Coping or caring?
Andrea Sutcliffe, Chief Inspector of Adult Social Care at the Care Quality Commission.
Last week I was invited to speak at the Health Care Plus exhibition at the Excel Centre — first to share our plans at CQC for the regulation and inspection of home care services and then to debate the acceptability or otherwise of 15-minute visits in home care.
Are 15-minute home care visits ever acceptable?
15-minute visits are a controversial topic in adult social care — a touchstone issue for some highlighting all that is wrong with adult social care. For others, it is a pragmatic response to squeezed budgets and rising demands. We had a good panel bringing different perspectives.
First was Jane Harris, Policy Director at the charity Leonard Cheshire Disability who has campaigned against 15-minute visits. Roger Booker, Chief Executive of Sevacare provided further insight from a provider perspective. Mike Webster, Assistant Director at North Yorkshire County Council put forward the view from commissioners and I completed the line-up. It could have been rowdy, but we had Colin Angel from the UK Home Care Association in the chair so we were kept well in order!
The audience were mainly providers who responded warmly to the Leonard Cheshire Disability video showing how difficult it is to provide care in 15 minutes. Jane and Roger were quite clear that the views of people using services should be taken into account and that a service should be measured by what it achieved, rather than the time it takes. Jane I thought had one of the best lines of the debate:
“A service focused on time and task is a coping service, not a caring service.”
CQC focus
I focused on how CQC would assess a service using our five key questions — is it safe, caring, effective, responsive to people’s needs and is it well led? My view was:
“If someone has to choose between a bath and breakfast — it’s not safe, it’s certainly not caring, it’s not effective or responsive to people’s needs and no well-led organisation should let it happen.”
I also worry about people living with dementia who need time and consideration that is not really possible in a flying visit and may serve to worsen their confusion and distress.
I have said all this before and am often challenged that we are focusing on the wrong people — that it is the responsibility of local authorities commissioning 15-minute visits not the providers who feel forced to deliver care in that way. Of course, it can be the contract, but it can also be poor organisation of rotas and timetables, cutting corners to reduce costs, inadequate assessments of people’s needs and a lack of flexibility on the part of the provider.
CQC’s focus is the quality of the service and how it impacts on the people using that service. If we rate services as inadequate or requiring improvement I would hope that providers will use our reports and rating judgements to reflect on the reasons for poor services — and if it is within their own responsibility to sort, then they do just that. But if it is an issue they need to raise with commissioners, they use our reports to explain why.
Commissioner’s view
So what of Mike at the debate? He explained clearly the intense pressure that adult social care budgets are under and the need for commissioners to balance so many competing demands. I know there are lots of tough jobs in adult social care but, for Mike and other commissioners like him, this must sometimes feel like an impossible balancing act. Mike made the case that 15-minute visits as part of a wider package of care are acceptable and that his council will commission on that basis. I’m pretty sure that Mike wouldn’t be asking people to choose between a bath and breakfast in the morning.
As ever, one of the challenges from the floor was about holding commissioners to account and ensuring good commissioning practice. CQC retains the power to inspect commissioners at the request of the two Secretaries of State for Health and Communities and Local Government. However, we do not do this routinely.
The Association of Directors of Adult Social Services and the Local Government Association have asked the University of Birmingham to develop standards to support effective commissioning practice in adult social care. The standards will support the implementation of the commissioning element of the Care Act and will provide a focus for sector led improvement. David Pearson, the current President of ADASS spoke from the floor to emphasise the collective responsibility we all have to improve standards, which was a good positive note on which to end the session.
Le Grand Depart
Regular readers of this blog know that I’m a bit of a sports fan and this week my favourite event of the year — the Tour de France — starts. Not only that, but Le Grand Depart is from the county of my birth, Yorkshire! I am pretty excited and will be heading up north to see all the action on Saturday and Sunday.
But even with sport, social care is never far from my mind — I wrote a blog for The Guardian Social Care Network about what social care could learn from Bradley Wiggins’s victory in 2012. As you can see from the photo, older people using services in Leeds have knitted yellow jerseys for the city centre statues. And I heard about home care workers planning on camping out in Otley to make sure that people get the services they need despite all the travel disruption at the weekend.
It’s not just the cyclists who are stars!
Originally published at www.cqc.org.uk.
