Letter from the European Parliament: Promoting Quality Social Services with the ESF Plus

Mary Baginsky is Senior Research Fellow at the NIHR Health & Social Care Workforce Research Unit at King’s College London. (611 words)

Dr Mary Baginsky

Dr Mary Baginsky

I was invited to attend an event (9 April 2019) at the European Parliament organised by the European Social Network (ESN) to discuss ‘Promoting Quality Social Services with the European Social Fund Plus (ESF+)’. The ESN has over 125 member organisations in 33 European countries and supports the sharing of knowledge, practice and policies between social services across Europe. The event was hosted by Sofia Ribeiro, a Portuguese MEP and member of the Employment and Social Affairs Committee in the European Parliament. The focus was on how the ESF+, amounting to 120 million euros in the coming period, could be put to best use to support the work of social services across Europe. Even though there are UK members of ESN none were present at the meeting. Continue reading

CQC emphasises the importance of human rights for high quality care home services

Caroline Green is a PhD student at King’s College London. (362 words)

The Care Quality Commission (CQC), England’s care service regulator and quality inspector, is emphasising the centrality of human rights and equality when providing high quality care in care homes and other care services. Human rights are the rights we all have because we are human beings. They are legally enshrined in the Human Rights Act 1998 and the Equality Act 2010.

Andrea Sutcliffe, CQC’s Inspector-in-Chief, recently explained at CQC’s Human Rights and Equality Conference in February 2018 what role human rights play for CQC’s regulation and inspection of care homes. She said, ‘Human rights thread through all our key-lines of enquiry. It informs the judgement that we make when inspecting care services and is one way that the CQC can emphasise the importance of human rights, raise the profile and make sure that the people are being treated the way that they should.’ Continue reading

Older People & Human Rights

Dr Joan RapaportJoan Rapaport reports from the 9th Annual Joint Conference of Age UK London, the Social Care Workforce Research Unit and Making Research Count. (1,789 words)

The conference, held on the Guy’s Campus of King’s College London, was chaired by Jo Moriarty, Deputy Director of the Social Care Workforce Research Unit, and attracted a capacity audience. Speakers’ presentations are available on the SCWRU conference webpage.

Human Rights Act: overview of current changes: Caroline Green, PhD student, Social Care Workforce Research Unit

Whilst human rights have been around for hundreds of years both globally and in Britain, Caroline acknowledged that our understanding mostly relates to post World War II developments. The European Convention on Human Rights, drafted in 1950, contains numbered ‘Articles’ each of which protects a basic human right. The European Court of Human Rights, based in Strasbourg, rules on cases brought under convention from the 47 signatories. Continue reading

Let’s Talk – Care Homes and Delayed Discharge

Bev EvansNorman CrumpBev Evans and Norman Crump, both of Lancaster University Management School, report from a recent meeting where participants discussed the transition from hospital to care home. (913 words)

According to the National Audit Office (2016), between 2013 and 2015, official delayed transfers of care rose 31 per cent and in 2015 accounted for 1.15 million bed days – 85 per cent of patients occupying these beds were aged over 65. Since 2010, waits for beds in nursing homes increased by 63 per cent. Across Morecambe Bay University Hospitals NHS Foundation Trust (MBUHT) waiting for a care home place can be a significant cause of delay.

In early October, Cumbria Registered Social Care Managers’ Network, Kendal Integrated Care Community (ICC) and MBUHT convened a special ‘Let’s Talk’ discussion group which brought together local care home managers, social workers, hospital discharge coordinators, ward staff and nurse practitioners from the community. The aim of the meeting was to explore how the transition from hospital to a care home could be improved. ‘Let’s Talk’ is a specially facilitated session delivered by King’s College London, Lancaster University, Dignity in Dementia and the South Lakes Registered Social Care Managers Network. Meetings are designed to enable participants to see issues from each other’s perspectives and to afford time to critically reflect on a particular ‘wicked issue’. Continue reading

Data and Debate – reflections on the SSRG Annual Workshop

Caroline Norrie, Research Fellow at the Social Care Workforce Research Unit in the Policy Institute at King’s, was at the Social Services Research Group Annual Workshop this week. (801 words)

This year’s Social Services Research Group (SSRG) Annual Workshop, held at the London School of Economics (LSE) on 15 April was a particularly thought-provoking event. Entitled ‘Evidencing Service Improvement for Vulnerable Children and Adults’, the workshop featured an expertly chosen group of speakers whose presentations stimulated animated discussion from the floor. With the Care Act coming on stream and the increased drive for integration, participants, who were predominantly social care managers with responsibilities for data and organisational performance, enjoyed a great opportunity to discuss service re-figuration and its measurement. Continue reading

New models of social care

Dave MartinThe Centre for Policy on Ageing (CPA) and Co-operatives UK arranged a roundtable event on 18 February 2015 to foster greater understanding and consider the development of social care co-operatives. Dave Martin (an associate with CPA) reports from the gathering. (753 words)

‘Hardly a month goes by without another scare story about aspects of our health and care services. Is there a democratically accountable ownership model for health and care services that could make a difference? Could the active membership and co-operative ownership of workers, service users, volunteers and family members rebuild public trust in services and put an end to cruelty and neglect through a socially inclusive solution where the system of care is owned by the recipients?

