Care home scandals – our righteous indignation should not blind us to the important work to be done in correcting the problems with everyday care

Adam Gordon is Consultant Geriatrician and Honorary Associate Professor in the Medicine of Older People at Nottingham University Hospitals NHS Trust.  He is also Honorary Secretary of the British Geriatrics Society and edits this blog.

Those of you with an interest in the quality of care in care homes will want to tune into Panorama on BBC 1 tonight.  The programme used undercover filming and recorded staff behaviour which was so worrying that it resulted, according to the Guardian, in seven members of staff being suspended and two being subject to criminal prosecution.

Horrendous stuff.  HC-One, the company involved, has since announced that it will be considering installing CCTV in its’ premises to mitigate against such behaviour. thirdSectorThe extent to which CCTV will limit abuse, and how issues of confidentiality and consent will be negotiated, remains to be seen.  How will issues of mental capacity be negotiated given that up to 75% of care home residents have dementia?  Presumably, to protect dignity, CCTV would not be installed in parts of the home where personal care takes place – which would be some bedroom and all bathroom areas.  So what protection will be provided there?

Paul Knight, President of the BGS, wrote a letter to the Secretary of State for Health and the Ministers of Health for the four nations in anticipation of the Panorama broadcast.  In it he stated that the BGS recognises there is important work to be done in care homes  and provided some practical examples of where improvements could be made.

It’s important to realise that – as shocking as cases of criminal abuse and neglect in the UK long-term care sector are, a lot of truly exemplary care happens in care homes.  One way of helping the sector to improve, so that all homes can emulate the best practice, is to stimulate care homes to help each other.  That’s not as easy as it might seem. Managers operate often in very small organisations without access to peer-training or support.  In many instances they receive little or no training in leadership or management, despite the leadership of complex care being their raison d’etre. The MyHomeLife movement led by Prof Julienne Meyer and colleagues has shown that if care homes are given the opportunity to foster communities of good practice, with appropriate support and training, they can work together to improve care

A major problem with the quality of care in care homes is the failure to provide healthcare which meets the needs of residents. The blame for this lies with the NHS. The prevailing model of healthcare for residents in the UK remains ad hoc, reactive and not truly multi-disciplinary.

This is at odds with a population where the average resident is recognised to have multiple diagnoses, take multiple medications and experience significant functional dependency.  Up to two thirds of residents have some form of incontinence and the majority have cognitive impairment.  The BGS outlined a more effective model of care – multidisciplinary, proactive and supported by appropriate expertise – in its Quest for Quality document and suggested how such care might be commissioned in our Commissioning Guidance for Healthcare in Care Homes published last year.  Yet such gold standard care remains the exception, rather than the rule.

Resolutions about CCTV and closer monitoring might help.  They certainly help to grab headlines. What they won’t do is help the care home sector to manage variability in quality, as the MyHomeLife Scheme has done. Nor will they help the NHS to step up to the plate and work to provide consistent, adequately planned and resourced care to older people living with frailty in care homes, as adherence to the BGS commissioning guidance might do.

We can – and should, all be shocked by what we see on Panorama.  But let’s not forget in our indignation that there are many more insidious issues with quality of care in care homes, the blame for some of which lies with the NHS.  These often don’t grab headlines but we need to get on and fix them nevertheless.

 

 

 

1 thought on “Care home scandals – our righteous indignation should not blind us to the important work to be done in correcting the problems with everyday care

  1. Neither Health or Care Services in the UK were developed or are currently organised to support the needs of people resident in care homes or for that matter to work with the providers (be they big, small for or not for profit etc). Regulation can’t fix this and commissioning is still in its infancy. Solution recognise that over 3x the number of beds than the NHS and consumption of over 80% of the adult social care budget might just warrant a new policy/practice leadership based on an agreed purpose. My challenge is can the BGS actually provide a catalyst for change, the reality is its failed so far in spite of honorable endeavour.

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