24th August 2015

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Health Chat

29th October King's Fund 5.30pm

Samantha Jones NHSE Director of New Models of Care and Vanguards.

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News and Comment from Roy Lilley
D'ya have a good weekend? Shopping, kids, F1, cricket, athletics, flop, travel, shop, garden, BBQ, friends, clubbing, family, gym or getting ready for Monday?
Me? I 'inspected' a care home. Elderly frail, dementia patients; one floor protected by keypad entry. An NHS manager, whose relative is in this home, asked me to have an impartial look.
It was impressive. Purpose built, wonderful gardens, wheel chair friendly. Reception like a hotel. The rooms had ample space for personal items, the bathrooms and loos were spotless and the whole place passed my 'sniff-test'. The laundry; neat and ship-shape.
The kitchen; as good as any I have seen, with an engaged and knowledgeable chef who understands special diets and nutrition. The dining room as good as any restaurant but homely. Menus on every table; lots of choice.
The staff... busy. Frankly, I would like to have seen more. I made the ratio 1:8.   The problem; the home is in one of the most expensive parts of Surrey and recruitment... a nightmare. House prices galactically high. The operators have purchased an apartment to ease the problem.
In the dementia unit a persistent buzzer disturbed the otherwise calm, well-ordered environment. A resident pulls the chords, incessantly, deliberately and non-stop.
I spoke to staff and relatives.  The families seemed full of praise and recognised the challenges. The front-line; caring and understanding of the foibles and eccentricities of their demanding clients.
A meaningful day-time programme, committed volunteers and although, to someone who has run services for the elderly mentally frail (as they were once called) in a counsel of perfection, I could see some issues, I have seen so much worse. On balance, without inspecting care plans and governance policies; 8 out of ten would seem fair.
The home had been rated as inadequate by the CQC. The report published on 19th August 2015, the report threatens closure.
This home is not perfect but by no stretch of the imagination is it inadequate. The CQC report is here. How do they arrive at one conclusion and me another?
It's all in the timing. I had a look on Saturday. We don't know when the CQC inspected; they say the date of inspection 'is to be confirmed'. In other words they've forgotten, lost their records, the dog has eaten their homework? We don't know.
How come the CQC don't know?  I have long since given up expecting the Board to feel responsible for anything their organisation does.
I asked the staff and the relatives. 'When was this place inspected?' They didn't know. One relative told me they thought it might have been months ago but couldn't remember...
So, we have a... a care home whose reputation has been traduced. A care home, struggling to recruit in one of the most difficult markets in Europe... prospective employees could see the report and decide to work someplace else. A care home... the victims of an out of date report and a regulator who thinks their job is done when they find fault but can't remember when.
It may well be the case, when the CQC inspector called the place was a mess? My contact tells me, in their (not inconsiderable) experience, whilst there has been a change of management and the usual churning of staff, it has never been close to being bad enough to close and the residents left on the pavement, like the CQC did a couple of weeks ago.
This underlines the fallacy of inspection.
Management school tells us inspection is a mug's game and the Godfather of management gurus Edwards Deming tells us (Number 3):
"Cease dependence on inspection to achieve quality. Eliminate the need for massive inspection by building quality into the product in the first place."
For this care home the damage is done. An out of date report, threats and compulsion culminates in reputation damage, relatives and residents in fear.
Instead of inspection the NHS needs a 'bottom-up' improvement model.
Scotland is very grown up and has a Joint Improvement Team. We should, too.
Swap inspectors for local, critical friends, who can coach, encourage, and support. Regulation cannot deliver improvement. People working together can.
The bar to excellence will vary. Localities know the issues. Geographically remote criticism is pointless. The route to what good looks like will vary. Understanding the local narrative and acting together, locally works.
Whole system thinking, involving secondary care and community staff, might solve staffing, training, recruitment and motivation problems.
One thing is for sure; undated reports on the internet solve nothing and tell us even less.
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Sam Jones
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Roy Lilley 
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... and NHSE Director of New Models of Care
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