In a growing number of countries, from Europe to Canada and Japan, diverse co-operative models of social care are expanding. We believe these approaches can be further developed in the UK and that they would benefit the lives of vulnerable people by empowering them directly in decisions that affect their care.’—Pat Conaty (Research Associate, Co-operatives UK) in The Guardian, 4 July 2014.

The roundtable event was attended by a diverse group of people, described as three circles of interest—first, people who had been involved with the co-operative movement for some time, secondly people seeking to develop (or convert to) a co-operative model for the delivery of care, looking for support and assistance, and thirdly policymakers and commissioners sniffing around—is this the way for the future? Continue reading

New directions in child welfare: good news from the Canadian province of New Brunswick

Geraldine Poirier BaianiDr Joan RapaportGeraldine Poirier Baiani (left) and Joan Rapaport report from New Brunswick. (931 words)

These days, high profile reports of child care tragedies, rising numbers of children being taken into care and social workers struggling with high caseloads are commonplace. Stories of positive developments in children and family services are rare. However, a chance meeting whilst on holiday led to a remarkable discovery: the caseloads of child welfare social workers in the Canadian province of New Brunswick now stand at an incredible seven. Continue reading

Risk, Safeguarding and Personal Budgets: exploring relationships and identifying good practice

Martin StevensDr Martin Stevens is Senior Research Fellow at the Social Care Workforce Research Unit in the Policy Institute at King’s. (900 words)

Published today are our findings from this timely NIHR-SSCR funded study, which aimed to provide evidence about the impact of using different forms of Personal Budgets on risks of abuse, to explore practice responses to the increased emphasis on using Personal Budgets and the experiences of Personal Budget holders who had been the subject of a safeguarding referral (suspected abuse or neglect). This collaborative research (undertaken by researchers from King’s, the University of York and Coventry University) was driven by our awareness of contradictory perceptions held by practitioners and other researchers. We had heard views that people on Direct Payments (one main form of Personal Budgets) were more at risk of abuse than other social care users, but on the other hand that the increased control offered by Direct Payments was a protective factor. In order to provide some evidence to address these contradictions, we re-analysed national and local data on safeguarding referrals and take-up of the different forms of Personal Budget. Continue reading

Towards a new national learning disability employment strategy

Stephen MartineauStephen Martineau is a researcher at the Social Care Workforce Research Unit in the Policy Institute at King’s. (782 words)

There is a flurry of policy activity in the field of learning disabilities and employment at the moment. Last Wednesday’s Summit on the topic, hosted by the British Institute of Learning Disabilities (BILD) in Birmingham, followed close on the heels of a run of associated consultation events. Led by a Department for Work and Pensions (DWP) civil servant, with the Department of Health (DH) also in the room, the focus of the meeting was a new national learning disability employment strategy. This is to be in final draft form by November, with a set of four learning and sharing events to follow, and sign-off by Mark Harper, Minister for Disabled People, expected in January 2015. Other indications that the topic of learning disabilities is ‘hot’ in Whitehall and Westminster, as DWP’s Simon Francis asserted on the day, include: the recent appointment of a Special Educational Needs Tsar (Lee Scott MP); the revamp of the GOV.UK website for potential employers of people with learning disabilities; and, a commitment to put much more of the information in this domain into easy read format.

It is too early to say much about the new employment strategy for people with learning disabilities in detail. The talk is of opening up a new funding stream, but quite what shape this will take (and whether, for example, it will entail new pilots)—this isn’t being discussed openly yet. Continue reading

Challenge the CQC

Caroline Norrie, Research Fellow at the Social Care Workforce Research Unit at KIng’s College London, and Esther Njoya, Research Intern at the Unit, report on a meeting held earlier this month at which the Care Quality Commission (CQC) was put on the spot by parliamentarians, professionals and the public.

The public had a chance to ‘challenge the CQC’ at an event held on 11 June at the House of Commons. This was an opportunity for the public, patients, and health and social care professionals to question representatives of the Care Quality Commission (CQC) about its work and especially the proposed changes to the regulation of primary and integrated care.

Held under the aegis of the All-Party Parliamentary Health Group, the meeting was chaired by Dr Sarah Wollaston MP with a panel made up of Chairman of the CQC, David Prior and Chief Inspector of General Practice, CQC, Prof Steve Field. Dr Sarah Wollaston opened the meeting with a brief description of the role of the CQC as independent of government and committed to transparency and the integration of health and social care.

Chairman of the CQC, David Prior

Chairman of the CQC, David Prior

Following the Winterbourne View TV exposé and Serious Case Review the CQC has been making significant changes. These are summarised in its strategy, Raising standards, putting people first – Our strategy for 2013 to 2016which it has been consulting on. As part of a new inspection regime, the five new key domains the CQC will be inspecting in all services are safety, effectiveness, caring, responsiveness to people’s needs and leadership. The new style inspections are being trialled in hospitals, mental health and community health services, and, since April 2014, in adult social care services and GP practices.

