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This blog post was published under the 2010 to 2015 Conservative and Liberal Democrat coalition government

https://socialcare.blog.gov.uk/2014/07/16/special-measures-coming-for-failing-care-homes-and-homecare-providers/

Special measures coming for failing care homes and homecare providers

Posted by: , Posted on: - Categories: Care and support, News, Safeguarding, Workforce

If a school or college is judged to be failing its school children or students through lack of leadership and/or poor quality teaching, there are systems in place to encourage rapid improvement or face the prospect of closure – so called ‘special measures’. We’ve seen these measures work in hospitals and other clinical environments over the last year and now new government proposals suggest the same structures are needed for social care provision – in both care homes and domestic settings.

Beth Britton: “People who use social care services and their families need to know that if a provider is failing in their duty of care there is a system in place to halt that neglect and change the culture
Beth Britton, social care campaigner: “People who use social care services and their families need to know that if a provider is failing in their duty of care there is a system in place to halt that neglect and change the culture."

In schools, the Ofsted applied status triggers regular and frequent inspections, senior managers and teaching staff can be held to account with the prospect of dismissal, and school governors may, in some cases, be replaced by executive committees. Similarly, social care providers found wanting may soon be subject to similar judgements and obligations to raise their game or be shut down. And here’s one reason why:

“Whilst the vast majority of the care my father received during his nine years in care homes was excellent, a six month period of poor ‘care’ resulted in his death from a severe aspiration pneumonia,” attests Beth Britton, freelance campaigner, consultant, writer, blogger and former carer to her father who had vascular dementia. “People who use social care services and their families need to know that if a provider is failing in their duty of care there is a system in place to halt that neglect and change the culture, and do so in a timely, but sensitive, manner.”

Beth, an experienced and powerful commentator on social care issues, will be working with the CQC’s Chief Inspector of Adult Social Care Andrea Sutcliffe and team, as well as colleagues from across the care sector, to fine tune the detail of a new special measures regime.

The new protocols will be administered by the Care Quality Commission (CQC), in collaboration with provider representatives, service users, friends and family.

Support for Secretary of State for Health’s proposals has come from a number of quarters, including the United Kingdom Homecare Association (UKHCA) which views the proposals as helping to showcase quality care as well as identify those who need to do better. “Combined with CQC’s forthcoming rating system of social care organisations, the regulator will be equipped with the range of measures which will recognise the high quality of the majority of social care providers,” says UKHCA’s Policy and Campaigns Director, Colin Angel.

Meanwhile, Professor Martin Green OBE, Chief Executive of Care England, welcomes the inclusive approach, noting “the Care Quality Commission's new special measures regime for failing services is being developed jointly with the care sector. It is our hope this regime will give new clarity and consistency in how failing services will be challenged to improve, and clearly define the process and timescales on when they will be removed from the market”.

Sheila Scott OBE from the National Care Association adds: “We hope this will be an arrangement that is rarely used, but as an organisation representing responsible care providers, we believe that special measures will focus attention on rapid improvement.”

The announcement represents Secretary of State Jeremy Hunt’s latest drive to encourage a more transparent ‘listen and response’ culture across the NHS and social care services – a cultural shift where patient and staff concerns are actively addressed in cases where compassion and good care are compromised. Hundreds of people died as a result of poor standards of care at Mid Staffordshire NHS Foundation Trust – it is hoped a special measures approach can help prevent these and other tragic failings in the health and care system ever happening again.

Tell us what you think

So what do you think are the best ways to mitigate bad care and elevate excellence? Are special measures the way forward? What would you do? Share your views using the comment facility below.

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27 comments

  1. Comment by Pat Hardy posted on

    I reported 3 care homes when my mum was alive. When mum died I also went and had my say at a Notts review on the home. Had done it the previous year and the Inspector told me she 'liked the manager and it would ruin her friendship and cause a lot of unnecessary work to follow a complaint through'. Along with the remark 'as your mum is old why bother'? What will this new system do to ensure standards are raised and maintained. CQC did not do as much as they could have done. Need other people to go in and do spot checks. Did contact your department back in 2008, 2009, 2010.......... only got lip service.

    • Replies to Pat Hardy>

      Comment by Jo uk posted on

      This is shocking and your mum may have been elderly but they should have taken your complaint further.Never mind them stating it would ruin a friend ship with the home manager and it would have taken a lot of time up,that's their job and what they get paid for.Your mum had rights and you and your family had and still have rights no matter what.I work for a Care Home run by Four Seasons Healthcare and I reported the Care Home my main concern was the safety of the Service Users.They are charged a lot to be cared for.Having to sell their homes to go into a Care Home.It's shocking the amount they are charged.

    • Replies to Pat Hardy>

      Comment by Jacqui posted on

      Every person In any care home, hospital any facility have rights. The cqc are failing a lot along with facilities. Shocking and should not happen. I work in a care home on a EMI Unit. If I ever see any thing happen that should not be believe me it won't happen ever again. I love my job. We aren't here to disrespect people were here to care for people we get paid for it.

  2. Comment by Kathleen Whittaker posted on

    I would raise pay and improve training for care staff, it is also important to raise staffing levels. We all want value for money but an excellent service, which we all want for our loved ones and ourselves when the time comes, does not come cheap. Too often staff are paid appallingly low wages and do not recieve adequate training and support, often having to work against the clock. All the inspections in the world won't really improve services unless they are accompanied by real investment in terms of money and staff.

