1. Improving quality and developing the workforce

The quality of care people receive is a major concern for users, their families and the public more widely. Read more about quality…

What do you think?

a. Should there be a standard definition of quality in adult social care as quality can often be interpreted differently? What do we mean by it and how should it be defined? How could we use this definition to drive improvements in quality?
b. How could the approach to quality need to change as individuals increasingly fund or take responsibility for commissioning their own care? How could users themselves play a stronger role in determining the results that they experience and designing quality services that are integrated around their personal preferences?
c. How could we make quality the guiding principle for adult social care? Who is responsible and accountable for driving continuous quality improvement within a more integrated health and care system?
d. What is the right balance between a national and local approach to improving quality and developing the workforce? Which areas are best delivered at a national level?
e. How could we equip the workforce, volunteers and carers to respond to the challenges of improving quality and responding to growth in demand? How could we develop social care leadership capable of steering and delivering this?
f. How could we improve the mechanisms for users, carers and staff to raise concerns about the quality of care? How could we ensure that these concerns are addressed appropriately?

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59 Responses to 1. Improving quality and developing the workforce

  1. judith Tunnicliffe says:

    My experience has been that the current regulatory system does not raise quality. I recently contacted the CQC to express my concerns about the way inspections are currently conducted in that they are so liberal there is no way bad practice would be unearthed!
    Given organisations are given a good rating which suggests a certain standard achieved, I am forever amazed by the number of carers who come to us from other organisations having had NO training, no recruitment follow up checks, no on-going supervision. How does this continually happen? Clearly the system is failing.

  2. Mark Galli says:

    I have to agree with Judith..I come from an ISO 9001 Quality Management background and I am constantly amazed by the lack of Quality Procedures, both written and practiced, within Social Care. Many companies simply do not demonstrate any understanding or compliance towards managing quality, let alone raising it, either towards their clients or staff. The introduction of the ‘Essential Standards’ has added even more confusion about what quality actually is. The use of the PCA Tool, in my opinion, does not help matters. How can you ‘Nearly Meet’ a standard or requirement? Surely, you either Meet it or you Don’t..! it’s time for a recognised Quality Standard to be introduced with clear Policy and Procedure that should be followed in a programmed and systematic way. Too many times I have found situations where written procedures are out-dated, not followed or not understood by the staff they are written to help. Companies should be forced to carry out regular Internal Audits that should be used by inspectors during their visits. Many staff have serious gaps in training and very little supervision. The government need to put money into the inspection system and quick. I have found that some of the companies I have worked with, have not had an inspection since 2009 and this is clearly unacceptable and so is the excuse that there is a lack of ‘man-power’ within CQC, after all, we are talking about people and their welfare..Other service industries are regulated much more closely, maybe they should have some input..!!! (rant over)

  3. Susan Rogers says:

    I am a health and social care trainer but have always known that management are the root of most of the quality issues in care. I have recently experienced this myself first hand as a parent was discharged from hospital with a health needs care package. The discharge was on a Monday. The phone call from the care agency was received by me on the Monday morning. They needed to visit before the discharge. They didn’t arrive until after discharge and simply asked me to sign pre-completed forms. No personalisation, no history of medical situation requested, off the shelf risk assessment form already completed. Nothing, nada, zilch. The manager was in the house for 5 minutes maximum. In the first week there were 3 medication errors(even though medication was in hospital issued blister packs with full instructions). On the first visit medication was not given at all. I have had to give each member of staff a history of the medical situation. They have all admitted that they had not read the care plan (in which there is nothing of relevance anyway). People turn up who are not on the rota and have no idea what situation they have to deal with. I get phonecalls asking me where the medication is (even though the office have a record of where it is kept and why). On the first night no medication was given because the carer didn’t know how to deal with my other parent (who has cerebral vascular disease and who was following her round the house) so she left without doing anything. I queried the lack of dementia training with the manager but got no response. She didn’t seem interested. Some of the staff are obviously long serving but I still keep walking in to find no aprons, no gloves – worst still, I was told by one that she always had a pair of gloves in her pocket in case she needed them. It was apparent that she meant she would re-use them. I had a phonecall one night to advise me that my other parent was not very well. The care worker had obviously NO first aid training as the first thing she had done was phone me (not the ambulance) – incidentally the problem was identified as a Hypoglaemic attack (seriously close to coma). The concept of Risk Enablement has been none existant. Each lunchtime care worker tells my parent that she must do nothing – it is her job to get lunch ready. I put 3 outfits on the bed every day so that my parent can choose what she wants to wear each morning. This doesn’t happen. The clothes are selected by the care worker. if I gave you examples of the lack of ‘quality’ of care I have witnessed in the last 4 weeks since discharge from hospital you would run out of web space! There is no quality of care. My experience tells me that the problem starts with management. Very poor management. Inadequate training, inadequate staffing levels, no personalisation, no risk enablement.

    • Mel Smith says:

      I can totaly relate to your details. I worked in a care home for nearly 9 years i was a care assistant and worked my way up to a senior. Money was always mentioned how short it was and would have to cut down on this and cut down on that. The food ordered is the cheapest of the cheap, if residants wanted something the home hadnt got they or the family are expected to buy for them selves. Laundry was always ruined or put into the wrong rooms. Choices taken away from the clients and care just provided to minimum standards. Baths given once a week if they were lucky. Night staff sleeping and managment knowing and doing nothing. Medication errors and reported to managment nothing done. Expected to do training on days off work and not get paid. Minimal staff levels for what is to be done. One thing I still do not understand how can you say you need so many people to so many clients it does not work that way. Staffing levels should be on what the clients dependancy level is and risks. I had 5 staff to look after upto 30 people at one point over seven of these people required two people at once to give and provide all care if you calculate time of all these needs from getting up in the morning , toileting, transfering it does not equate. Staffing levels are a magor part of the problem. Systems from managment not followed properly policies and procedures not followed and not passed on correctly. Clients left to sit in wheelchairs for hours on end. I loved my job when i first started but has become more chalanging with less rewards.

    • Jenny Weinstein says:

      I totally agree

      My whole career was spent in trying to improve the quality of social care or social care education in one way or another and I am now doing the same thing as chair of a local LINk..

      I cannot tell you how many books of targets, standards, quality indicators etc I have seen or contributed to. They were all excellent – but did not change practice.

      Excellent management, training and time are essential with resources to back them up. My heart sinks at the idea of more highly paid consultants being paid yet again to devise definitions of quality when any service user or carer will describe it in a few sentences. Whilethe people who deliver direct care are the poorest paid and the least trained with no time to offer. e.g. home carers being cut to half an hour per person with specific tasks and no time to engage – and hospitals not being able to afford to provide high quality personal care to older people – these problems will continue and we will continue to try to find new words to make it better.

  4. David Rolph says:

    I also happen to agree with Judith and i was not impressed either by the lack of understanding from the CQC. The CQC seems to have a laissez faire attitude to people who are vulnerable within society. I am also disabled myself and fortunately do not live within a care home, but there has to one simple truth there must not be any more slips up along the and stop saying that they are learning lesson this is used to often as a means of sweeping it under the carpet. The answer is more choice and personalisation.

  5. Judith Brown says:

    I am totally sick of buzz words. What I want as a 72 year old is to be sure that wherever my care comes from in the future, I will be recognised as an individual and treated as such. We all know that quality care simply means treating people with empathy, with kindness and with patience, with knowledge of their physical and emotional needs and the training to provide what is necessary for someone to live as fulfilling life as possible.
    We all also know that training costs money, and that care needs to be monitored to ensure the above is happening. The CQC is only as good as the training the staff receive and the number of staff available to do the job which is so essential. The Government appears to be confused about the CGC. I met Andrew Lansley this
    week, and he agreed that quality care is essential, but when I asked why in that case there was a consultation out about reducing the workload of the CGC so that fewer things were inspected, he did not know about it.
    I asked him pointblank if the work of the CQC was going to be diluted, and he assured me it was not. The need for quality standards has never been greater, when the Social Services run by local authorities, with their strict monitoring of standards, are being phased out in favour of private care. At this point I usually hear someone saying, “But personalisation means choice”. No it does not, if the only choice is between different private/independent sector agencies, who may not even register, much less be inspected!The old C&G courses 325/1,2 and 3 produced care staff who were informed, and proud of the job they did. Even National vocational Qualifications in Care made people examine what they were doing when they carried out their job.
    I really do fear for my generations, and yours, if we do not get this right. I look forward to hearing Dilnott next week. Judith Brown Chair Bristol Older People’s Forum.

