Friday 22 March 2019
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Chaos, bureaucracy and an unhappy workforce are not good for residents

There are care homes where chaos reigns, where the managers spend their time in the office obsessed with paperwork, and where most of the staff have no confidence in the management but feel that they can’t speak up for fear of being victimised. Fortunately, there are very few such places because they are not good places for residents, and most care home managers try to be with residents and staff as much as they can, try to keep bureaucracy to a minimum, and have the respect and affection of their staff team.

Where would residents, relatives and staff go if they did pluck up the courage to complain about a bad home? The obvious first port of call would be to the organisation that keeps an eye on care homes to check that they are being run properly - yes, CQC, the Care Quality Commission (in England).

But what if a relative discovered that the organisation they expected to help them was also chaotic and obsessed by bureaucracy, and bullied its unhappy workforce into submission? Or what if they were told that while the organisation “took all complaints very seriously” and added them to the information that they already held on the home, they could not visit the home and, in any case, they did not investigate individual complaints. What if the relative decided to Google CQC and saw reports of the chaos that the completely unnecessary registration process was causing, of CQC staff overwhelmed by paperwork and desperately unhappy with their employer?

Is this really an organisation that is working for residents, relatives and the public? Or is CQC too taken up with its own internal problems and politics? More and more social care leaders are plucking up the courage to question whether CQC is an effective organisation. We have the opportunity now to redesign the care home inspection side of CQC and make it into an organisation that will protect residents and help care homes to progress.

The Association of Care Managers calls for a new approach to regulation and inspection of adult social care:
 Prioritise the quality of care and the rights and safety of the people who use the services – this is the primary purpose of inspection

 Inspect services as often as necessary but at least once a year

 Inspectors should aim to prevent bad practice rather than to condemn it after it has occurred and after residents have suffered

 Inspectors should be locally based and known – and accessible - to the public and users of the services
Inspection reports should be written for the public

Inspectors should work directly with residents and relatives, staff and managers, NOT with the provider groups and organisations

 Inspectors should respond to and investigate complaints, and be willing and available to visit the service without notice and at any time

Inspectors should understand how the services work and be willing and able (when appropriate) to help services to improve

People who use services should have a formal and influential voice in the assessment of care.

We believe all of this can be achieved without increasing inspection fees. However, it will mean a total reorganisation of CQC, dismantling the centralised bureaucracy and grandiose management structure, and setting up local inspection teams employing independent inspectors who will be judged by - and paid by - results.

ACM supports the effective inspection of care services, concentrating on the rights, safety and wellbeing of those who use the services.

John Burton, Head of the Association of Care Managers
August 2010