Pentland Hill in Edinburgh is the latest UK nursing home to have new admissions suspended because of poor quality of care, as The Herald reported yesterday.
Until about 15 years ago private nursing homes were monitored by small health authority inspection teams, comprising a doctor, nurse and administrator. Residential homes were inspected by local authorities. These teams had in-depth knowledge of each home in their patch, and GPs, community nurses, therapists and the public knew whom to approach with concerns. These l teams were replaced by remote, centralised bureaucracies: the Care Inspectorate in Scotland and the Care Quality Commission in England.
Also until about 15 years ago many people (including young disabled adults) now resident in care homes would have been in hospital under the care of a consultant in geriatric or rehabilitation medicine, supported by nurses and therapists. These specialist staff now generally visit care homes only on request, and then only to see individual residents. They have no responsibility for care homes. This means care home residents are often denied therapies, equipment and other outside help available to people in similar circumstances living in their homes.
From 2004 until 2007 several "more challenging" care homes in the Glasgow area were provided with modest but regular additional input from a physiotherapist, speech and language therapist and occupational therapist. The physical and psychosocial wellbeing of many residents improved considerably, and the therapists were able to change the ethos of all homes from the passive provision of 'care' to helping residents to achieve their potential. Residents thought unable to walk at all or to socialise with others were found, with the appropriate therapy, to be able to do so.
A super-abundance of paperwork was evident during our study: nurse managers occupied with this rather than leading and supporting staff. Opportunities for learning were not taken: when GPs, therapists and others did visit there was little communication with staff and no suggestion they might contribute to rehabilitation. Care assistants quite often failed to report problems they identified because they felt this was not their responsibility.
The enthusiastic therapists reviewed residents and their needs weekly, seeking remedial action from care home staff and managers as soon as problems were identified, thus achieving continuous improvements in wellbeing. Inspections can identify problems only after considerable time delay, and even then serious problems are often brought to light by a persistent relative rather than by inspection.
So what could be done to ensure problems in care homes are identified early so that prompt and effective remedial action can be taken?
A central body is required to maintain an up-to-date register of care homes, giving location and basic information as a starting point for choosing a home. The early identification and resolution of problems can only be achieved locally, by encouraging feedback from residents, relatives and staff and a return to local inspection/regulation teams whose main responsibility would be sharing and encouraging good practice, promoting learning and motivating staff, sanctions being a last resort.Jeremy Hunt, Health Secretary for England, is injecting a further £40m to the Care Quality Commission after serious failings such as those at Stafford Hospital and Winterbourne care home. This despite a predecessor, Labour's Alan Milburn, urging him to resist a "regulatory knee-jerk response". Mr Milburn said the problem was not too little regulation but too much, arguing that more regulation risked confusion, not clarity, and maintaining that feedback from staff, residents and relatives should act as "smoke alarms."
Care homes have become isolated from community health services. NHS front-line staff are needed to promote rehabilitation and enablement in care homes. And care home managers need time to lead and develop staff rather than meet the requirements of grand inspection agencies. Funds used for feeding these bureaucracies should be redeployed to the direct benefit of care home residents.
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