  6. Mark Galli says:

    I whole heartedly agree with all the comments so far and especially with Susan about the problems starting with Management. My experience and audits clearly show that the root cause is poor ‘management’ of staff, as opposed to poor staff. Managing staff is a skill and one that not everyone has. Too many times I hear that staff are ‘un-manageable’ but when you talk to the staff they say they have no guidance in the way of supervisions and are just talked at rather than to. Most only have time with their manager when there is a problem or complaint. Communication is another key area. Good communication between client, family, manager and staff are crucial to get the level and detail of care correct. Good communication raises confidence that when issues do arise, which inevitably they will, they are effectively dealt with to the satisfaction of all concerned. Effective Communication enables Managers to ‘Manage’ efficiently but this one simple area is all too often overlooked. Just because someone has been a good ‘Carer’ for many years, does not mean they will be a good ‘Manager’..!
    Quality needs to be ‘driven’ and this has to start at the top which means with Management. I have great respect for the organisations that have taken it upon themselves to get accreditation to ISO9001 and this should be recognised within Social Care just as much as organisations that promote the GSF for example. It should also have a bearing on any ‘excellence’ awards that the CQC decide on in place of the ‘star’ system.

  7. The recent Select Committee Report on CQC Accountability really is a wakeup call for government that a new regulatory body is required to uphold quality care practice. So Step 1 is change the method of managing the compliance of social care providers with the new statutory regulations. This needs to include a route for service providers and social care providers to hold the new inspectorate to account when they use their authority inappropriately, or fail to meet acceptable levels of customer service and support.

    The new Outcome Based Framework used by CQC Inspectors is designed for all Health & Social Care service providers. Everyone from a Care Home to a Dentist, including NHS Trusts. It is far too idealist for it own to work, but more importantly too difficult and subjective to interpret what is viable evidence to demonstrate that a specific quality outcome has been met. So Step 2 is to design a simplified common set of KPI’s – based on the existing regulatory Outcomes – for each type of registered provider that can be easily understood by all parties, including service users. The Outcomes will then make more sense.

    Last but not least is a common quality management tool that can be used by all social care providers for them to measure at practical operational level their ability to achieve set outcomes and comply with statutory regulations. Since the Care Standards Act 2000 none of the inspectorate bodies, including CQC, have offered or put the stamp of approval on any practical quality assurance auditing tool. Instead the 15,000 plus registered social care providers today have all had to develop their own, leading to inconsistency, uncertainty and wide variations between good and poor quality care practice. Not within our remit says CQC.

  8. Jackie Hewlett-Davies says:

    Please ensure that the NHS workforce planning, education and training policy (new paper currently awaited) takes into account the need for integration across health and social care. The new arrangements need to enable flexibility of funding for commissioners and providers to put resources into the right places to support the workforce in the statutory and voluntary sectors to develop the right skills and knowledge and learn together to deliver integrated pathways of care. The Local Education & Training Boards need to be able to respond to Health and Wellbeing Boards and Clinical Commissioning Group requirements, therefore there needs to be appropriate channels of communication and influence at HWB Board level and the ability to manage devolved resources to deliver local workforce development needs.

    • caroline post says:

      I agree and it would be so good to see integrated health and social care training available without all the arguments about who is responsible for clincial skills training within Nursing homes etc. I think we need to work together on this. Whilst Health and Social have different pots of money it will never change and all that is a concern is whose budget is it coming out of.

  9. DavidPybus says:

    Individual workers need to sign up to a statutory code of practice. There should be an official minimum qualification obtained before they can practice, as with nurses. Standards should be independently tested. Organisations, local authorities, and companies that operate in social care should have similar standards and be subject to unannounced inspection. Inspection needs to be thorough, regular and done by a properly equipped workforce.
    You can’t do much about volunteers who are just helping out a neighbour or relative but you could promote a set of guidelines that they could easily get a copy of in libraries, council offices, community centres, and surgeries.

    • caroline post says:

      Not forgetting that we already have the GSCC codes of practice for both employers and social care workers. And the mandatory Common Induction Standards through Skills for Care that have to be completed within the first 12 weeks of starting employment in an adult social care setting.

  10. Tam Harrison says:

    Although there are problems with equating meeting particular criteria to the concept of “quality” , getting rid of measurable minumum standards does not seem to have helped. I cotnacted CQC recently about concerns over what appeared to me to be low staffing levels in a care home, as the ratio of staff to residents has been removed, it is up to the care home to decide what is an appropriate level of staffing to meet the residents needs. While i could see that the staffing levels just about enabled meeting medication, personal hygiene and support to feed residents, it didn’t allow for time to engage in activities, social and mental stimulation and this then becomes a debated area over priority of needs. I’ve also noted with care agencies that the standards of training and understanding of very ordinary conditions (dementia, diabetes, parkinson’s disease, learning disability etc) by the care staff varies greatly. Minimum standards don’t garuantee quality but they help to identify levels below which standards cannot be met. Perhaps the debate should seperate “minimum standards” from “quality” as meeting standards does not automatically give evidence of quality, but it does give a bar below which concerns about a service or worker can be addressed. If you want quality in your life, this usually means over and above a minimum standard, personalisation should lead to quality but not when people have limited choices of what is available at the basic cost, it gets to be a choice between “economy services”.

    We need to be building in a requirement for care staff in social services, health services, care homes and care agencies to have regular training to keep employment as well.

    • Tom Cooper says:

      Actually there has been no ‘official’ staff/resident ratio standard for many years. It was not mentioned in the old National Minimum Standards for care homes, published by the DOH, that came into force in 2002. This is because the correct levels can only be worked out taking into account the situation in the home i.e. the number, needs and dependency levels of the residents at a given time. Nevertheless I accept your point about having sufficient staff resources to sustain a reasonable lifestyle for residents.

  11. As a Registered Manager of over 10 years in Domiciliary Care, Private Sector, I have to agree with most of what has been said beforehand. The one area in which I wish to make what I consider a valid point, is in regard to the comments that say the quality of care starts with the Manager. I wholeheartedly agree here, and take my responsibilities as a Manager very seriously, including the need to work at least a 70 – 80 hour week just to keep up with legislative changes, development & training, supervision & appraisal and the myriad of paperwork that arrives on my desk and within my email box, each and every day! (Including the weekends!!) The shortage of Registered Managers within the Sector comes as no surprise to any of those who take their role seriously, and even I had to take time out 4 years ago due to burn out and the feeling of constantly hitting my head against a brick wall in regard to quality commissioning and provision.
    Unfortunately, where we are let down within the care sector, time and time again, is with the lack lustre quality of care monitoring that exists at all levels, including Local Authority and, dare I say, CQC. We have recently been advised by IIP to undertake the Gold Standard, as we have worked very very hard to ensure we (our workforce included) can walk with our heads held high as a Private Quality Care Provider. The Company is very lucky to have a Director that is more interested in the quality of our care provision, the welfare of our service users and the retention, training and development of our staff team! This does not happen very often though, and most Company Directors are more interested in the profits to be made in regard to the number of hours care they can provide, taking care staff from the field, who have not even undertaken a Supervisors role, and place them as Managers with no intention of providing the necessary training or supervision they require! It is an absolute farce! The amount of staff we have employed who have never had any training, or if they had, it was by being placed in front of a DVD player to watch a 30 minute training DVD, and gain a certificate for doing so, who have never SEEN a policy, let alone be trained on it, or, the most serious, have never had an enhanced CRB produced, but have been out in the field within a day of their interview!
    I am very proud of my commitment, training and CPD as a Manager, my work force and our Company ethos, but sometimes, I hang my head in shame at the daily atrocities that are happening in the Health & Social Care Sector… and unless we have a regulatory body with some teeth, a Government that is really interested in listening to those who work in the Sector, and not just gathering opinions for white papers content, that they have already more or less decided upon, then this will continue for many years to come!
    There is no excuse for bad practise…. involvement, respect, dignity, empowerment and a commitment to ensuring your Service Users wellbeing and safety cost nothing (maybe a small training cost!). If you are not happy as a Service User or a Carer …complain, complain and complain again … because Complaints should be seen as a learning curve, not something to be swept aside or under a carpet!

