Another Panorama investigation of abuse in the care industry and renewed calls for the sector regulator to be held to account. Watching ‘Undercover Elderly Care’ felt like a bad case of déjà vu, and the comparisons with last year’s Winterbourne View expose are difficult to avoid. The public are outraged, the Care Quality Commission (CQC) are once again under the lens, and the clamour for political action sadly predictable. But did the case of Maria Worroll actually tell us anything new?
Investigative journalism and covert recording has redefined the meaning of external scrutiny in adult social care, and if nothing else the determination of Jane Worroll to find the answers to her questions is a caution to anyone prepared to cross commonly accepted moral, ethical and professional boundaries. However, the latest Panorama special was lacking in any serious analysis and was a missed opportunity to explore the many and complex reasons why we find ourselves in this dark place yet again.
Fiona Phillips was clearly shocked by Jane Worroll’s footage of her mother’s experiences at Ash Court Care Home, but her examination of why these appalling events occurred was distinctly tabloid in nature. The video images of staff abusing Maria Worroll became a justification in itself for the programme, rather than the reference point for a developing narrative about how we change for the better. It was uncomfortable viewing on a number of levels.
In response to the programme CQC issued a statement that many have seized upon as indicative of the regulator’s disappointing performance to date. Chief amongst these were Judy Downey of the Residents & Relatives Association who used the platform of the Today Programme to advance her claims that CQC had once again failed the elderly and vulnerable.
However, the reality is that after a painful birth, the regulator is finally getting a grip on who and what it is. CQC’s statement clearly explains its role and that it responded to events at Ash Court in a manner consistent with its statutory duties and responsibilities. Downey’s dissatisfaction lies not in any failure by the regulator to discharge its current functions, but rather that she has advocated for many years for a quite different model of regulation.
Abuse of the kind metered out by Jonathan Aquino is rarely witnessed through inspection activity, and the CQC are right to stress the limits of its powers and resources. The principles of better regulation exist for good reason, and the misconception amongst many in the media that it is a viable proposition to have inspectors onsite 24/7 has to be tackled collaboratively by politicians and key stakeholders alike. The CQC are but one cog in a collective wheel of sector responsibility and accountability; they are part of the solution, not the sole answer to poor care that many naively claim.
Care providers must also stand up and be counted. Poor care thrives in environments where weak management allows it to happen and where effective recruitment, appraisal and whistle blowing arrangements are non-existent or unfit for purpose. The statutory framework makes clear that it is the provider’s responsibility to ensure that they comply with regulatory requirements and demonstrate their fitness to operate. Blaming the regulator for every care home scandal is simplistic and only serves to absolve failing care providers from their primary legal and moral duty of care.
Local authority and NHS commissioners also have a responsibility to look beyond the current fees debate and develop procurement strategies truly informed by quality and safety considerations, not just the exclusive question of the bottom line and the application of restrictive terms.
Then there is the need for the Government to use the opportunity of the imminent White Paper to finally address the long overdue need for reform in the adult social care sector. Sarah Pickup of the Association of Directors of Adult Social Services has rightly questioned the current reliance on the Dilnot Commission’s recommendations as the only game in town where the question of future funding and systemic change are concerned. Pickup has rightly challenged providers to up their game in the dialogue with commissioners.
Part of this conversation also has to be focused on pay and conditions in the sector, because whilst no justification whatsoever for the abuse of people like Maria Worroll, there is clearly a growing issue of resentment and dissatisfaction at the rewards available to many who enter the sector. We need incentives to make the delivery of good care an attractive proposition, and the sanctions for bad care real and tangible. Forest Healthcare’s response to Jane Worroll’s disclosure was lamentable and does nothing to inspire confidence in the wider public.
One of the positive messages from events at Ash Court is that of the growing confidence and willingness of people to become involved in challenging bad practice and expressing their views about the quality of care generally. In a piece for Care Industry News last year called ‘What Price Quality’, I explored the benefits and tensions of the move towards online rating platforms as one solution to informing the public and industry stakeholders about commissioning choices in care provision.
Since then the Social Care Institute for Excellence (SCIE) has announced its intention to enter the arena with its ‘Find Me Good Care’ initiative. Under the innovative leadership of the departing Chief Executive Julie Jones, SCIE has brought the credibility of its brand to a wider audience, and ‘Find Me Good Care’ looks set to address many of the concerns highlighted in my previous article.
Early indications are that SCIE are likely to position themselves with an interactive tool that will meet the needs of professionals and novices alike, and which will aggregate intelligence from a range of sources rather than provide one narrow view from the perspective of a vested or explicit interest group. Crucially, it would appear that the moderation of consumer and trade feedback will be a key element in the SCIE model, thereby ensuring balance and equity for the public and care providers alike.
‘Find Me Good Care’ has the potential to become a trusted and high profile point of reference in much the same way as Tripadvisor has become. By gathering information from a wide range of sources, it has the potential to provide a unique overview of quality in adult social care sector. The evaluation and ratings of CQC will form but one component in a methodology that will embrace a far wider community of assessment, and will require providers to raise their performance in response.
At one point in the Panorama broadcast, Jane Worroll talked about the opportunity for “a new day, a new beginning”. This was said in response to the findings of her first efforts at covert recording at Ash Court, but it serves as a mantra to which we should all aspire. Apportioning blame and avoiding collective accountability gets us nowhere, its time for a new compact in adult social care.
Steve Carney is the Business Director for Care Quality Consultancy Services and provides strategic support on regulatory and stakeholder relations to the care sector. Steve was until recently the Director of Investigations for the Scottish Public Services Ombudsman, and is a former National Head of Service Improvement for the Commission for Social Care Inspection.