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The Future of Primary Care - Is there one? 

HealthChat with Mike Bewick, Clare Gerrada and James Kingsland.

19th January - HealthChat evening - details here 

Wave a flag
News and Comment from Roy Lilley

For as long as I can remember it's been a phrase beloved of some in the NHS and more recently had its currency extended. It appears in the Oxford Dictionary and the Urban Dictionary.


Oxford describes it as; focusing on the potential for things to go badly wrong if certain policies or actions are adopted. As we would recognise it in the NHS; 'shroud waving'. The Urban Dictionary claims a wider currency.


This morning I find myself having the potential for being described as a 'shroud waver'. I've thought about it, ruminated and cogitated, deliberated and reflected and all I can say is; it is not my purpose. See what you think.


My angst turns on two documents and one set of circumstances. The first document published by ADASS, the organisation for Directors of Social Care, called 'Achieving Closure', good practice in supporting older people during residential care closures. It is thirty-odd pages of common-sense, researched by the University of Birmingham.


The nub of it starts on page 19. Basically the report says closing care homes has a detrimental effect, don't do it and if you have to; take your time, support the residents and their families and protect friendship circles. Ensure independent advocacy is available and work at a time and pace that everyone can cope with.


The second report is from The Cambridge Journals; Reviews in Clinical Gerontology; Forced relocation between nursing homes: residents' health outcomes and potential moderators. In brief it says; don't do it and there is a high risk of 'post move mortality'. In other words it kills people.


The reason I have been reading this stuff is because of this. It is a Sky TV report 'Patients Moved After 'Unsafe' Care Home Closed'. The report claims frail residents were hoiked-out of their residential home on a dark, freezing evening, wheeled into ambulances and taken off to someplace or other, because the CQC deemed their home unsafe. The relatives claim they were not consulted. The BBC carried the same story.


The care home, Merok Park in Surrey was called, in the Daily Mail, a pigsty. Apparently there was a broken lift, a smell of urine, no hot water and staff shortages. The CQC website says it was OK in February but now carries a red flash saying 'action is being taken'. It doesn't say what action.  So, it's far from clear what's-what.


Let's assume it got pretty horrible; the CQC would have trailed through its ineffective inspection regime and achieved nothing and onto its enforcement palaver, ending in court. Once they have a closure order they have to act, otherwise they become liable for what happens subsequently. If they close a home it becomes their problem.


Their problem is also the relatives' problem (if anyone tells them), the owner's problem, the staff's problem and most of all the residents' problem.


Left with a choice, faced with a bad care home, do we throw out the residents or throw out the management? Who should be left on the pavement on a freezing December evening; elderly, frail residents or the owners and managers?


The ineffectiveness of inspection as a method of improving or sustaining quality is made manifest by these events and well researched (Read Edwards Deming and countless others) and the dangers only too obvious. The care home owners will have had inspection after inspection, fiddled about with improvement notices and the up-shot; yer granny is on the pavement. Inspection improves nothing.


Is it shroud waving to point out the CQC's processes don't improve quality and their ultimate solution, throwing people into the back of ambulances and carting them off, is likely to be worse than the problem.   Is it shroud-waving to enquire how many of these upended residents will die as a result?


The care home market is in jeopardy; fees pushed down and eligibility thresholds hiked-up.   On the CQC's own admission 9 in 10 care homes are not up to it. How many twilight removals can we expect?


The answer to abysmal care homes has to be to throw the managers out, not the residents. Insert an NHS hit squad of qualified staff, proper management and builders, cleaners and maintenance staff. Sequestrate the asset to pay for it, or enable another company to take it on? Run the place properly.


Could it be done? If we wanted to, I guess we could find a way to keep vulnerable people in-situ and safe? I'm not waving a shroud; I'm trying to wave a flag. 


What's the future for primary care?

If you want to know, too, join me, the NHSE Primary care Tsar and Deputy Medical Director Mike Bewick, leading GP Dr Clare Gerada and the president of the NAPC and former policy advisor Dr James Kingsland, at the Kings Fund for a night of

 The Big Conversation about Primary Care. 

  Details here. 


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