  12. Tony Butcher says:

    One of the issues I think holds back the improvement in quality is the gap between what is said by those who make the regulations and the reality of front line care provision.

    At the national, legislative level social care is often portrayed as a single entity, like the NHS. However the reality is very different. The latest CQC report states there are 4608 nursing homes, 13,475 residential homes and 5894 domicilliary care providers registered in England. The vast majority of these are small businesses.

    What is lacking in raising the standards of quality and workforce development is more direct engagement between policy makers and those providing services.

    In my experience I have often found that there are many care providers fully engaged in wanting to deliver quality services and it is these providers who actively contribute to forums such as this, send there staff on training that goes beyond the minimum standards and actively participate in improving the quality of care.

    However there are also many providers that do not do this and it is these providers who often only provide adequate or poor care. This may not solely because they are only interested in profit, some small providers do no have sufficient time or resources to participate.

    It must be rembered that in these times of rising inflation care provider income has fallen dramatically with most care providers not having had an increase in fees equivalent to inflation for the past five years. Additionally many care providers relied on Train to Gain funding for staff development – this has, of course, been scrapped now putting increasing financial pressure on services.

    If we really want to improve the quality of care and workforce development there needs to be a direct engagement between policy makers and front line services, particularly those who are not deemed to be providing quality services. Whilst the new CQC penalty framework may work on one level there needs to be a push (funded by the Government) to help some providers understand the standards they need to attain and support them in reaching those standards.

    We also need to ask what incentive is there to improve quality and workforce standards – at present a service offering what is deemed an adequate service will receive the same care fee as one providing an excellent service. Why spend the extra money on improving when it actually costs you more in the long run?

    It is a peculiarity of the care system that it operates in a totally different world from most business sectors. Here it is the buyer (i.e local authority) that sets the price it is willing to pay and the seller (care provider) has to agree to that or lose business. This, in turn, often leads to the unacceptable practice of care homes charging private paying users a higher rate than local authority funded users for exactly the same level of service.

    There also needs to be a real look at the social care workforce – over a million people – before any workforce stategy can really work. The general population demands higher care standards yet care workers are amongst the most vulnerable workers in society with low pay and poor working conditions. What incentive do they have to improve themselves? Many documents from national bodies love to compare care workers to those working in supermarkets saying that care workers are paid roughly the same amount but how many supermarket workers have to provide support for those who are incontinent or have to provide intimate hygiene care for individuals. For all those not in care – would you do those tasks for a wage barely above them national minimum? and how would you respond to the criticisms that you needed more training and to be more professional?

    Governments are afraid of social care because it is an expensive problem that will not go away and, if you look back over the past 3 years, we have endless consultations with very little in the way of action. Yet what we really need is realistic action that benefits the ever growing number of care users and recognises that society is going to have to pay a lot more is it really wants to improve care and support for the most vulnerable in society.

    • Barbara Kaye says:

      I fully agree that there needs to be a real look at the Social Care Workforce before any workforce strategy can really work. I am a Home Care Assistant employed by my local council, these are just some of my working conditions -
      £6.84 per hour to provide intimate hygiene care for individuals eg stoma care
      -Apply creams that District Nurses no longer do.
      -Use heavy hoisting equipment to move people.
      -Work unsocial hours/shifts.

      Why do I do it? Because I care, and I seek to improve the care and support for some of the most vulnerable people in society which includes the thousands of other care workers like myself. We really do deserve more and it’s about time the policy makers spoke to us.
      Thankyou for recognising some of the poor work conditions we endure.

  13. John Cotterill says:

    I am professionally qualified as both a nurse and manager and am leading the operational management of a range of care services provided for people with disabilities by a well-established charity. I have managed similar services in the private and charitable sectors for over a quarter of a century.

    The UK (and others) cannot afford to deliver ‘top quality’ care any more. In an ageing population and with medical advances preserving life in circumstances previously beyond technology, there are ever more people to care for with ever higher levels of need, and less and less people to pay the taxes needed to meet the needs in a world where there is in all likelihhod a long term flattening out of economic growth.

    The primary need is to geta grip of this reality and begin to work on public awareness that only by the strengthening of family and friends units can we all expect to have agood quality of life in our ever longer lives.

    We must learn again to share resources and support one another with kindness and consideartion rather than being expected to choose to live in isolating single occupancy little boxes with the state sending us economically inefficient ‘packages’; or alternatively despatching us to a care home where the funding from the state is only half of what the actual cost of good care would require – with inevitable results.

    We – the general population – all have to accept the value base that the provision of care for family and friends is our familial and personal responsibility and duty – and that the professional care system exists to guide and support us in providing care, or to provide medical or technical care that it is genuinely beyond our ability to provide even with professional support and adequate equipment, training and environmental resources .

    If that can be established – a ig IF but essential. Then our all too often protectionist professional care and support system will need to realign to provide for the change.

    This is the only long term way out that I can see; and therefore I think inevitable. Politicians have surely known this for well over 20 years but across all parties and professional health and social care and housing bodies they urgently now need to map out the route to this vision of the future and guide us through if we are to avoid as many of the desperate situations that are increasing in number through allowing things to drift.

  14. Paul Dunn-Sims says:

    Quality should be the guiding principle for social care. I am always amazed that Quality is almost universally considered as a provider’s prerogative in the care sector and not as a purchasing issue. The sad fact is that the largest influencer on quality in domiciliary care in the country is the public sector commissioners that congratulate themselves on having driven the price down to levels that can only sustain poor quality management and supervision, cheap training and absolutely minimal rewards for staff and in some cases complete dishonesty! Any GCSE student in business would be able to point out that at a £14.40/ hour rate paid only in client face-time, divided into 15 minute visits, anywhere across a county at petrol at £1.36/litre with holiday pay and add-ons leaves you able to pay staff at not much above national minimum wage, even before we can introduce the necessary but additional costs of recruitment, training, supervision and operational management.

    Quality would change as individuals increasingly fund or take responsibility for commissioning their own care if the Council’s influence was completely removed. The early evidence of personalisation is that this is not the case. In my local area “inner circle” providers have been appointed who now are strongly recommended to personalised budget holders because their rate has been fixed and the personalised budget is calculated at this rate. The rate is low because the inner circle providers have agreed a rate based on a volume of instructions (committed to them at tender by the council) with budget holders advised that the difference in prices of outer circle providers will need to be topped up by the service user. Personalisation is not about quality –it has become about funding. Furthermore, questions need to asked about how anyone seriously anyone can talk of improving quality of care while endorsing the commissioning of 15 minute visits to meet toiletry, meals, medication and a spot of social inclusion?

    With a pay rate barely above NMW it is inevitable that many of the workforce cannot afford to see this as a serious career and are forced to be the first to withdraw when domestic pressures occur and in the process reducing their own and their agency’s reputation for reliability. The cultural assumption that in these circumstances a justifiable solution is in foreign workers that can barely speak English, or speak with such a heavy accent that elderly people are left unable to communicate with carers, must be wrong and needs to change. The knock on effect is that we are less likely to grow and develop the sort of high calibre management candidates from within that will eventually lead the sector towards better performance.

    Furthermore, having been responsible for setting the cultural assumptions for the sector, private service users are largely served up with the same diet of poor quality. It is also no secrte that some Councils actually suggest that domiciliary care providers should charge private service users in a way that can subsidise the service of others (make your profits out of them so you can afford to do council work). There is no doubt that Private clients do demand and expect more in terms of quality and a truly personalised market environment would drive up quality. Unfortunately, contray to that there is plenty of sad evidence that the cost of private care means that many elderly with more than the £23,000 threshold are denying themselves sufficient care for their needs due only to the cost.

