State of Care Report 2016

Well it finally was released amid great expectations in what was fully expected to be the most dramatic report by the CQC yet! The press got a pre-release which was featured in several newspapers. David Behan reputedly made the statement that "this was the worst crisis in care he had experienced in 38 years." We at Your Voice Matters had been telling him and others that for several years. But neither he nor his colleagues believed us and like Ostriches, buried their collective heads in the sand of self denial and hoped it would all go away. Sadly it hasn't and the wolf is not just at the door, it is now in the house.

This isn't a review of The State of Care 2016. In truth there is really little to review. It is very predictable.

Like many special reports in special areas, one needs to look at specifics in the report, rather than the caption headline summaries, to get a grasp of the real implications and seriousness of the situation.

The report mentions well, the vital need for more trained nurses and the shortage of nursing staff. The report mentions equally well, the importance of good management and how this is a major contributing factor in poor quality care. How is this to be achieved? The Government must pay more to the Local Authorities to give to cash stripped providers. Our dear friend Professor Martin Green, CEO of Care England, mantra of causation is repeated and nauseum. It's all the Governments fault. More money needed. Maybe so! But poor care existed prior to the financial depression of 2008, and vitally to the point affecting big providers like BUPA and Four Seasons. A time when care providers were receiving more than adequate funding from Local Authorities. Throwing money at something that isn't working or operating well isn't the solution to the problem. Let's say our new Prime Minister Theresa May waved her magic wand and the providers got their money, would this change everything? Would this change anything? This assumes that the money would be put to the purpose for supplying quality care, rather than been pocketed by providers and the company's shareholders. There is no guarantee that any improvement would occur. What happens twelve months further down the line? Would the begging bowls come out again? "Can we have some more please, Good Fairy Godmother Theresa, we can't cope!'' PM '' But you got your money last year" "Ahh yes, but that was to recuperate previous years losses we are still broke!'' Throwing good money after bad doesn't work financially. Margaret Thatcher spoke that doctrine. No bail outs.

Disappointing that the report never considered to look deeper into the real causes of the financial crisis in the care industry. Not a mention! Are we surprised? No. Perhaps an indication of this financial naivety can be grasped in Professor Louis Appleby's comments ''Our evidence suggests that finance and quality are not necessarily opposing demands'.

Statistics and Implications. One has to look deeper than just the caption bubble summaries the CQC are presenting. We are told 71% of Adult Social Care is Good, 1% outstanding, 28% non-compliant. Two years ago we at Your Voice Matters first started to note 25% non-compliance in specific geographical areas and locations. The North East, Kent, Huddersfield, Halifax, Bradford & Leeds. At this time the generally held view we were all subjected to time and time again by the CQC, was that incidents of abuse and neglect were isolated, reinforcing the wider held viewpoint by mass media that it just involved a few bad apples among care staff. Your Voice Matters never believed that. We note CQC seem to have now dropped that standard response. Your Voice Matters soon realised we were dealing with individual systemic system failure of a individual care home. Then as our research went deeper, we realised this was but a tip of the iceberg and we were dealing with company systemic system failure, which finally led us to economic systemic system failure, due to inappropriate economic theory and practice. The Neo- Liberal Market Driven Economy. Recently we have noted a % between 30 to 35%. But there are greater variations. Liverpool was this year going by CQC figures touching 50%. Then in the last few weeks again CQC figures Leeds was too. These are way above the CQC 28% mean. I suspect that Manchester, Kent, Bradford, Huddersfield & Halifax aren't far behind around 45%. The situation is far more serious than the CQC figure of 28% indicates. When we split individual types of care provider we see a very different picture. Take nursing homes. The non-compliance ratio here is collectively 38%. When we split this down further into size of care home we find this variation: Large nursing homes 44%. Medium 41%. The number of nursing homes is 3,649.

So 38% failure rate but 44% failure rate in large ones. This means the likes of BUPA, Four Seasons Healthcare, Barchester, HC-One, Care UK, plus several mid-sized care providers. Born out by CQC inspection reports. This level is increasing in our view. Residential homes do much better with 73% compliance. There are far more residential care homes than nursing homes, 9,100. Here the percentage ratio is 25.6 %. That non-compliance mostly in large residential care homes.

Many of these residential care homes are the single home provider or 2 or 3 Homes. They are usefully covering the seriousness of the care crisis by their number, getting the figure of compliance to 73%. But even here 25% non-compliance is still worrying. What these figures indicate is that where non-compliance is involved, the true mean rate of this is between 8 and 40% very different from 25, 26, 28%. Ironically it is those who are shouting the most (The top five big boys) who have the worst percentages. We should be doing detailed research into why these high non-compliant areas are like they are and why other areas are so much lower taking into account geographical density and number of care homes.

Andrea Sutcliffe, Chief Insp of Adult Social Care

Blog 13 October 2016

http://www.cqc.org.uk/content/state-care-blog

Richard Humphries, Asst Director Policy, King's Fund[endif]

"Balanced & authoritative assessment of whole range of health & social care services, that doesn't pull it's punches."


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