Better care
Andrea Sutcliffe, Chief Inspector of Adult Social Care at the Care Quality Commission.
Throughout my career in health and social care I know that when things go wrong, the people affected usually want to know what happened and why; often they want someone or an organisation to take responsibility and be held to account; but overwhelmingly they say that they don’t want someone else to go through what they have experienced.
For us to do justice to that, the organisations involved need to recognise that change is required, learn the appropriate lessons and make the necessary changes.
All three steps are important or the ‘lessons learnt’ that we claim sound meaningless and hollow.
Quality failure
In recent months a number of care homes have closed as a result of urgent action taken by CQC. This is not a decision we take lightly. We understand the disruption is extremely distressing for residents and their families and can seriously impact on their health and wellbeing. When we find failing services our first priority is to secure improvements so that people can stay in their home. But when we are faced with a service that is not improving or is actually making things worse and people are at serious risk of harm or neglect, then we have to act to protect them.
Managing these urgent situations requires all local organisations to work well together to ensure suitable new homes are found, transport is arranged, everyone is kept informed, moves are managed well and there is good follow-up. There have been examples of urgent closures over the last year where that has happened with minimum fuss, but on other occasions despite the efforts of everyone involved, the closure has not gone as well as we would have wanted (see my previous blogs about The Old Village School and Merok Park).
Improvement
Just as CQC would expect providers to reflect, learn and act upon any serious incident, then we must do that too — which is what led to the Better Care symposium held last week to focus on how we can improve to manage better care home closures caused by quality failures.
One of the challenges about these situations is that so many people and agencies need to be involved for it to run smoothly — CQC cannot do this alone. So I was very pleased that we co-hosted the meeting with NHS England where Ruth Holt and Margaret Kitching are leading work on strengthening the resilience of care homes. Nearly 50 people joined us — from organisations speaking on behalf of residents and their families (Action on Elder Abuse, The Relatives and Residents Association, Healthwatch and Carers UK) to providers, their trade associations, commissioners and national organisations. There were many others who may have wanted to attend so for openness and transparency we live tweeted the event with the hashtag #BetterCare.
People focus
All our discussions focused on putting the needs of people living in care homes at the centre of our thoughts and actions. Gary Fitzgerald, Chief Executive of Action on Elder Abuse anchored the day by powerfully describing the experiences of people affected by the closure of the Old Village School.
We concentrated on two discussions — the first on how we can handle closures for quality failures better and the second exploring some of the wider issues and solutions. The aim of the first discussion was to come up with a set of principles for all agencies to sign up to which would guide any closure. Key themes that emerged were the importance of preventing quality failures in the first place; ensuring that there is good information and communication between everyone involved and with residents, their carers and families; being clear about roles and responsibilities; and good coordination.
In the second we discussed the limitations of the regulations and options to deal with quality failures. These inevitably mean that we are restricted from sharing information with the people directly affected and that our ultimate sanction is to close the home which means that it is the people living there who suffer from the failure of the providers and have to move. Important points included the need to be more transparent and secure changes to regulations to allow this, and providing better support from the health and social care system to enable providers to improve.
Next steps
So what does success look like from this meeting? Our intention is to produce a set of principles to guide any closure in the future which all organisations can sign up to and deliver. We will also establish an action plan of the more developmental work required so that we can make sure there is clarity about who is taking what forward. We will share the outputs and progress from the meeting as it happens.
Thank you
The meeting was a shared endeavour from all perspectives to understand the problems, the limitations and the possibilities. I am very grateful to everyone who attended and particularly to Anne Murray from Bedfordshire Clinical Commissioning Group, Julie Ogley from Central Bedfordshire Council and Jemima Burnage, CQC’s Head of Inspection for the Central Region, who all honestly shared their experience of the Old Village School closure — and of course — Gary Fitzgerald who made sure the voice of the people affected was at the heart of our discussion. It’s the reason we are all determined to get it right.
Originally published at www.cqc.org.uk.