As has been widely reported, inspections are now being carried out by specialists (including experts by experience) within professional areas rather than generalists. Services will soon be graded as outstanding, good, requires improvement or inadequate. The CQC hopes this new grading system will encourage service improvement. The CQC has also undertaken a review of care homes and found about 3,000 care homes with no qualified registered managers; in some of these the owners have been penalised. Finally, a new aim of the CQC is to understand and measure service users’ experiences of integrated working. Final plans will be published in September 2014 and come into effect in October 2014. This meeting was part of CQC’s strategy to engage the public in this change process.

Professor Field outlined in more detail his vision for inspection in primary care, which includes improved access to care for vulnerable people (such as homeless people, people with learning disabilities, and sex workers, among others). The CQC will use ‘levers’ to improve integrated care and its commissioning. The aim is to ‘celebrate good practice as well as shining the light on poor practice.’  He outlined all the areas that are covered by CQC primary care inspection including GPs, dentistry, mobile doctors (e.g. the 111 service) medicine management, prisons and safeguarding.

The majority of this forum was taken up with discussion around a wide range of questions from the audience.

Baroness Hollins, a prominent Learning Disabilities (LD) campaigner, urged the panel to introduce levers to ensure GP practices fulfilled the regulation of noting when a patient has a learning disability. She asked whether the CQC had made any headway in implementing the recommendations set out in the Confidential Inquiry into premature deaths of people with learning disabilities (CIPOLD). She stated that 37% of the deaths of learning disabled people were preventable—making this a discriminated against group. Prof Steve Field replied he was taking notice of the comments and that such implementation might be possible using intelligent monitoring (a new system being developed to combine informal intelligence and formal performance management data).

Several service users and carers used this meeting to complain about lack of joined-up services and inequality between London boroughs in the provision of mental health services. Suggestions were made about providing crisis phone lines, which might reduce hospital admissions. The speakers took notice of these comments and also offered the audience information about making complaints to local Health and Well-being Boards (HWBs) and the CQC call centre in Newcastle.

A representative from Healthwatch asked about links with the CQC and how to make the most of their work (e.g. their role in being able to enter and view services) while avoiding duplication of roles. Prof Steve Field answered that the CQC was focused on ‘listening to people on the ground’ and the HWBs acted like the ‘eyes and ears of the CQC’ and so both organisations should be working together. It was not entirely clear how these mixed metaphors would work locally,

Concerns specifically relating to GPs were raised—for example, out-of-hours services, the trend for phone rather than face-to-face consultations, and regulation of single-doctor practices. Service users asked when electronic patient records were going to be introduced and whether patients would have permission to check and amend their own records. Questions were also asked about regulation of follow-up-care and post-discharge services and insurance for independent midwives.

Another representative from a Healthwatch organisation, who declared that they were willing to support individuals who wanted to expose acts of neglect and abuse in care homes as whistleblowers or witnesses, asked whether there were avenues that such organisations could use to effectively collaborate with the CQC. She observed that they could contribute to the CQC’s work in providing oversight roles for inspections, regulation and monitoring, as it was evident to her that the CQC had overlooked previous cases of abuse scandals—for example the case in The Old Deanery home, which was shown by Panorama at a time when CQC was actually carrying out an ongoing inspection. Professor Field replied by saying that it was unfortunate that such an incident had happened while still under their scrutiny, but that at the time they had relied on information from the management of the home. He reiterated that the CQC welcomes the contribution of Healthwatch organisations who are able to provide information.

In contrast, Paul Beresford MP noted his concern about over-regulation and suggested closer working together of the General Medical Council (GMC) inspections and the CQC. Professor Field replied that this was in the pipeline, and there were general murmurs of approbation to this news.

A representative from the care home sector then put forward the case for private providers. He said there was a danger that good quality operators offering services for people with long-term conditions would be driven out of the sector due to the growth of regulation. He called for increased funding and more training to be made available for care home managers. Prof Steve Field agreed, but noted that care homes should also take some responsibility for training and ensuring that their members of staff have care home management skills and professional qualifications.

One member of the audience questioned whether the CQC has capacity to undertake this more stringent inspection regime. Professor Field replied that the CQC was recruiting more staff and that it did have capacity to undertake the work. The best providers will only be regulated once every two years, rather than annually as is currently the case.

As researchers currently involved in projects about adult safeguarding, this meeting provided an interesting insight into the CQC’s vision for regulation. Plans for the CQC to carry out more stringent inspections of social care services and to use their powers to encourage more effective joined-up working across health and social care sounded highly positive aspirations—although the policy shift to more infrequent inspections of the ‘best homes’ needs to be tempered by an acknowledgement of the risks of such homes being quick to deteriorate.

Caroline Norrie is Research Fellow at the Social Care Workforce Research Unit at King’s College London. Esther Njoya is a Research Intern at the Unit.