    Funding is of course not the only barrier to quality. The situation is confounded by the gulf between Regulator and providers. Given the fact that the majority of domiciliary care businesses are both small and local, the impact of the Regulator should be as significant as, say, the RICS on surveying practices throughout the country. Not just “stick” but engagement with the providers to improve and share best practices. However, the sheer scope of responsibilities for CQC in regulating the NHS as well as small dom. care firms is a challenge almost set up to fail. They are therefore too remote to influence, only threaten. I don’t believe any private organisation requiring justification to shareholders and bankers would have been allowed to have accepted the mission set for the CQC.

    The CQC should however be commended for devising the outcomes orientation of the quality standards even if stronger policing is the only way to ensure standards are actually delivered. This for me is the standard definition of quality as required for the sector. However, too often Quality for many in the care sector is a by-word for safety/safeguarding and not the actual quality of the “care” delivered. Of course it’s true that there are risks/ opportunities for criminal and abusing activities on vulnerable people in care but we should wrestle back the impetus on quality being (as in other sectors) on the actual services we deliver.

    We could use a registration required publishable balanced scorecard on quality performance across the essential standards of quality and safety incorporating actual performance returns and feedback from service users. Our service users being elderly are acutely aware and have a view of our performance to meet their requirements for reliability, timeliness, the suitability of their care plan in meeting their needs, care plan reviewing, caring performance of the carers and engaged information about their care. Might these be good criteria to start with?

    • As a Private Domiciliary Care Company, that has chosen not to be “boxed in” the list of the Local Authorities “Preferred Providers”, we have the taken the luxurious decision of not providing 15 minute calls, as we consider them nothing but bad practise! How can anyone profess to be acting in the best interest of the Service User when expecting a Support Worker to visit, “pop” a meal in the microwave, make a drink, tidy a kitchen area after using it, check the well being of their Service User and then write an accurate record of their visit?
      On the other hand, when providing a 30 minute visit, our Team Members cook a meal of fresh meat and vegetables, make a drink, chat with their Service Users, tidy round and know that they have left someone secure and feeling cared for!
      No Comparison! 15 minute calls should be abolished… along with the insistence that our elderly population are “alright” with the provision of just a pop in service, a lack of nutritional dietary provision and a lack of dignity. I say again… Bad practise!
      We have also had the first hand experience of being told by a prospective Service User when assessing their needs for self direct support, that the LA has told them they cannot use our Company, as we are not on the preferred list, and are too expensive! This was soon rescinded by them when I emailed the Commissioning and procurement officer with information from their own website, and copied in our local CQC Inspector! It cannot be denied that an overwhelming desire of not wanting to conform to the LA’s scheme of care provision by these “preferred providers” has left us “out in the cold” in our local area, but if providing quality care by team members that are paid well, listened to and trained extensively is our outcome, then we will carry on regardless!

      • Bill Clayton says:

        Good comments and I am glad you are working to provide choice to people who want it. Preferred providers can sometimes get in the way of that but, I guess, if I wanted a council commissioned service I might take a “prferred” provider. If I took a direct payment then your right, I might want the choice from the whole market. Also, I agree about the 15min calls. But, I dont think we should be prescribing the length of calls at all. Commisioners should be commissioning a budget per week or month. The provider should be working with the person to see how they want that bugdet spilt up or used. I realise, with rotas and staff planning some form of scheduling may be enivitable but, if as a user of the service I want support with a task that may take 15mins, then perhaps I should be supported with that. I would want to use my personal budget as it best suites me. I dont think I would want to be told what the minimum time I can have a worker for. I dont think its about slots of time being delivered its about what I want to achieve and how best the provider can help me do that.

  15. Tom Cooper says:

    Let us not forget that CSCI introduced a quality star rating system for care homes and domiciliary care agencies etc. in its last couple of years before its demise in 2009, using a formulaic set of statements (the KLORA) describing, as they said in their blurb, how services operating at various quality levels “might look”. Unfortunately CSCI inspectors proved incapable of acting remotely consistently, with the personal views of individual inspectors heavily influencing the quality ratings awarded. Providers seeking to challenge their quality ratings`were fobbed off by local CSCI and latterly CQC offices and were highhandedly referred to the farcical appeals system that in almost every case upheld the original rating no matter how subjective or poorly evidenced. I saw this repeatedly in my role as a care consultant advising providers. I became convinced that inspectors lacked the necessary knowledge, detachment and in some cases integrity to be able to identify high quality provision and in practice they rarely genuinely consulted the people who could tell them i.e. the service users themselves. Consequently, I have little confidence in any formal quality standards unless the calibre of those assessing against them (whether they be CQC inspectors or local authority commissioners) can be markedly improved. But will this be done with no extra money available?

    There is staggering hypocrisy in this debate. How can ministers like Paul Burstow and his apparatchiks at the CQC keep getting away with telling the public that they are going to force standards continually up when at the same time the government has slashed local authorities’ budgets and all private sector providers’ incomes have been dramatically eroded over the past five years? Am I missing something or do we still live in a world where you get what you pay for? I mean, is the social care industry subject to different rules to any other business? John Cotteril may be right that the UK cannot afford high quality care any more but evidently no politician or policy maker is prepared to admit the reality that costs of social care will inexorably rise along with the population of service users and that even to maintain today’s patchy level of care provision will soak up ever more resources let alone going for the gold standard. If we are truly serious about improving quality then show us the money! Otherwise, get real and accept that there are limits to what can be achieved. Champagne tastes on a lemonade budget are bound to lead to disappointment and to mix metaphors the road to hell is paved with good intentions. If providers cannot make profits they will simply not invest in ‘developing the workforce’ or true quality assurance and that is the bottom line whether anybody likes it or not.

    As for CQC, that is simply unfit for purpose, having been set up by New Labour to fail with an impossibly broad remit and should be disbanded. It should be replaced by locally based inspection units staffed by properly trained inspectors specialising in particular disciplines, who not only enforce the regulations and essential standards but also work collaboratively with providers so that the knowledge of good and bad practice inspectors acquire as they travel from service to service can be shared around to the benefit of all. If that is too expensive then at least make sure that every service is thoroughly inspected at least once a year with a proper report published. I have clients who have not seen an inspector since 2008 and I defy anyone to argue that their so-called quality ratings remain valid after so long. Also, CQC should scrap the abject Provider Compliance (self) Assessments, which tempt providers to declare compliance with the standards (“would I lie to you?”) whether they actually do or not, reasoning that they will probably escape scrutiny as it’s common knowledge that CQC does few inspections nowadays. Also CQC should investigate abuse allegations itself rather than farming out concerns to unreliable and partial local safeguarding teams. Current CQC practice is not proper regulation and leads directly to Winterbourne View situations, where a complacent management was left to preside over truly awful abuse of service users. If CQC were subject to a quality assessment like a care provider I am afraid it would score nil points at a cost of £160 million to all of us taxpayers.

  16. Deborah Tranter says:

    I work for a local authority that has taken an innovative approach to ensuring that there is a skilled social care workforce to deliver quality care to service users in need of such support. We work very closely with our social care partners on various pathways but regarding training and development we use consortiums to enable best use of limited resources. The providers in our locality are given the opportunity to join a small consortium (up to 7 organisations) of care provider organisations. The consortiums then have access to a limited budget allocation which can be accessed by training requests submitted by each consortium (not individual provider). Not only does this allow the consortiums to have access to funds for training (budget permitting) but the consortium members also share their own funded training and also use their own resources such as in-house trainers to share with each other. There is also a good level of sharing skills and knowledge amongst the care provider managers which has seen a rise in the quality of care being available. We also support our providers with other initiatives which includes providing access to Train The Trainer courses so organisations can train their own staff. This initiative has been in place for 2 years. In a world where resources are dwindling and we all have to find other ways to achieve higher standards with less funds especially when caring for the vulnerable it is important to believe that we can achieve this by working together. Yes we all have to work a bit harder and the role of the social care provider is hard enough but my experience with providers in my locality is that they are definitely up for the challenge and have achieved much in the past 2 years. If we can now expand and ensure that partnership working takes place across the board ie social care providers, health care providers, local authorities, inspection bodies (CQC), local community groups and use of volunteers including supporting the family carer then maybe we can do more for less whilst not just maintaining quality but raising it so that care support received is quality support no matter where you live.

