It has not been a good week for the care home sector. The BBC Panorama programme ‘Behind Closed Doors: Elderly Care Exposed’ has once again shown shocking evidence of abuse and woefully poor practice in the very places that exist to care for vulnerable older people.
Yesterday in parliament MPs called on Norman Lamb, Care Services Minister to explain what was being done to protect people and to prevent such situations from occurring. In a well-chosen ‘soundbite’ one MP said it was left to the BBC rather than CQC to bring such shortfalls in care standards to public notice.
Arguably the one positive that has arisen from the awful revelations is the extent of public outrage about how people were treated and the sense that we should ensure that there are systems and procedures in place to prevent it from happening in the future. There has to be zero-tolerance of abuse in care settings which means holding providers and their staff to account alongside commissioners and regulators.
The programme left me thinking about three factors that are crucial to understanding what makes the best quality of care – none of which were sufficiently developed in the interviews and discussions.
The first is that of culture: this is primarily the result of leadership
A culture in which the call-alarm buzzer is sounding almost constantly is about as far away from being person-centred as it is possible to get. To live (or work) in such a noisy environment would be incredibly stressful and says simply ‘you have to wait.’
The second factor: exercise of power
I don’t recall it being specifically mentioned in the programme but the interactions we witnessed between the staff and the residents in the two care homes featured were about the exercise of power. Someone deciding when you can go to the toilet is a fundamental manifestation of power. It is an attack on respect and dignity and rights. Such behaviour has no place in good residential care settings.
The third factor: ratio of staff
Having the necessary ratio of staff to residents is a prerequisite for registration and to meet essential standards. This is because staffing levels are crucial to the delivery of consistent person-centred care and support. In fact good quality of care cannot be delivered without it.
We recognise the importance of a voice for people receiving care; involving families and communities; a commitment to continuously improving quality; leadership and management; training and development; pay and conditions; supervision and support; accessible information; sound governance, accountability and transparency; sharing research and best practice; and being transparent and open. The National Care Forum (NCF) developed NCF Quality First - a framework which demonstrates the commitment of our members to providing high quality and continually improving services. It consists of all of these elements. NCF Quality First is a public commitment by care providers to the highest standards of practice and continuous improvement designed to gain the confidence and trust of people who use services and their families. You could add regulations and standards and the frequency of inspections to the list.
Ultimately the best care and support is about the quality of the relationship between the person receiving the service and those employed to deliver it. I believe that culture, power and staffing all contribute to this. Addressing the issues arising from culture, power and staffing is the best way to build positive relationships in care homes.
Last night I had the privilege to attend the launch of The Things Between Us: Living Words Anthology a book of words and poems of people experiencing dementia. It was something of an antidote to being immersed in trying to make sense of the awful findings of the Panorama programme.
Living Words is about learning to listen with an open mind. It has developed into a way of working with individuals and care staff to embed communication techniques. The words and the poems are the result of taking time to connect with people and they yield surprisingly powerful results – they reflect the supremacy of relationships. And that is where, I believe, we should really be focusing our attention.
Des Kelly OBE
National Care Forum