Care Quality?

Another day, another report. This time, Which? has done some undercover work into the quality of homecare delivered to older adults as reported by the Guardian.

The team at Which? asked 30 families to make notes and diaries over a week in January and feed back the information, some of it is horrifying but the sad thing is that it doesn’t shock or even surprise me. That’s the real shame of the system.

One elderly woman was left alone in the dark for hours unable to find food or drink. Another was left without a walking frame, leaving her unable to get to the bathroom, while one man was not given vital diabetes medication, the watchdog said.

Which? has not named the agencies which I feel is wrong. I hope they are going straight to the Care Quality Commission (CQC)  with this information because for a consumer organisation which is supposed to be behind us as consumers of care services (oh, it’s coming in health care too – just wait) I’m surprised they feel they need to protect the names of those companies involved.

The reason they do is that those companies will not be removed from their positions of providing care to those who have been subject to institutional abuse such as that meted out in the examples given, because yes, this is institutional abuse.

These companies are probably tied into long term extensive contracts with local authorities than are bound in law and allow for a certain level of ‘default’ that makes them difficult to replace.

So what should and can be done?

1) However admirable Which? is, the fact that we have to rely on  Which? and Panorama to do the job of council quality assurance teams and more importantly the Care Quality Commission is not acceptable.

2) Embedding advocacy into the system far more fully. These people monitored were the ones who had families to complete the diaries. What about those people without families particularly those who may have cognitive impairments. We have to replicate the ‘checking’ role that involved families have to those who don’t have family support and for me I see that as happening through greater advocacy.

3) Commissioning (again, apologies to Guilty Commissioner who I know does things differently). The people who buy into and commission these block contracts aren’t the people who use them. They award on the basis of cost where quality has to have a greater impact on quality of life and quality of care provision.

4) Politicians. People go to their MPs about Forests but not about social care. The people who need the changes aren’t the people who are most likely to be politically active and that’s why this area has slipped so far down the political agenda. Politicians of worth need to advocate for electors who might not be clamouring at their surgery doors. They need to think of those who may be disenfranchised and take the advocacy and representation role more seriously to affect change.

Let’s hope we stop seeing these reports soon but i remain sceptical.

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4 Comments to “Care Quality?”

  1. Independent advocacy is a MUST in these situations for exactly the reasons you describe. The big problem not reported so far is the fear that is ever present for people who never know whether the agency staff will turn up, if they do who it will be – I don’t need to rehearse here the bewilderment caused by dealing with a dozen different strangers a week trooping in and out of your bedroom – let alone what might happen if they don’t turn up or, the one after that does and finds you seemingly ‘unable to cope and a safeguarding risk’ and promptly sends for a social worker or your already harassed family. The fear of complaining is a real problem too – being left at the mercy of a disgruntled or ticked off carer or one of their mates isn’t an enticing proposition. Independent advocates who can also scrutinise service quality would help enormously but who will pay for this? Advocacy organisations are disappearing every day and the thought of what next weeks budget will bring doesn’t bear thinking about – as long as we put so little value on the skills and dedication needed to care for our most vulnerable members of society – and wittier about forests and gay marriage instead of what really matters, then little will change. Which is why everyone out there reading your blog, following your tweets, delivering a good service DESPITE, must keep chipping away.

  2. Is it possible for home based care to be made safe? Unfortunately the answer has to be no. Staff cannot be supported and supervised – the individuals who are receiving care are often unable to protect themselves – it will never be viable for providers to charge a fee that could provide safer care. All in all in the current climate home care is a disaster .
    The responsibility for maintaining standards does not just rest with the regulator – all involved should share in providing protection. The current system of home care does not allow this to happen – underfunded – poorly trained – under resourced – unsupervised – the results are not surprising.

  3. I entirely agree with this. The lack of proper advocacy services in particular is appalling – but understandable when one realises that they are usually funded from social services – who are their main targets. Advocacy needs to be truly independent from service funders.

  4. Thanks for the comments. I agree re: advocacy as I hope is clear from the post. I think it could go a long way to helping.

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