    • I whole heartedly agree with your comments.As a new provider we have found it very difficult to source funding for training. In my opinion the consortium concept allows us to take a creative approach in achieving maximum efficiency and to develop a great working partnership with other providers.
      I believe that the cost of training is the one of the key concerns of providers and whilst we are all expected to deliver great services there is no financial incentive for providers to do so. We are are committed to delivering the best services possible and at times have to be very resourceful in order to achieve high standards.Domiciliary care should be seen as a worth while career and should be invested in, not a means of earning easy money.

  17. Karen says:

    I don’t work in the Social Care sector but have an elderly mother. I have a number of comments regarding social care.

    1) Elderly people cannot always rely on family to help as they move away from their home town to find work.
    2) My local authority have just been forced into making cuts and unfortunately adult social care has been badly hit. As we have an ageing population I think, if anything, more money needs to be spent in this area.
    3) I worry about my future when I get old even though I have a reasonable pension. My own mother is 80 and lives on her own. She is disabled but still managers to shower and dress herself. My sister organises her shopping using a supermarket online service. My mum pays for a cleaner out of her diability living allowance and my husband and I do her gardening and DIY. Fortunately we don’t live too far away. Other people may not be as lucky as my mum.
    4) Old people need to be treated with dignity and respect. They were young once and had interesting lives. This should not be forgotten. I think all too often some care workers (not all) do forget this and patronise old people.

  18. Tony Probbing says:

    With many Social services department chosing to out source the care of individuals to private agencies, and selecting different priorities for care it is increasingly difficult to define what is an good service. There should be greater control on what has to be provided based on evidenced based practice and effective working models. Not base on what is currently a hot topic or on what is percieved the department can afford.

    • Bill Clayton says:

      Quality standards should be driven by the people who use the services. In our local unitary authority we are working with our user-led-organisation (ULO) for them to come up with what they expect, what standards and how they want them measured. If the person who provides the service sets the quality standards then all we will do is manage expectation rather than maintain or drive up quality.

  19. Sadly quality has never equated with equality. All the NVQ’s in the world have failed to muster this. The biggest problems are a) a lack of understanding of the real problems, b) poor training, c) the marginalisation of useful courses in disability equality. This leads to ongoing fears as to how outsiders will include disabled people. That they fail and often bring extreme forms of discrimination to bear through abuse and hate crime is something that we too easily tolerate inthis country. Only yesterday in assessing someone with a learning disability a professional said, “we have tried everything here other than the friendly approach” to which i replied so you thought you should use an advocate rather than a social worker which caused much laughter. the social workers in question are well established, qualified and have experience. This suggests taht it is not only about quality but also about usefulness and advocates should seek to contniue having a real usefulness in these areas. Local endeavours should include advocacy, the particpation of disabled peopl ein decision making fora and proof given that shows they are heard and their words acted upon. Leadership from disabled people has to come from disabled people’s organisations especially those who promote self advocacy and who can bring other disabled people into the frame. Complaints as they refer to social care should be summarised and passed to a forum of professionals and service users who can assess the usefulness of departments involved in care.

  20. Ruth Jackson says:

    Standards are required but we need to ensure that they are clear and concise and enable providers and service users to understand them. Standard should not just be tick boxes or mathematical calculations but need to reflect the needs and wishes of the service user.

    Quality and standards need to have buy in from everyone in the organisation and there should be a realistic and workable monitoring mechanism.

  21. Karen Dobson says:

    Like most dedicated staff members in the social care environment the cases of bad practices that we hear and see on the TV etc send shivers down my spine. I think the route of the problem in cases of bad practice and poor quality of care is bad internal managment systems, inadaquate supervision, inadaquate staffing levels, poor pay levels and lack of induction and training- training not just in practical service delivery but in moral and ethical issues surrounding social care. Many formal standards are outside the budgets and capcity of the smaller organsiaitons who i many cases do a fantastic job with the minimum of standards in place. Examples would be small local charities, without any contractual/statutory income who are not monitored for qulkaity in any way but with heart and soul and a desire to do good produce excellent results. That said I think some form of qulaity measurement is good – as the manager of a small local Mind group, we adhere to Mind Quality Standards and the standards set by the Council who pay us via a contract. It takes up al ot of our time and capacity to manage these standards. However despite teh standards I think our biggest assest in a team of staff, carefully recruited, who can adopt our values and who are well trained , have support and whose values reflect those of our organisaiton. This is priceless and isn’t always measured by a quality tool

  22. Eunice Wormald says:

    When I was in a care/Nursing home whilst my bathroom was being altered
    I was shocked that no towels were in the toilet only paper ones, despite washing being done every day, the bath towels were thin and scrawny,
    they had no grab rails in the bath room one was expected to use one walking frame. But sopposing a hertofor fit person suddenly felt faint or ill, or if their knees suddenly ‘went’ and they had no walking frame because uptil then they had not needed one?
    The carpets were so dirty I could not let my grandson crawl on it. The paintwork was old, dirty, and looked messy.
    I could not eat in the dining area because the tables cloths and table mats were covered in old food and gravy.
    when I complained to a social worker, she told me it had passed inpection, to which I asked how much had ben paid to the so called inspector to get the home passed.?
    She seemed totally indifferent. And did not reply.
    I hope I never go into a home if that is the standard of care.
    I had to go out and buy my own hand towels.

    Eunice Wormald

  23. Julia Segal says:

    If nurses and other carers are to care properly, they need help dealing with the emotional (as well as physical) stresses of their job. Being around people with dementia or other cognitive problems can make it hard for carers to think clearly. Being with people who are suicidal or angry can make carers feel suicidal or angry themselves for a while. Lack of resources for patients can also make carers angry and distressed. When under pressure by management they are likely to put their patients under pressure. When neglected by management, underpaid and not allowed time to eat and take care of themselves, they are likely to neglect and fail to feed patients.
    Nurses and carers, paid and unpaid, need good, ongoing supervision, including both support and understanding, which helps them to deal on regular basis with the destructive and distressing emotions provoked by their work. They need help coping with the bad feelings and consequent guilt which can assail them. Without this, carers’ lives will be damaged as well as their patients’.

  24. Bridget says:

    How CQC can be expected to catch up on 70% of unmade visits with 25% more staff, AND take on GPs and dentists is beyond me.

    And care home staff quality would be raised not only by improved management (including more time taken by managers to talk to staff, and for staff to talk to residents) and training, but also by appreciating that care staff do an extremely challenging job and reward them accordingly with a decent salary and other terms and conditions. I fail to see why care is so poorly rewarded

  25. Ildi McIndoe says:

    One of the biggest fears that parents have is that their child (no matter how old they will be) will be cared for as well as they have been cared for while under the responsibility of a parent. Some parents have already made that choice and their young person/adult is being cared for in good quality care homes. But it is too hit and miss. From the obviously disgraceful treatment at the Winterbourne Home in Bristol to excellent care homes.

    My first suggestion is that we raise the bar for the qualifications of the people who are to be employed in care homes. Rather than settle for people who are paid a minimum wage we need to be employing people who have at least an A level qualification. A minimum of interest in physchology if not a qualifcation. I think that whistleblowers ought not to feel that they will be victimised. If that is the feeling, which it will be, then it is a very sad reflection indeed.

    In the meantime parents and carers will continue to save the government millions of pounds by looking after the disabled but will cost more in the long run because they are not able to work, become unhealthy through stress and are likely to need care sooner than later.

  26. Margaret Schöttler says:

    We all know what we need so why discuss? Carers have to receive at least a one year basic nursing training before they are allowed to work in this field. Carers and qualified nurses should be at a ratio of one to one, that means that every shift should be made up of 50% qualified nurses. There should be a seperate qualification for nurses who intend to work in geriatrics and not in general nursing, which means that sociology, psychology and neurology, replace unecessary subjects such as obstetrics.
    Dump the useless documentation of procedures that are never carried out anyway and reduces the time spent with the people that we are here to serve.
    I,m a geriatric nurse of many years. I trained and work in Germany, where many of these measures are already in place.
    Discussion? Cut down on the commitee meetings and use the money saved to start training a few nurses.

