Who should carry the can for neglect?

Paul Burstow MP, the former care services minister in the Brown government, is calling for company directors, chief executives and senior managers to be held to account for poor and failing care homes in their organisations.

There is an increasing spotlight on abuse in health and social care. The Care Quality Commission are under-pressure to show their teeth; the media are constantly on the hunt for a new salacious story. The government need to show that they are doing something about it.

The difference this time is that there is a semblance of cross-party support for this move. Last week Norman Lamb MP, the current incumbent of the Care Services office made similar overtures towards increasing accountability for those at the top.

I have personal experience of life under the stewardship of a venture capitalist-owned care company as a compliance manager. My job took me around over 60 care homes on a regular basis across the south-east. I can tell you that a frighteningly high proportion of those services were not fit for purpose with poor care and were poorly/understaffed. I witnessed abusive practices in homes and attitudes from senior managers citing that if the contract price was right then the placement was right. Home managers earned bonuses for saving money rather than quality outcomes for service users. In one instance I visited a recently purchased, large supported living group, without doubt one of the poorest services I have ever been to. I tore the service to shreds in the internal quality and compliance report and put together a clear action plan for improvement.
I was threatened by a senior manager with disciplinary action, the report findings were ignored despite a show of concerned hand rubbing. Worryingly, CQC visited not a month later and gave the service a completely clean bill of health. Nothing was done. I returned to the service 6 months later and literally nothing had been done. The service had worsened if anything. CQC visited again a matter of days after my inspection and this time placed warning notices on the service.For at least 6 months, but probably a lot longer, vulnerable adults with learning disabilities were subject to abusive practices.The service had been subject to a local social services embargo on admissions and safeguarding alerts for over a year, but again nothing had been done. It seemed that there was a absolute lack of will from the company and social care professionals to make the changes the service users needed.

This is one example of a clear case where there was corporate neglect. True, some of the staff should never have been working in care in the first place, but staff were poorly paid, working up to 70 hours a week with highly challenging clients in a service without any effective day-to-day management. The problems were not just localised to that service, but there were significant systemic failings. My reports were shared with the service manager, the regional manager, the operations director, the head of the specialist services division and the board of one of Europe's largest health and social care provider. Nothing was done.

So who should be held to account? The staff who are abusive and should be frog-marched out of care. Yes. The senior managers who knew exactly what was going on, wrung their hands and then sat on them. Yes. The local authority who were complicit and colluding with neglect. Yes. The board that institutes a culture of penny pinching and blatant disregard for the care of vulnerable people. Most definitely yes.

We have to press for a co-ordinated cross-party plan. There is far too much money being made out the frail, ill and vulnerable, which is highlighted by the fact that big business and money-makers are invading the care sector. The one thing they do know how to do is butter their own bread.

http://www.harriscareconsultancy.com

Ode to the Ronseal Deal

These are my toes
these are my feet
these are my ankles
and my knees.
These are my calves
these are my thighs
they are my hips
the pelvis is mine.
I've got my ribs
and vital organs
these are my shoulders
...up holders.
This is my face
and my neck,
this is my nose
...that grows.
My eyes, my ears
my mind, my fears
my shortfalls
my lack of balls,
my courage
my fate
my all-in-all
my state
of being.
This what you get
this is what you see
take it or leave it.
This is me!

Lance the boil

I hate Lance Armstrong. I used to love Lance Armstrong. I don't hate him so much for the whole drugs thing; it was an age when every single, sodding one of them pumped some shit into their veins whether they knew it or not.

No. What I really hate about Lance Armstrong is that he fooled me. Completely bamboozled. I cannot for the life of me believe how I watched him year after year. High cadence peddling to the top of every Col and me thinking he was really clean, despite what the detractors said.

The cancer charity philanthropist blazed across my screen like a meteorite entering the atmosphere. I watched his competitors trailing in his wake. Ulrich, Landis, Hamilton. My suspicious eye looking them up and down thinking 'surely a drugs cheat'.  But my Lance? Not a chance Lance.

The boil turns up on Opera Wonfrey this week. The man is a consummate actor having graduated from the  PD school of drama and psychopathy. He will wear his face full of regret mask and talk about how he was pressured; it was out of his control; he was depressed, bi-polar and schizophrenic with a sex, alcohol, gambling and caring addiction. How he was just a pawn in the game.

The audience will be shocked, they will shed a tear, applaud his honesty and think to themselves, 'but he has done so much good'.

And the boil will rise from his seat. Wonfrey will stroke his arm and thank him oh so sincerely. He will turn and walk, chastened from the stage. As he gives a last humble wave of acknowledgement he will hold his gaze firmly on the wings. The applause will begin to subside and he will look at his agent with the subtlest wink.

Lance will feel clean.

Volcareno Warning

The heat on the world of health and social care is turning up. Don't underestimate the tacit reference to a cap on social care costs in the lacquered mid-term review. I can feel the earth rumbling under our feet. There is a volcareno brewing.
The Health Select Committee today released a report on the Care Quality Commission (CQC) that will be missed by many because of the Con/Dems audit. They have been backed into a corner and need to change now or face extinction. I'm amazed that they have lasted this long under DC to be honest.
Amidst a catalogue of criticism is the odd sliver of acknowledgment, but really, very little for the new CQC Chair to hang on to.
So, like a trapped animal, CQC must come out bearing their teeth. They have recruited over 100 locum inspectors in an effort to meet inspection targets. Don't be fooled by the spin that this is to promote better quality. It is driven merely by spreadsheets.
An actual positive is the widening of the Specialist Advisor role. Compliance Inspectors are jacks of all trades. The breadth of caseloads cover 2-bed care homes to NHS Trusts. It is impossible for one person to have knowledge that spreads that widely.
Dilnot is also looming large giving every social care provider kittens. Unlike CQC, care homes generally just have to roll over and play dead when they are faced with a mortal threat. Care home providers and services work in their own little bubbles and there is no sense of organisation to carry any sort of fight to the regulators. DC, Jeremy the Hunt and Normal Lamb have yet to reveal what watered down version of the Dilnot report they plan to follow, but for the people it is potentially an election issue. The big care home providers are still making a pretty penny out of care, but I fear the consequences will have the effect that big business has had on the high street. Soon you will only be able to choose from Tesco or Sainsbury's care homes and all the little independents will be boarded up.