of older adults in particular in very large institutions but that’s another story for another day.
Regulation can at least help to monitor some of the issues that may arise and while it is far from a panacea to cure all ills, I think that better and more frequent (unannounced) inspections are better than fewer, announced inspections as long as the inspectors are both knowledgeable about the legal aspects of the requirements of the home (I’m particularly thinking about the Mental Capacity Act and Deprivation of Liberty Safeguards here where I’ve found very little attention/knowledge from the CQC reports) and the inspectors aren’t afraid of pressure from providers.
It’s a step of course and while I can think of niggles/problems/answers – most of them involve more resources but the current situation where inspections are so rare as to be happening once every two years or less in some circumstances, does not provide a level of regulation that should be expected in such an important area.
I’ll certainly be keeping my eyes peeled for the results of these changes and I hope they will make things better.
CQC – Care Quality Commission
CSCI – Commission for Social Care Inspection (predates the CQC which took over in 2009)
Deprivation of Liberty Safeguards – particular legal tenets relating to adults without capacity who are detained and deprived of their liberty in care homes or hospitals.