  27. DAVID HOGARTH says:

    I am the co-ordinator of a charity that offers befriending and outings to local older people so I see a lot of home and residential care. I agree with almost every one of the 31 preceding comments that we are faced with a serious quality problems.

    Only this week I was helping an elderly lady receiving so-called reablement from a carer who claimed not to know how to work a toaster or a microwave .

    To Susan Rogers’s list of tyypical misdemeanours I would add a brash, rude, bossy manner, inflexiblility about work to be done and above leaving before time. Some of this may be because of the failure to pay for time between jobs but much is systematic short-changing of users. Many of the comments rightly complained about low pay for care but if you’re only working 20 minutes in every hour, the pay becomes quite desirable.

    I agree with Susan and Mark Galli that management is a major part of the problem and that it is a skill not necessarily possessed by a long-serving carer. Here we have one provider Chief Executive who is really good. When carers call in sick, she personaly fills in for them , which of course gives her first class information about the way the work is being done. But she also meets staff needs for emotional support that Julia Segal talks about..

    The CQC comes in for a lot of justificable criticism in the comments but I can only find one reference (Tracey Bergin’s) to local authority contract monitoring. If these teams did their work properly, Tom Cooper’s sensible demand for inspection to be localised would be met. But do they? We lost faith in ours here when we found them dishing out scores of 99 out of 100 to providers we knew to be indifferent at best.

    As far as I can see, no comment touches on electronic monitoring. In our area all approved providers are supposed to have and use this clocking in system. If it was properly used, it would end fraudulent charging for time not spent and would probably cause the welcome departure of many poor quality carers. But our contract monitoring team have not insisted on it and have allowed providers to let agency staff refuse to use it.

    The silver lining to the black cloud of recent eligibility changes is that fewer hours of care will be commissioned, so if bad carers leave, staff shortages are less likely to result.

    In the long run, though, John Cotterill is surely right that we can’t afford the amount of good quality care that’s going to be needed, so family and friends must carry the burden. The trouble is that families are often far off and friends of the same age and equally in need of care. I wonder if the way forward isn’t to build geographically based communities. We find here that many older people living independently get a lot of selfless support from neighbours but there would be even more if there wasn’t the fear of an occasional act of kindness growing into an insupportable, on-going burden. I would like to see councils leading in the creation of street or staircase communities which would collectively take responsibility for their failing members.

    Centrally commissioned care could then be limited to things neighbours can’t easily do like personal care. However, the community could make sure the personal care was properly provided – and do it more effectively than CQC or LA contract monitoring.

    I would like to see similar geographical communities round care homes with neighbours from nearby streets popping in to visit and incidentally keeping an eye on what management and staff were doing or neglecting.

    I can’t close without saying how much I admired Barbara Kaye – working for a pittance because she felt the job needed doing. If only more were like that

  28. David Kennedy says:

    It seems an unfortunate contradiction to have Cynthia Bower on the reference group for quality as an expert in her field when her own organisation, the Care Quality Commission is mistrusted by both the general public and many health and social care professionals for failing to ensure quality services are being provided.

    • web editor says:

      David, thanks for your comment. Representatives from a range of organisations with a key interest in quality in social care were invited to join the Improving Quality and Supporting the Workforce reference group. They include Skills for Care, The English Community Care Association, Social Care Institute for Excellence, Mencap, National Institute for Health and Clinical Excellence. The Care Quality Commission is the regulator for health and social care and as such it is quite right that the organisation is represented on the reference group.

      • Nick Johnson says:

        ..But not the Social Care Association, the only long standing organisation for people working in Social Care – one thing that would help raise standards would be personal commitment by workers verified by their membership of an organisation like SCA which has existed for 62 years to promote good practice in social care through the efforts of the ‘workforce’

  29. Kaarina says:

    David Hogarth says, “only this week I was helping an elderly lady receiving so-called reablement from a carer who claimed not to know how to work a toaster or a microwave.”

    This is happening on a regular basis because I visit the elderly. Carers are also told what they are allowed and not allowed to do to the point of being utterly ridiculous, in my opinion.

    My mother had carers in for a short post op and as the carer was late, my mother had got herself up, dressed and breakfasted. These tasks having been done she asked if the carer would kindly wipe some water up that was lying at the bottom of her fridge. The reply was, I do not do that type of thing, if you want a cleaner inform the office. My mother was rather gobsmacked and decided she would continue with the help of friends and family only rather than the “caring” service.

  30. Susanna says:

    I have just learned that 0.5% GDP in England was spent on long term care. In Sweden it was 3.65% and in Holland it was 3.5%. Long term care included nursing and residential care, personal care and domestic help. OECD average is 1.5%. England is one of the lowest in Europe.

  31. Ken says:

    Personalisation carries with it costs as well as benefits. One of these is to do with the stability of the workforce. Personal assistants employed by individual budget holders now make up a significant proportion of the social care workforce. Many provide high quality support. However, their occupation is inherently unstable. They have few prospects for qualification and career progression if they remain p.a’s. Most are on low wages. Many work in isolation without the support of colleagues. By their nature, their employers often do not have the capacity or skills to support their professional progress. There are intrinsic rewards to the job but across the p.a. ‘sector’, as it grows, we would expect to see low levels of job security, high turnover and strong incentives for talented people to move on. This may not be a problem for p.a’s who are relatives or neighbours but will be for employees who are looking for job security and career development. In the long run, as the economy picks up, a low wage, low security sector like this will lose out to other employers who offer a better employment deal. Supply and quality problems will follow. We should look for solution here but not one that bureaucratises the business of employing your own support. It probably makes sense to talk to p.a’s themselves, and to disabled people and others who have a strong interest in being able to improve the conditions of the p.a’s they employ.

  32. carol foster says:

    I care for my husband, he recently went into respite care,and i was appalled at his treatment,he wasn’t showered or shaved and was expected to sit in a chair all day,he was worse there than he is at home .The CQC inspected the home in December 09,do they carry any weight? or are these care homes a law unto themselves.

  33. michele poole says:

    I have no faith in any of these consultancy exercises. Its just a sop to the caring community as the powers that be will continue to preside over a dwindling care service with less and less monitoring or control. And we think its bad now? Wait until the NHS is gone….in all but name that is.As the previous comments state, its all been said before…..and now were being asked again…..

  34. Mr L P Byrne says:

    My wife has dementia. Asked for help in sept. 2008, diagnosed with prognosis in Oct 2009.
    Nurse and social worker Oct 2011
    Not good enough

  35. Kaarina says:

    People working in care homes, visiting the elderly in their own homes or whatever type of care it is, need not only some qualifications but a love of that type of work. I feel many, although having no interest in helping others, do it because it fits in with their life style ie shift work, children at school or nothing else is available for them. To my way of thinking a carer who is kind, compassionate, responsible, willing, speaks clearly and has patience can well outweigh a person with all the qualifications in the world who hates working with the vulnerable. There are these lovely people around but unfortunately they are very few and far inbetween. Good workers should be repaid with good terms of employment and at the moment they are mostly not.

    • Iris says:

      I agree with the comments above, lets hope the report issued on care in the home does not get lost with other news, it is so hard to make people understand that you can pay up to 12.50 per half hour for care for your loved one, only to find you are faced with having to check everyday that the care you have asked and paid for, has not been completed or carers have even arrived!!!! Leaving the people and their carers with little choice of ensuring their loved one are cared for at home where they want to remain. Carers are often faced with having to make the choice of admitting them to a Care Home, which if you ask the person or their carers is not where they want to spend the rest of their lives. The majority of them want to remain in their own homes surrounded by familiar things, memories of their life with family, friends, neighbours, living an independent life with the support of home carers who can be relied on to provide the care requested. Who are trained to understand the person they are caring for, who has probably cared for their loved ones and friends and would only expect the same care they gave being given to them. Staff also need to feel appreciated by the company they work for, are suitably reward with recognition, pay and working conditions

  36. Mark Williams says:

    I believe for too long care has been the poor relation to the national health service. If you want to imporove the care services you have to invest money. For many older people they do not want to bother with direct payments and we have to make sure providers provide a high quality of care.

