People are looked after in their own homes all over the country. Carers pop in and out once, twice or more times in a day. Sometimes carers stay all night. Each time the carers have specific jobs to do, such as preparing meals to administering medication and providing personal care, all in accordance with an agreed care plan. This good work goes on tirelessly every day of the year but what more do we know about it, the quality of care, consistency, pay for carers, commissioning and so on? This article takes a look at these questions following the recent publication of a report prepared by the Equalities and Human Rights Commission (EHRC).
An initial study of home care was undertaken by the EHRC in 2011 and came up with an exhaustive list of recommendations set against the requirements of the Human Rights Act and the expectations of the so called FREDA principles (Fairness, Respect, Equality, Dignity and Autonomy). Although about 50% of older people thought the care they received was good, it was found that many others experienced poor care and neglect with rushed visits, people not being helped with eating and drinking, left without water, left in soiled clothes and bedding and being put to bed in the afternoon. All of these findings contravene these principles to a greater or lesser degree.
The care regulator, the Care Quality Commission (CQC), looks at care at home from the perspective of the regulations that they are expected to inspect against. In their latest report on care at home they found that 94% providers were protecting people from the risk of abuse and 74% were meeting all of the five standards. Concerns about the balance of providers (26%) centred on staff training and appraisals, continuity of care and late and missed calls. By coming from different directions it looks on the surface that CQC sees a greater level of ‘compliance’ than the EHRC. CQC came up with a number of recommendations which in summary state services must:
- continue to work with commissioners to understand the challenges around late or missed calls and find solutions.
- investigate incidents to identify problems so that action will stop it from happening again.
- ensure that new care workers are introduced to the people they care for.
- give new staff a full induction according to national standards before they start work.
- train staff to support people in the best way possible, and give them the relevant information about local safeguarding procedures including how to raise concerns.
- gather the views of family and carers more proactively.
In recognising that Local Authority commissioners of care at home have a substantial impact on how care is delivered by saying that there is pressure on services due to the arrangements for commissioning home care, strains on social care budgets and the rise in the number of people with complex needs, neither CQC nor the Local Authorities refer to either the Human Rights Act or the attendant FREDA principles when inspecting or commissioning care. This can make things very tricky for providers who are obliged to observe the Human Rights Act in everything they do and can be challenged in the courts but appear to be not so well supported when the fees for domiciliary care are so low that their staff are not necessarily adequately trained, do not receive a minimum wage and be given insufficient time for each visit to deliver the care expected of them.
It could be that by giving greater prominence to the Human Rights Act in regulation, inspection and commissioning care, providers may be supported to deliver better care. EHRC see this as needing a predominantly commissioning approach and give these practical pointers:
- At all levels of the local authority, including elected members, there is an understanding of human rights and a commitment to put them at the centre of home care commissioning.
- Human rights are considered not only throughout the planning and commissioning stages, but also built into monitoring of home care service delivery.
- Service users are empowered to use the language and framework of human rights, have a voice in the planning, commissioning and monitoring of home care services and know that they can complain about services they receive without fear of retribution.
- Individual needs assessments are person-centred, supporting independence and autonomy as far as possible.
- Service providers are contractually obligated to promote and protect human rights, with zero tolerance of neglect and abuse – recognising some rights are non-negotiable.
- Service users understand that, while other human rights may be restricted, this can only happen when the restriction is proportionate and necessary.
- Human rights are used by the local authority and providers to guide difficult decisions, for example, there are competing interests between staff and service users in terms of Health and Safety.
- Special attention is given to groups who may be at particular risk of human rights abuses, especially those already at risk of discrimination.
So, adopting a comprehensive human rights based approach will mean reviewing commissioning practices holistically to complement rather than compete with the existing regulations applied by CQC. Some local authorities have done this, others are part way there. Authorities should not assume that putting in place measures to promote Dignity in Care, personalisation and safeguarding means that their human rights obligations are fully met. While such initiatives are a step in the right direction, full compliance with the HRA is likely to need a more comprehensive, cohesive and focused approach.
Julie Hopkins 01935 423667 Julie.firstname.lastname@example.org