The Care Quality Commission (CQC) publishes the first five reports from a targeted programme of 150 inspections of hospitals and care homes that care for people with learning disabilities.
The programme is looking at whether people experience safe and appropriate care, treatment and support and whether they are protected from abuse. A national report into the findings of the programme will be published in the Spring.
These first five reports are from the ‘pilot’ inspections carried out to help test and refine the inspection approach. The five inspections were of hospitals that provide assessment services.
Although it is too early to draw universal conclusions, the indications from these and other completed inspections from the programme is that leadership and governance needs to be stronger to ensure that services are safe and meet essential standards. Findings so far suggest a lack of understanding about what safe, person-centred care looks like.
Only one of the five services inspected was found to be fully compliant with the government’s essential standards of quality and safety required by law.
Commenting on the publication of the first reports, Dame Jo Williams, Chair of the CQC, said:
“These inspections are the first of many, but already we can see the effects of a lack of strong leadership and governance. Where we have found problems, they can often be traced back to poor procedures or poor understanding of procedures.
“Another recurring issue in the first inspections is a lack of person-centred care. It is especially important that services make sure that the care of people using these services, many of whom have extremely complex and individual needs, is tailored to their needs.
“CQC inspectors have been joined by ‘experts by experience’ – people who have first hand experience of care or as a family carer and who can provide the patient perspective as well as professional experts in our learning disability inspections. This has been invaluable to help us build a detailed picture of the care that people are receiving from these services.”
Terry Bryan, the nurse who drew attention to the abuse at Winterbourne View, and who is now one of the professional experts working with CQC’s inspection teams said:
“After Winterbourne View, there was a consensus that the inspection processes at the time did not always stand up to close scrutiny. The current unannounced inspection programme has been slimmed down sufficiently to obtain honest ’snapshots’ of daily life for people who live in services, together with ’gut feelings‘ about the services themselves.
“By using people who have either worked extensively in the care sector, or who have experience of that support first hand, we are now managing to obtain more substantial and qualitative results. However, the Commission should not be expected to work in isolation, as there is also wide consensus that providers' local governance procedures be sufficiently robust, because ultimately, that is where the real daily safeguarding operates.”
Where we identified concerns, we raised these immediately with the providers and managers of services. In the case of two services, Kent House and Townend Court, our inspectors sought assurances that the providers would take prompt action to ensure the safety of people using services. In both cases, the major concerns were in relation to safeguarding people who use services from abuse.
- At Kent House in Wirral, inspectors found staff were not following agreed safeguarding procedures, which was putting patients at risk. In addition, systems to check that staff were competent in, and understood, their safeguarding roles were not strong enough.
- At Townend Court in Hull, inspectors found that suitable arrangements were not in place to safeguard patients against the risk of abuse because of failings in patient records and because the trust had not recognised that use of restraint may amount to abuse. Nor had the trust responded appropriately to allegations of abuse made by patients.
All the services where concerns are identified must tell the CQC how and when they will improve. Those failing to meet essential standards could face enforcement action by the regulator if improvements are not made.
Our inspectors have already returned to check progress at Townend and found improvements. Other services will be re-inspected shortly.
Inspection teams also observed examples of good practice. For example, at Rose Lodge in Tyne and Wear inspectors found that decisions about how behaviours that challenged were managed were based on the individual’s needs, and support plans were comprehensive to ensure that responses to behaviour that challenges were appropriate, reasonable and proportionate and justifiable to that individual.
All the reports relating to these inspections will be published over the coming months. The national report due to be published in the Spring will draw conclusions about the overall state of this type of service.