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Tactics to help us handle with care

In the face of an unpleasant and persistent problem, the Care Inspectorate has been doing a good and reliable job.

In recent months, thanks to the organisation's solid regime of unannounced visits, a number of care homes in Scotland have been exposed as falling way below the standards expected of them. Where necessary, homes have also been closed to new referrals to prevent any more elderly people being exposed to an inadequate standard of care.

To the inspectorate's credit, it now intends to go even further and routinely name the worst nursing homes, nurseries and other care agencies with a view to shocking them into improving their service.

There is a strong case to be made for such a name-and-shame strategy although, as the inspectorate itself has pointed out, the vast majority of care homes and nurseries in Scotland perform well, with less than 1% falling to the lowest grade of 1 on a scale of 1 to 6 (where 1 is unsatisfactory and 6 excellent). For this reason, as well as naming the worst homes, the inspectorate also intends to highlight the best ones.

At the other end of the scale, the worst examples of care in Scotland are upsetting and disturbing. In one recent case - Ainslie Manor in Girvan, Ayrshire - some residents were left with untreated bedsores; in another - Torbrae House in Castlemilk, Glasgow - some of the staff did not know how to spot the symptoms of dehydration.

Under the new regime, the Care Inspectorate will name such homes when they reach the lowest two grades of care: 1 (unsatisfactory) and 2 (weak). It already publishes its reports online, but the inspectorate says it wants to be even more open and transparent by specifically highlighting the services that give it cause for concern.

Such transparency is welcome, although it will always be important to put the inspectorate's findings into proper context. The care sector in Scotland remains under-funded and, while a poor standard of service is never acceptable, many homes are falling behind because they do not have the funds they need.

If and when the inspectorate does go ahead and name sub-standard homes, it may have the effect of encouraging people to use other agencies, but it will also be important that, should an agency remain immune to bad publicity, the inspectorate is prepared to use its enforcement powers. In the past, the inspectorate and its predecessors have leaned too far in the direction of encouraging homes to improve rather than forcing them to.

Of course, the Care Inspectorate also has a duty to offer incentives to improve and in this regard the scheme in which poor agencies are mentored by others that are doing well is an example of good practice. But for those that do not respond, the name and shame policy offers the prospect of shocking the poor performers into action. If it also creates a culture where action is seen to be taken when an agency falls below par, it could help to persuade the public too that it is always worth complaining when they, or someone they care about, does not receive the service they deserve.

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