Monday 18 December 2017
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Money for old rope

Money for old rope
CQC has increased fees for a vanishing service; now it proposes that homes pay extra for “excellence”. This is money for old rope, and old rope is neither safe nor secure, says John Burton, the Head of the Association of Care Managers (ACM)

The Care Quality Commission’s proposal for a New Excellence Scheme for Adult Social Care reveals CQC’s confusion about its role and task, its further abdication of responsibility, and its willingness to take money for nothing.

Excellence is in the eye of the beholder
The fruitless pursuit of the misunderstood business concept of “excellence” has diverted us from the core task. The only people who can judge a care home to be excellent are those who use it, because what’s excellent for one may not be excellent for another. Excellent care homes come in all shapes, sizes, and styles, and people’s needs and preferences vary.

Is “excellent” food the sort you’d eat in a top-class restaurant or is it delicious, home-cooking?
Is “excellent” care given by expert, uniformed staff or is it given through the love and commitment of people you regard as friends?
Are “excellent” activities concerts and bridge parties or are they peeling potatoes, reading the horoscope together while enjoying morning coffee, and watching Coronations Street with your friends?

You pays your money and you takes your choice, and it really is a matter of personal preference.

Or is “new excellence” going to be what CQC and the licensed assessors of excellence can most easily measure? It is impossible to measure matters of taste and personal preference with the consistency that provider organisations will demand. Care homes should be different in order to provide a choice. Variety, difference and inconsistency are essential elements of evolution. Standardisation is the enemy of development and progress. Think about it!

Time and energy (and additional assessment fees) spent attempting to jump through the hoops of CQC’s new “excellence” scheme will be resources diverted from managing a home that only residents and their relatives are qualified to rate as excellent or not.

The caring, safe, and homely practice of a home (although still a matter of judgement rather than established fact) is a little more straightforward to identify with consistency. It is the regulators job to judge whether a home is adequately caring, is safe, and is “homely” in the way its residents want it to be homely. But that judgement can only be made by observing practice. CQC measures care homes by The Essential Standards of Quality and Safety but have now largely abandoned inspection (observing practice) in favour of “reacting to signs that people may be at risk of receiving poor care” which really means “when enough people tell us that a home’s not safe we’ll do a site visit . . . if we’ve got anyone available.”


(Peters and Waterman published “In Search of Excellence” in 1982 and its central theme was people, customers and action; very different from the bean counting and box ticking approach of CQC.)

John Burton
Association of Care Managers
March 5th 2011

For more information about ACM, please contact
Kate Hawkins, Hawker Publications Ltd. Culvert House,
Culvert Road, London SW11 5DH
Tel: 020 7720 2108 ext 201
Fax: 020 7498 3023
Email: kate@hawkerpublications.com