Actually, since we are referring to the recent BBC Panorama programme, ‘Behind Closed Doors’, then the word is something of a misnomer because we did not see the whole picture, only a very narrow glimpse of some awful practices by a few care staff. It was shocking and unacceptable but rather than go on about how terrible it was why don’t we take a broader look at what the public, the care sector and the regulator can learn from it and leave politicians to issue their sound bite statements that tend not to be too helpful in the bigger picture where over 17000 care homes employ over 1.5 million carers to deliver 24 hour care, 7 days a week, 365 days a year.
Firstly, to put this in context, very few care homes have Notices raised against them. It is difficult to flush out the actual figures from the CQC website but a recent article suggests that this is about 2% and of these even fewer relate to the regulatory standard about ‘caring for people safely and protecting them from harm’ which is what was found so sadly lacking at the Old Deanery Care Home. This means that the vast majority of care homes provide good if not excellent care and we must therefore not risk condemning the whole sector because a few are underperforming.
So let’s explore what factors will generally ensure good quality care is delivered consistently and effectively. These largely revolve around management, leadership, staff and training. Good management ensures that the records are in place to evidence all of the activities in a care home such as employment records: staff appraisals, reference checks, vetting and barring checks and so on. For the residents, care plans are a crucial element of understanding the care that is required for each resident, that this is a live document and is constantly updated as things change, and also reviewed on a regular basis. Medication records are similarly crucial to good care. Knowing and understanding each resident is so important in enabling personalised care and this can be reflected in the care plan as well as documents such as ‘This is Me’, involving residents in every aspect of their lives, seeking their opinion and understanding and responding to their wishes. Of course there is all the other stuff that needs to be well evidenced such as environment, repairs and maintenance, hygiene control, nutrition and hydration, waste management, shift rotas, training, policies and procedures, relative and resident feedback, complaints and compliments. The list is endless but the key is to organise evidence in such a way that it is able to answer the following questions about how the care home provides care: is it safe, effective, caring, responsive to peoples’ needs and is it well led?
But just having the records in place is not enough. Good leadership learns from the evidence collected and steers the culture of the care home so that it is a truly good experience in every respect for the people who live there. Good leadership inspires everyone involved in care, especially the staff but also the residents, their relatives, visitors to the home and, yes, even the regulator. The phrase coined by the National Skills Academy for Social Care, ‘leadership starts with you’ makes the point that everyone involved can be a leader in their own right, whatever their job. Had this understanding been held in the Old Deanery example, then it is unlikely that such abuse would have occurred.
Of course training helps enormously to support this and it is so important that staff at all levels receive appropriate essential training as well as specialist training to support them in delivering care that meets the needs of the diverse nature of people receiving it. Good training improves knowledge and understanding, develops self-confidence and encourages career development in the sector.
Finally, staff. Turnover is high in the care sector and many leave within a couple of years of joining the sector. This can be an indication that people come into care without the right values to sustain them in their roles. Such high churn rates do not encourage good care so the risks highlighted in the BBC programme are heightened. It may be a slow and methodical process to achieve better and more sustainable recruitment, but if care homes are able to move towards values based employment then only good care can result.
So, in summary, if everyone involved in care revisits the fundamental questions about the outcomes we would all wish to see: that the care home is safe, effective, caring, responsive and well led, then the chance of another ‘Panorama’ is seriously diminished.