24th February 2015

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Health-Chat with Roy Lilley 

Dr Sarah Wollaston MP Chair Health Select Committee

11th March - King's Fund 5.30.  Details here

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News and Comment from Roy Lilley

You can buy their T-shirt; but would you be brave enough to wear it? Switch to 'in private browsing' and you could visit their website... no one would know.


Actually, if we apply Occam's Razor theory, they present a pretty enticing case. Devised by William of Occam the 'razor' says that among competing hypotheses, the one with the fewest assumptions should be selected.


By way of justification Occam is prayed-in-aid of the Flat Earth Society. The simplest solution; if it looks flat, it is. Yes flat-earthers still exist! And so does the Care Quality Commission.


Last Sunday, once again, the CQC were implicated in the cross-fire of more damaging allegations in another BBC5Live expose of care homes. FoI and other investigations reveal that some 14,888 claims about the standards of welfare of care home residents aged 65 and over in 2013-14 were reported to 74 councils. The upshot? Empty words.


Apologists always say that there are some good care homes and terrific staff.  For them to do that is to excuse a plane crash on the grounds that on that day 500 other planes landed perfectly safely.


There is no efficient, reliable, timely and independent complaints procedure. To believe that inspection is a technique that has anything to do with quality is to believe, like the Flat Earth Society, that NASA fake their stuff.


I looks to me that the care home sector is at a tipping point. Our only response; keep finding fault and bundling vulnerable people off to someplace else... in pursuit of a cruel deception that 'something must be done' and we are doing 'something'.


I don't think we need a root-cause analysis to tell us what is wrong. Too many of our frail elderly are looked after by the cheapest people we can find to do the job, in places prepared to do it at the lowest price.


We know, too many care homes are staffed at minimum levels, by poorly trained people. Care homes are part of a disaggregated provider model, dominated by small enterprises, without the resource to train and recruit properly. They are driven to provide care at the margins of break-even.


There is not a care home proprietor in the country that set out to run a home stinking of urine, clients dehydrated, malnourished, unwashed and abandoned. The combination of cuts in fees, the impossibility of finding sufficient qualified staff and pressure to take clients with lower levels of acuity than otherwise they might, creates a dangerous cocktail.


There is no hope of leveraging quality by inspection. Exposing failings does nothing to resolve issues. We need to be more intelligent.


The sector screams out for investment and consolidation but that is beyond the reach of a prompt resolution. At the heart of the matter, I judge, are workforce issues. Care work can be minimum wage, slog and dead-end. However, the work itself requires leadership, training, patience, skills, experience, a sense of vocation and can be hugely rewarding.


Care assistants need to be lifted from casual to career. Proper remuneration, proper training and a proper shake up. Can we do it? If we can imagine it, it can happen...

Care homes are not the only employers of HCAs; Trusts employ care assistants, too. Why not merge health and social care HCA workforces, have all HCAs employed by the Trusts; providing proper training, staff rotated between hospital and care homes... gathering experience and skills on the way. 

Career pathways; HCAs gaining knowledge, know how and training, moving towards an 'enrolled' qualification... just short of nursing; with an open door into nursing for those who want it.

Hospitals have back-office, HR, training facilities and the capacity to recruit HCAs, well beyond the ability of most care home operators. HCAs employed by Trusts, rotating between care homes and hospitals paid for by a reimbursement mechanism through existing fees and contracts. No new money required.

Does it make sense for a local health economy to syndicate its problems in search of a solution? I think so. Does it make sense to up-skill a workforce that can play a pivotal role in preventing admissions and helping early discharge? I think so. Would this be a radical step-change? I think so.

However, there is one thing I don't have to think about; keep doing what we are doing is a recipe for more BBC programmes.  


'What is the point of a select committee' come and join me in conversation with Dr Sarah Wollaston MP, chair of the Health Select Committee.

 Kings Fund 11th March - details here. 



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