  37. David Durston says:

    I am a service user of domicilary care. I was allocated a local care agency by the Continuing Healthcare Team. They were completely unsuitable. To read the CQC report you would be lead to believe that they were professional, trained their staff adequately, and had high standards. None of these things were true; i have heard many negative comments from other service users and staff. I complained to the CQC who said that they would be investigated. The complaints procedure was not particularly user friendly, and I didn’t feel they were very interested. I suggest that there should be a forum where peoples views can be expressed about care agencies easily, and scores given. Users looking for care services would then be able to judge performance based on users/staff experiences. That should make agencies improve their standards, otherwise they will go out of business. The CQC reports are meaningless!

  38. Natasha Muirhead says:

    I would like to make the point that it is absolutely essential that people such as myself receive HIGH QUALITY support from an Autism specific organisation such as Autism West Midlands. This is far more important to me than the QUANTITY of support hours that I receive.
    It is so important to because it enables and empowers me to look after myself for longer, stops any existing or potential health problems from occurring or getting any worse, helps to reduce my levels of aniexty particularly regarding how I will cope with life when my parents who I am still heavily dependent on are no longer around. It will also help me to take more control over my own life.
    1) Quality of care
    How could care be better?
    I am an individual with Asperger’s Syndrome. When I decided to move out of the parental home and into my own home I needed some help and support to find out what options were available to me and to weigh up the pros and cons of living on my own and living with others so that I could decide what I wanted to do. This support was provided to me by the then community support practitioner at Autism West Midlands (a local autism specific charity) who helped me to do this. I had never lived outside of the parental home until I decided to move into my own flat so I did not know how to run my own home which meant that I need some help and support to live as independently as possible in my own home. I have been living in my own flat for approximately 8 years now. I initially needed a lot of support to:
    • set up and maintain my tenancy
    • buy and look after things in my own home
    • keep myself and my home safe,
    • deal with my benefits, bills and correspondence,
    • claim the benefits that I was entitled to
    • develop my domestic and life skills ,which helped to make me more independent at home
    • understand and cope with my Autism better
    • monitor my own health and emotional wellbeing
    • monitor my medication
    • Know what to do about home repairs
    • learn how to do my own supermarket shopping
    • access local public transport and learn to travel independently
    However, this support was gradually reduced over time as I learned how to do things for myself and became better able to cope. The support that I received to do this for the majority of the time that I have been living in my flat was provided for by Autism West Midlands. I was very happy with the support that I received from them.
    I always regarded the staff who supported me extremely highly; I was never in any doubt that the staff were very highly trained, qualified, experienced, skilled and knowledgeable at knowing how to support people with Asperger’s Syndrome. This meant that I could always have complete trust and confidence in their ability to help and support me. The support that they provide is expensive but I whole heartedly believe that this is reflected in the quality of support provided. In my opinion this type of very high quality support was extremely good value for money because they have been able to support me so successfully in so many ways so it will work out to be cheaper in the long run. They helped me at times when I was feeling anxious, frustrated and depressed, not only when I was contemplating moving out of the parental home but also when I moved out of the parental home for the first time ever in my life when I was 27 years old. One of the ways that my disability affects me is that I suffer from severely increased states of anxiety in stressful situations. I am in absolutely no doubt whatsoever that, if it had not been for their help and support, I would have been feeling extremely anxious and frustrated by my situation. I am completely convinced that this is the type of support that is going to save the UK a lot of money in the amount that spends on Autism in the UK because I have no doubt that the staff at Autism West Midlands were able to preempt any potential problems that I was likely to encounter and could either help to prevent them from occurring or knew how to help me with them. The staff were always extremely knowledgable, aware and understanding of how I must be feeling and why without me having to tell me them and they knew how and what to do to help me no matter what the situation was. I am convinced that due to the help and support from Autism West Midlands I have been able to look after myself better and for longer.

    By comparison to this, the support that I receive is now being provided by a non autism specific organisation. It has become obvious to me over the past year or so that they have been working with me that they quite clearly do not understand how to help and support someone with Asperger’s Syndrome, although I am in no doubt that they do their best to do so. The staff supporting me do not seem to know anything about Asperger’s Syndrome. When I questioned what training they had received or were going to receive they told me that their training was going to be on the job so I very much felt that it was up to me to train them, which I was extremely unhappy about doing since I have never ever had to train any staff in my whole life and therefore certainly did not know how to do this! Another member of staff told me that they had had training about working with people with autism but never seemed to be able to communicate with me in any ways which I understood and did not seem to pick up when I was feeling anxious about something or be able to help me feel less anxious. Even when I tried to explain what I thought would help me or how I was feeling they still did not understand; they responded completely inappropriately. My parents and I have recently written a letter to them telling them about some of the problems that I have been experiencing and as a result of our correspondence with them we have received written replies to our letter and attended a meeting with staff in an attempt to address our current concerns. The staff listened to what we had to say and assured us that their staff would be provided with autism training although this training was not going to be coming from an Autism specific organisation such as Autism West Midlands who have a very good training department. It remains to be seen how well they are trained. I have the following concerns about being supported by a non specific organisation:
    • one of my biggest concerns is that it will take too long for them to build up anywhere near the same level of expertise that an autism specific organisation such as Autism West Midlands already has
    • I very strongly believe that any staff working in a non autism specific organisation cannot become immersed in autism in quite the same way that staff at an autism specific organisation can because the staff at a non specific organisation are going to unavoidably come into contact with people with other disabilities
    How could people who provide care be trained better?

    The people who provide the help and support to individuals such as myself could be better trained by using a very well qualified, highly regarded autism specific organisation like Autism West Midlands to deliver their training. When people who provide help and support to someone with autism receive specialist training from Autism West Midlands they will be able to change their approach, which will help someone with autism such as myself to feel more comfortable and less anxious. The chances are that the interaction will be more successful and both parties can achieve a better outcome as a result.
    Reasons for using an autism specific organization like Autism west Midlands to deliver autism training:
    • Having spent over 25 years working with people with Autism to improve the quality of their lives, the Autism West Midlands training department not only train their own staff but they also train a wide range of external organisations.
    • The trainers at Autism West Midlands have both practical and academic knowledge of autism and are able to draw on a range of personal and professional experience to reinforce their message.
    • They know the latest autism research and contribute to academic journals.
    • The people they support such as myself have been shown to have reduced levels of anxiety and have been able to take far greater control of their own lives
    • The staff at Autism West Midlands train health and social care professionals in dealing with autism and also have close links with clinicians, academics, speech and language therapists and specialists in psychology and psychiatry.
    • Where possible they involve people with autism in the delivery of their training. Listening to someone with autism talk about their experiences can be a revelation to their audience and make autism become ‘real’ to them.
    • By using their training you can be confident that the staff will be receiving expert, practical advice and knowledge based strategies, which they can then use when working with someone with Autism such as myself.
    • They are committed to providing high quality training to meet the needs of staff working with individuals with autism of all ages and abilities.
    • They offer an ongoing support and consultancy service for organisations that have received their training so that they can be reminded of the training that they have already had and if necessary receive coaching in using positive behaviour support techniques, so that they can then put these into practice in their workplaces.
    How could we improve the mechanisms for users, carers and staff to raise concerns about the quality of care? How could we ensure that these concerns are addressed appropriately?
    Users like myself need to have clarification on who they should go to raise their concerns and under what circumstances. They also need to know what the hierarchy and therefore in who they can go to and in what order so that the proper channels and procedures can be followed.

  39. Virginia McCririck says:

    We all know how important staff training is to delivering quality. In that case, why does there continue to be no national system to quality check training that is delivered that training providers can afford to sign up to? The system devised by the National Skills Academy is lacking in clarity – particularly in respect to what they mean by service user involvement, it is too bureaucratic and far too expensive. Surely a better approach can be devised?

    In addition, the competency descriptors developed by Skills for Care for autism, learning disability, end of life care, etc etc are very long, and lack a consistency in approach across them. There continue to be significant gaps. The approach to e-learning is even more mixed – surely some national e-learning materials that have been validated etc would be useful to guide care providers, with some method of sign off that key modules have been completed. Recording this and evidencing take up is very patchy.

