Regulation needs a human touch

I have little doubt that the CQC decisions in relation to the Merok Park Nursing Home in Banstead Surrey were grounded in very real concerns for the well being of the residents. The media talks about, 'people were being washed in cold water, were in inappropriate beds, and that there was an overpowering smell of urine in the home. The last CQC inspection report also found that staff that worked there were not given criminal records checks'.

Now, we are the last people to resist action being taken to protect vulnerable older people who are being neglected or abused, and it does sound as though Merok Park merited urgent action.  But we can't help but question the logic of moving vulnerable older people at 7pm on a cold night, involving uniformed police officers, and with apparently little advance notice for relatives. That feels like institutional abuse on top of the abuse those older people may have already suffered.

I fully accept that the options available to CQC are limited in such situations, but surely it must have been possible to get the local authority to at least draft in emergency staff to run the place until the closure could have been arranged over a longer, and better planned timescale. Particularly as it is well known that sudden changes of environment can have dangerous consequences for older people.

In the last few years High Court judges have pointed out that adult safeguarding should not take actions that merely make someone safe, but then leave them miserable. And they have pointed out that local authorities should be satisfied, before taking any action, that the impact was going to improve and not worsen the situation. It seems as though the 'new' CQC needs to think about these messages if they are not to end up becoming the 'old' CQC once again.

And ideology wins once more ...

A month ago I blogged about the intended changes to the Care Home regulations, which effectively deleted three critical requirements: the responsibility of a provider to tell residents about complaints procedures, the requirement to offer a choice of food, and the requirement to plan for and have in place emergency procedures.

In an attempt to get this decision re-considered we had several conversations with the Department of Health, and Lord Hunt agreed to trigger a debate about it in the House of Lords, which happened earlier this month.

So what was the outcome?

Well, according to the Community Care magazine, ‘the concerns will now be addressed in the government’s new proposals and will be brought to the attention of the Care Quality Commission, who are due to issue guidance on how care homes can meet the new standards.’ 

And, in some quarters this has been hailed as a success. I wish we could agree, but I’m afraid this simply puts a positive spin on ‘no change’.

The Government has not moved an inch on this matter. The legal requirements of the regulations, in relation to these three issues, have been downgraded to guidance instead. And the regulator cannot take enforcement action on guidance; it must go back to the regulations, which are ambiguous to say the least.

An esteemed colleague of ours, Michael Preston Shoot, makes a distinction between 'evidence driven policy' and 'policy driven evidence'. One is about addressing and understanding facts and developing policy on that basis. The other is about developing the policy, and then making the facts fit around it. With little regard for reality.

You can decide for yourself which this is. Ideology always wins over reality!

Ideology never allows reality to get in the way

(Or, why care homes no longer have to tell residents about complaints procedures, or offer a choice of food, or plan for emergencies)

In England there are at least two different ‘realities’ when it comes to adults experiencing abuse; adults that are very often old and frail.

Firstly, there is the reality of being abused or having a loved one abused. That often results in fear, anger, hurt and a need for justice. It is usually only at that point that people look at the systems for protection – regulation, inspection, intervention and criminal justice – and find them insufficient. They often feel that what they thought were robust systems are full of jargon and pious sentiments, but short on fairness, justice or consequences for the abusers. Sometimes, how they feel is unfair because – sometimes – it would have been impossible to stop the abuse or bring the abusers to justice. That is an unfortunate reality. But often, it is the system that is failing, and will continue to fail in the current climate. People not surprisingly become cynical and critical as a consequence, and usually end up being labeled as a problem. Don’t shoot the messenger is not a very strong guiding principle in this context.

Secondly, there is the reality that politicians and policy makers see. This is a world in which every frail person can make their own decisions and can control what they want and how they want it. This is a world in which support can always be given to help people make their own decisions, where empowerment, choice and control are the guiding aspirations. And this is a world in which there is no need to be prescriptive with care providers, because too much regulation restricts their ability to do good, kind things. The ‘light touch’ is empowering to better care.  Sometimes, this approach works and many individuals successfully reassert control over their lives, and many care providers seize the opportunity to do even better. But often, it doesn’t work like that. But in this world, ideology never allows reality to get in the way.

So, last week a little known Commons committee nodded through changes to the statutory regulations for care homes. The care and support minister, Norman Lamb, said (having) fewer rules would “strike a balance” between effective safeguarding and flexibility in the running of care organisations. Consequently, they removed the responsibility of a provider to tell residents about complaints procedures, the requirement to offer a choice of food, and the requirement to plan for and have in place emergency procedures. These deletions will apparently increase flexibility in the running of care (?)

Somewhat belatedly, the deletions received limited publicity (through David Brindle in The Guardian) and the Association of Directors of Adult Social Services suggested in response that there will really be no change, because these deleted requirements would continue to be expectations in any CQC inspection. An un-named Department of Health spokesperson quickly agreed stating that a care home resident must have their needs and preferences taken into account, for instance, they will go beyond simple provision of two alternative meals, neither of which the resident may like.

Which begs a couple of questions. Why delete them from the regulations in the first place if they are going to continue to be ‘expectations’? (If it ain’t broke, don’t fix it, as the saying goes.) And secondly, what evidence is there that the care home sector is so well funded and motivated that there will be a sudden leap toward offering multiple choices in food provision? Here is surely where ideology bumps into reality, and simply ignores it as an inconvenient truth.

Now it isn’t as though the Government didn’t know what they were doing, or the implications, or the concerns that people had about these moves. In May 2014 a colleague charity, the Relatives and Residents Association, wrote to the Chair of the Health Select Committee, Stephen Dorrell, and copied it to  several other MP’s (including the Minister for Care, Norman Lamb). At that point they drew attention to a number of these deletions, but apparently got no-where. In the current climate, if you are not saying what they want to hear they just don’t listen.

Ideology never allows reality to get in the way.