Archive for October, 2011

The villain of the piece

Sunday, October 30th, 2011

Research for the Sunday Times today proves what many already knew – funding for elderly care by local authorities is highly variable and can alter dramatically between authorities only a few miles away from each other, and in that sense mirrors one of the common complaints of NHS treatments. We have long campaigned for much clearer advice and guidance for those considering care for the elderly, but today’s revelation will make a confused system even harder to unravel. People will now have to consider where they live in addition to their own financial circumstances when approaching their local social services for care.

The first question that will spring to people’s lips is why? The government originally issued guidelines, Fair Access to Care in 2003, which were then revised in 2010 under the Putting People first initiative. These were aimed at local authorities and aimed to give them a framework for assessing and categorising people’s care needs under 4 main areas, low, moderate, substantial and then critical. However, as funding pressures have grown, these same local authorities have found it increasingly difficult to keep to the set criteria, with many introducing sub-groups or different classifications as a way of trying to make what funds they did have go further. Matters came to a head earlier this year with Birmingham City Council taken to court, and subsequently losing, over its decision to withdraw care for a group of disabled people. Every day commissioning managers are having to make hugely significant decisions over who is eligible for care and who isn’t when faced with significant cuts in funding.

Do we need to look elsewhere for the villain of the piece, if indeed there is one at all? The coalition has cut £1.3Bn from local authority elderly care budgets since coming to power and it is these cuts which will have gone a long way to exacerbating the situation this research highlights. Yet the difference in funding between some councils varies massively, with two neighbouring councils in Yorkshire having over a £10,000 difference in the maximum contribution for care. Are some councils better at husbanding resources than others or do others have older demographic profiles meaning the pressures on their budgets are more acute? These questions merit further investigation, but in the modern age one’s postcode should not define one’s ability to receive care. the sooner the government creates a level playing field the better.

A register for care workers?

Monday, October 24th, 2011

The roving media spotlight on the state of care in the UK continues to search for evidence of malpractice or incompetence, and has alighted this week on the issue of how and why to regulate the ‘grey’ workforce of care assistants and nursing auxiliaries in the UK. This has come about after the revelation that nurses struck off by the NMC can, and I suppose do, return to work as care assistants.

At first glance, the argument at the core of this debate seems common sensical. Why should nurses who have been struck off be allowed to continue in care in any capacity? Certainly the comments I have seen echo this point of view – if a nurse exhibits incompetence or misjudgement when delivering care, then even if they are subsequently responsible for a much lower level of care, it still just doesn’t feel right, particularly to a patient who may be oblivious to their work history. In the real world it can take up to 2 years for the NMC to consider cases of nursing malpractice, and who’s to say where the accused might work in the meantime?

The corollary to all of this is the on-going issue of healthcare assistant registration. The bottom line has to be; would a register of care workers make a fundamental difference to the quality of care delievered? In a word, No. Nurses are all registered with the NMC, but stories of sub-standard nursing care abound and 200 are still struck off every year, so the fact they are registered does not necessarily improve care. The fact that the CQC registered and monitored all of the institutions that have witnessed appalling lapses in care recently demonstrates as well that registration per se is not the answer.

 There is also the very real danger that by adding another layer of bureancracy to the administration of care, people will soon not be able to afford to become care workers. As a sector, care workers are often not paid as well as they could be, and having to fund a CRB, uniform, travelling expenses and then the undoubted fee for registration, might lead many to feel they would be better off stacking shelves at Tescos.

So how do you ensure care  workers are fit for purpose? The answer is already with us, in the shape of the CQC. If they can deliver clear and achievable guidelines on care worker training and supervision, and ensure the latter are rigorously enforced then the quality of care will improve. Stung by recent criticisms over Winterbourne View and Stafford Hospital, the CQC is becoming more active in this role now and that is to be welcomed. As for the issue at hand, well credible, quality-driven businesses  will always conduct substantial work history checks on potential  employees to uncover past misdemeanors, regardless of who they are registered with.

Quality erodes over time unless it is constantly checked and then re-checked, no matter what business or organisation you are in. Care is no different, which is why strong and consistent leadership from the CQC, conducted with a  minimum of political interference, would allow a culture of quality to become the overriding objective for the sector, rather than something that is only discussed after another harrowing incident or embarrassing revelation. Everyone, from the largest NHS Trust to the solitary care worker, has their part to play in this, they just need to be shown where to go.





More elderly care scandals in the NHS

Thursday, October 13th, 2011

As if things couldn’t get any worse for the elderly receiving care in the UK, the CQC has today published a damning report on how the elderly were cared for at 100 hospitals across the NHS. The CQC made a series of unannounced visits to the hospitals and what they uncovered once again highlights the inadequacies of the current NHS setup for certain types of care.

Before we look at the negative side of the CQC’s findings, there are some positives here. Firstly, and most importantly, the CQC is doing exactly what it should always have been doing – conducting spot checks on the standards of care across a range of institutions. I wonder how many of those hospitals that received these visits had previously received a clean bill of health from the CQC when the visits were notified in advance? It is only by constantly checking that care is being provided in an appropriate way that the CQC can hope to raise standards, not by the beauty parades of inspections that often take place in their place.

Although the CQC seems to becoming more adept at uncovering the symptoms of poor care as shown in this exercise, what is being done to tackle the causes of these shameful events? Andrew Lansley’s assertion that more nurses should become whistleblowers does little to tackle this problem and smacks of desperation. Is the training of staff to blame as in the RCN’s recent pronouncements, or does this mistreatment of the elderly go deeper, possibly into the relevance of hospitalsthemselves? Let us not forget that 20 of the 100 hospitals visited fell below legal minimum standards, so something, somewhere is wrong.

Nor will the heavily revised Health and Social Care Bill, currently making slow progress through the House of Lords, make much difference to the lives of the confused and frail elderly people in our hospitals. How we treat our elders is one of the defining tests of a society’s humanity, and how good our intentions are, we are not meeting their needs at present. It is becoming increasingly clear that hospitals are not the best places to care for the elderly, given the demands on resources and people’s time. Instead the returning them to the community, whether it be ina residential or domiciliary care setting, seems the best answer. In this sense, Andrew Dilnot’s suggestions as to how elderly care will be funded in future and where it should take place, suddenly become very pressing indeed, and will once again attract attention as the most obvious alternative to hospitals.