According to the CQC, regulation and inspection of social and healthcare is intended to ‘put people first, stand up for their rights, and act quickly to remedy bad practice’. But analysis of the DANI inspection reports (which CQC summarised on Thursday) actually shows nothing could be further from the truth.
While inspectors witnessed practices that were variously illegal, cruel or heartless, they took no immediate action to guarantee the safety of the patients affected. Instead, the hospitals with the poorest record of care were often given 28 days to devise a plan, and then were not monitored until many months later.
Unlike the response to nursing and care home abuse, there were no immediate protection plans, suspension of admissions, or ongoing monitoring to ensure immediate patient safety. Instead, the regulator walked away and left it to the Trusts. And, as Paget Hospital recently demonstrated, that gave no certainty of improvement.
During the visits, inspectors recorded health staff falsifying food and drink records to give the impression that uneaten meals had been consumed, a patient left for 30 hours without sustenance because medical notes had been ‘misread’, barrier nursing of an isolation ward ignored, patients being squeezed into extra beds without the necessary equipment to allow adequate nursing, high risk patients without nutrition plans implemented, and patients with their genitals, underwear or incontinence pads exposed. Inspectors even described some patients as being ‘at risk’, but still the deemed the hospitals compliant with the standards.
Despite this, the CQC did not make a single adult safeguarding referral or refer any staff member to their professional body or to the Independent Safeguarding Authority.
We are all rightly concerned about the sub-standard care provided on some of these wards, which degraded older people and put a number of them at obvious risk. But we also need to consider what the regulator did, or rather did not, do in response. A large number of these hospitals were deemed ‘compliant’, but had requirements placed on them which meant that they were in fact not compliant at all. This misleads the public. And the CQC have lauded the fact the no hospital had a ‘major’ concern around dignity. But, the definition they used made it impossible to record such a ‘major concern’, so this too misleads the public.
Of particular concern was the casual disregard of the national guidance on ‘Do Not Attempt Resuscitation Notices’. In some cases these were routinely inserted into patient files on admission. In others the decision was left to junior doctors, who never consulted the patients or their families. In one case Inspectors found a notice from a previous admission, still wrongly active in a patient’s files. This is a dangerous situation, as evidenced by the case of Peter Carter who died in 2010 when a nurse assumed a blank DNAR notice meant he should not be revived. Inspectors noted these issues in hospital reports but the regulator then took no further action.
The quality of care is obviously the responsibility of the hospitals and the Trusts. But the public expect a regulator to take immediate action when it discovers neglect or abuse, and to ensure that patients or residents are immediately safe and protected, today and tomorrow. The CQC did not do this. This leaves the unpalatable question as to how many older patients continue to be neglected and abused in these 100 hospitals, and others throughout the NHS. We need better quality NHS care, and we need better regulation too.