The majority of adult social care services provide safe and high quality care but there are still too many instances of poor care. As the CQC is itself criticised for failing to act appropriately in the case of covering up a suspected rape, the CQC’s State of Adult Social Care Services 2014-2017 has much worthy of more detailed consideration and lessons to learn.
Following the completion of its comprehensive programmes of inspection, the CQC has, over the past few months, published a series of reports on the State of Care in the different health care sectors culminating with publication of its report into the State of Adult Social Care Services 2014 – 2017. Whilst the CQC was satisfied that most of the adult social care sector met the “Mum test” (is this good enough for my Mum (or any other member of my family)?), by providing safe and high quality care, there were concerns that too much poor care remained, with examples of unacceptable care which occasionally led to actual harm to people using services.
So what lessons can be learnt from the CQC’s report? What aspects of good care can providers model to improve the services they provide and what shortcomings should they look out for which could lead to poor care (and potentially harm to service users and/or civil or criminal action by the CQC)?
The CQC goes to some length to emphasise how strong leaders and good managers can have a positive impact: inspiring a positive culture and influencing the quality of care provided. By supporting staff, listening to them and to service users and their families and carers they can create a positive culture, which is open and transparent and which is focussed around person-centred care.
Providers should not therefore underestimate the importance of appointing appropriate managers and the impact this will have on the quality of care provided. The CQC explicitly linked inadequacy in leadership to inadequacy in safe care. From a risk management perspective strong leadership is key, time and effort should be invested in ensuring the right person is in post.
Staffing issues were, perhaps unsurprisingly, highlighted as a characteristic which led to poor quality care. Whilst there were issues with insufficient numbers of staff being available, preventing people from getting support when they needed it (e.g. with delayed responses to alarm calls), the CQC was also concerned about the lack of suitably skilled staff, even where there was technically an appropriate number of staff in place. Managers need to ensure that they know what skills their staff, and any agency workers, have to ensure that they have enough skilled staff to support people with complex needs.
Concerns were also raised about staff training, in areas such as infection control, risk assessment, safeguarding and medicines, and staff understanding of the training they received. Medicines management was a particular area of concern associated with unsafe care. Some cases had had extremely serious consequences with actual harm being caused to people using services. Providers should ensure that appropriate training is available to, and understood by, staff and reviewed periodically.
The CQC has taken civil enforcement action, ranging from warnings through to cancellation of registration, in a number of cases with the most common breaches relating to a lack of good governance, issues with safe care and treatment, staffing and person-centred care.
In addition, criminal prosecutions were brought against five providers for breaches in safe care and treatment requirements. Fines imposed ranged from £24,600, where a 79 year old woman suffered serious burns when she fell against an uncovered radiator, to £190,000, where a 62 year old man died after breaking his neck in a fall from a shower chair.
The report emphasises the importance of employing the right people to do the right job – providers need to ensure they have an adequate number of appropriately skilled staff to meet the needs of the people using their services. The value of strong leaders and good managers cannot be underestimated and the consequences for failure – poor care, harm to service users, CQC registration implications and criminal sanctions – certainly shouldn’t be underestimated.
Judith Davison, professional support lawyer