    CQC, from reports I have heard from various providers, are very unclear about what a workforce plan is, and what they should be looking for. Some inspectors ask to see it, others do not. This is pretty basic, and should be put right. Perhaps there should be some sort of Care Provider Employer Charter to help set some consistent and clear standards.

  40. John Smith says:

    Nothing excuses abuse or (seemingly) wilfully negligent care. However, I believe that it is vitally important that those who are delivering care should be treated with the same level of respect as those receiving it. “Equality and human rights” means, of course, that all people should be treated with respect and dignity. As a domiciliary care worker myself – who seeks to do a good job to the best of my ability – I am actually, in effect, being paid LESS THAN THE MINIMUM WAGE, due to the fact that the private agency for whom I work refuses to pay a mileage allowance. Also I have to use my own mobile phone for work with calls paid for by myself, and I even need to rent my compulsory uniform! I am, of course, looking for other work, as I cannot sustain this position for more than another few months before bankruptcy strikes. I am actually worse off now than when I was unemployed following redundancy earlier in the year. This is a scandal, and I am appalled at the low morale among my colleagues, who are fed up with being, frankly, exploited as cheap labour. Do WE have no “human rights”? Can WE not qualify as “vulnerable people”? I am well aware that there are some truly appalling and incompetent care workers, but there are also many who are not, and who deserve to be treated well by their employers. But no matter now much one complains, NO ONE LISTENS. NO ONE DOES ANYTHING ABOUT THIS PROBLEM. For example, UNISON brought up this issue over a year ago, but it has made no difference (see: http://www.nursingtimes.net/whats-new-in-nursing/hcas/home-carers-exploited-says-unison/5015846.article ). I despair that this post that I am writing will probably not make the slightest scrap of difference. The government will continue to grant huge salaries to heads of useless quangos, which do nothing – vain and self-serving talking shops. I have written to CQC about the appalling abuse that I and my colleagues suffer as a result of our working conditions, but will anything be done about it?? Perhaps we will have more “hand-wringing”, more “initiatives” etc, but what we want is very simple: a living wage and our expenses paid. IT’S REALLY NOT A LOT TO ASK, IS IT?! How is it that MPs demand expenses for everything under the sun, and yet we are having to pay to work by providing free transport services to our employer (which, as far as I am concerned, constitutes theft – i.e. the financial abuse of vulnerable people). And we have to pay for this out of miserly wages. WHY? Is there anyone out there in government who is actually going to crack down on these irresponsible care agencies and demand that they treat their staff properly? I really hope that the government will listen, but, as the cliche goes, “I am not holding my breath” (Posted under a pseudonym – for obvious reasons!)

  41. J Collinge says:

    I have young onset Parkinson’s and as a result have had to give up my career as a business process analyst documenting processes and procedures for one of the major UK banks and take early retirement. If I had failed in my job to document business critical services which ensure the safety of customer’s money, I would have been sacked a long time ago, and there would have been a run on the bank.

    My illness is degenerative and it really worries me as to what the future holds – I don’t want my children, who are still in full time education, to have to take responsibility for my welfare. I want then to leave home, travel, have the opportunities to do the things I never had the chance to do. I have always had the faith that the care system would ensure my needs are met. Helloooo cloud cuckoo land.

    Boy oh boy have my eyes been opened at reading some of the above comments. I am absolutely shocked and appalled. I am not stupid enough to think that abuse doesn’t go on in the care system, I am more than well aware that it does – I just didn’t realise how bad it was. I also know that the social services are stretched beyond imagination. When in hospital last year I unfortunately witnessed an elderly lady being blatantly abused by a senior member of nursing staff. All the poor lady wanted was to have the use of a commode before she wet the bed, to which the nurse replied that she had had enough of her constant whining and demands, and that she would have to wait until she had finished the meds round – and we all know how long that can take don’t we? The old lady then pleaded with her, saying that she didn’t want to make her angry, and that she just wanted to die. The nurse then replied saying that she should bl**dy well go on and do it then, and that did she really think that she did her job just for fun. There then followed a 10 minute rant about at the poor old dear that she ha been on her feet all day and that she wanted to go home and not run around with bed pans looking after stupid old women like her.

    I, and the other patients who were there, were absolutely appalled, but frankly none of us had the courage to stop this rant. That said, had I not been confined to the bed as I was recovering from a serious post-hysterectomy haemorrhage at the time, I would have got out of bed and gone and got the commode myself. But, I did ensure that I reported the member of staff to the Sister before I was discharged two days later. Absolutely disgraceful.

    I’m beginning to think that should I ever find myself in the situation where a care home is the best solution, I would rather end my life in my own dignified way than to have the horror of that. There is obviously an urgent need for DRASTIC reform, and successive governments have failed in their duty to not only acknowledge this, but to also act on it.


    • Tom Cooper says:

      Dear Ms Collinge, my heart goes out to you and it is easy to see why you feel the way you do. However your perception of the care industry is wrong. I was an inspector of care homes and have been in hundreds of them so I know that good care is given in the vast majority of establishments. Do not despair as there are many many good people working in care homes all around the country. Obviously contributors to a forum such as this will tend to highlight problems and the media does the same because good news is boring and bad news is their stock in trade. However this tide of negativity does not represent the true picture. If you get good advice when selecting a home you have an excellent chance of finding yourself being looked after by wonderful, caring and competent people. Staff in care homes do struggle on low wages but they all have to do a lot of training (it’s compulsory) and in my experience most managers and staff really do want to provide a good service. Quite apart from that, all home owners realise that complaints and scandals are bad for business so they have great incentive to ensure that the quality of their service remains high even if they don’t particularly care about their residents as people. As a result you are a lot safer in a care home than a hospital.

      I really hope that you will not give up. I have seen really handicapped people living interesting and stimulating lives in care homes, supported by wonderful staff who genuinely want to make a difference. Good luck to you.

  42. The Gender Identity Research and Education Society (GIRES) wishes to respond to the following question with regard to transgender people, particularly this who share the gender reassignment protected characteristic. “How could we equip the workforce to respond to the challenges of improving quality and responding to growth in demand?” The number of people seeking medical care for gender variance is growing rapidly. Care staff are ill prepared to met the special needs of this vulnerable group. Transgender issues should feature in the basic training that every one of them receives. Given the large number of people involved, the Department of Health may favour providing them all with a basic leaflet and access to an e-learning resource, both of which GIRES can provide.

  43. Cynthia Dize says:

    Service users are well able to define ‘quality’ in regard to care and often its in the humanity rather than the mechanics of care where this is located. As for the staff delivering the care – training, reasonable wages, support, feeling part of a team and having their work valued are all important factors. As the number of personal assistants employed directly by clients, the challenge will be how to ensure that these workers get that support too.

  44. Guildford Soroptimists says:

    While ISO standards are useful it is sometimes doubted whether these are really what people would mean in this context. Principles and guidelines, not ticks in the box are what is needed. Above all else good basic training with an emphasis on the care of the individual, with due regard for their dignity, and regular refreshers are what is needed. Those attended by the carer are the customer, not any other organisation or person.

    Until the the vulnerable individual is seen as the ultimate customer there will always be a shortfall in care as the training will not focus on them.

  45. Matthew says:

    It shouldn’t mttear whether nurses are university graduates or not. The most basic criteria for nursing is caring’ it’s as simple as that. If these people don’t care for whatever reason then nursing is doomed. It is not rocket science to know that an elderly patient needs the toilet or needs cleaning with dignity or needs assistance with feeding or just needs a kind word and compassion. Any nurse of any grade should be capable of that. There can be no excuse for neglect of the elderly or indeed any other patient.And it’s not because they don’t have time. In the 1950/60 s nurses had a far more extensive role than they have today. Nightingale wards with around 40 to 50 patients were common. There was very little disposable facilities bed pans and urinals for instance had to be cleaned by nurses in the sluice. Instruments and glass syringes had to be cleaned and sterilised on the wards. Patients’ temperatures, pulses and blood pressures all done without assistance of a high tech easy to use machine. Sisters or Charge Nurses were proud of their wards and supervised their staff efficiently. I’m afraid too many bad nurses just reflect the ignorant society in which we live today.I wonder what sort of outcry there would be if the word elderly’ was replaced by the word children’!

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