    • Replies to Kathleen Whittaker>

      Comment by Brends posted on

      Yes we need care workers to be recognised for who they are but until society changes it's attitudes to how valuable they are, and not as a person who does jobs that are seen as menial and does not reflect the important part they contribute, and Government central and local stop screwing providers into the ground by offering rates that are not sustainable to deliver quality care the care sector will remain in crisis

    • Replies to Kathleen Whittaker>

      Comment by Barrie Warner posted on

      The raising of pay and conditions for care workers is good in principle, BUT it will be impossible to implement as this will increase the costs of the provider, and the commissioner will not be prepared to foot this bill. In an ideal world we could do this and it would lead to an improved service and recognition of the valuable work that care workers do. The independent sector have been forced to reduce their costs in order to keep their contracts with local authorities for some years now and the inevitable is therefore happening, the quality of services are being forced down. This whole process with it's inevitable consequences must be halted before lots of providers are forced out of the market place and then what is to happen to those people who are supported?

  3. Comment by Geralfd posted on

    The situation at the Mid Staffs Hospital is peculiar to the NHS, there is no way that the CQC would have aloowed this to happen in the Private Sector Care Homes and they definately would NOT have tried to cover up reports by teir own Inspectors and be party to the intimidation of whistleblowers.
    Treat the NHS as they deserve to be treated and treat the Private Sector as they deserve to be treated do not use the Private Sector as whipping Boys for the Public Sector.
    Refer to the way that the BBC Panorama programs "highlight" to deficiencies in the Private Sector and then Practically ignores far worse problems in the NHS

  4. Comment by Pat Gordon posted on

    It is about time Care Homes and Care Providers were more stringently checked and bought to order if not doing the job properly. My father in law died following weeks of neglect in an awful care home. He was finally moved to a more caring environment but too late, he died 2 weeks later. After fighting in Burma during the war, after working 50 years, raising a son, it was disgusting what they put him through. We only had their word that he was eating, and sleeping. They lied consistently, he had several falls, but his wife was never informed of what had happened, it was only when we saw cuts and bruises on his face that they admitted to any falls. I am sickened by his treatment. He had dementia in his latter years so couldn't speak up about what was happening to him. It made our heartbreak even worse when he died.

  5. Comment by Bryan Dottin posted on

    I welcome the prospect of 'special measures' being introduced to more stringently regulate care services. Having been employed in social care for the past few years and witnessing the disregard and poor leadership displayed by service providers pertaining to the care offered to clients I would say that it is about time to hold those responsible to account. In my view, if you profess to provide a particular type of service then that service should be provided in all its forms, especially when you have a duty of care to vulnerable people. I am positive that the introduction of special measures, especially for care homes, would be wholeheartedly received and appreciated by the families and relatives of the people in the care of unscrupulous service providers who appear to be more interested in financial gain as opposed to delivering quality social care and support.

  6. Comment by Bryan Dottin posted on

    I welcome the prospect of 'special measures' being introduced to more stringently regulate care services. Having been employed in social care for the past few years and witnessing the disregard and poor leadership displayed by service providers pertaining to the care offered to clients I would say that it is about time to hold those responsible to account. In my view, if you profess to provide a particular type of service then that service should be provided in all its forms, especially when you have a duty of care to vulnerable people. I am positive that the introduction of special measures, especially for care homes, would be wholeheartedly received and appreciated by the families and relatives of the people in the care of unscrupulous service providers who appear to be more interested in financial gain as opposed to delivering quality social care and support. In addition to this, there are some good quality services available which treat their client's with dignity and respect and ensure that the staff they hire share that essential ethos and are effectively trained to that end. It's just a shame that this mindset is not shared and reciprocated across the board.

  7. Comment by Sukbinder Gill posted on

    All of us who are involved in adult safeguarding and especially large scale multi-agency enquiries/investigations into systemic care provider failure, will emphatically welcome the pronouncement by the Health Secretary Jeremy Hunt that care homes and domiciliary care services will be put on a special measures initiative by the external regulator, when there are significant concerns raised in regard to the safety and adequacy of care provided by care homes or home care agencies.
    The fact the special measures will be of comparable worth to those measures currently applied by the Care Quality Commission to hospital trust, will enable there to be a parity to the standard and the level of care and treatment an individual should receive irrespective of whether they are a inpatient, a resident in a care home, or a recipient of home care.
    Furthermore the universal application of special measures by CQC will mitigate against the risk of avoidable and unnecessary harm to those individual receiving care and treatment. There should never be a two tier regulatory inspection regime between hospitals and other registered care providers
    As a safeguarding professional it is heartening to hear the news that most of the hospital trusts that were put into special measures a year ago have shown significant improvements. Hopefully we will see similar improvement in service provision provided by care homes and home care agencies. Local authorities and their key partner constituents all know what time, effort and resources, are required to conduct complex large scale investigations as part of the adult multi-agency safeguarding process, and I look forward to the external regulator stepping up to the plate with a more robust national framework to ensure the safety and well-being of anyone receiving care.
    It is my contention that the greater the rigor and sanctions applied by the external regulators to registered service provider who are providing substandard care provision, the less likely we are to have a repeat of Winterbourne or Mid Staffordshire.

    Kind regards
    Sukbinder Gill
    Adult Safeguarding Practice & Training lead

  8. Comment by Lucy posted on

    I think all staff no matter what jobs they have in care homes have the appropriate and specialist training.They need to be supervised more and regular supervisions.I work in a care home on a Dementia Unit.You have to have the right attitude also.I do know about cover-ups in care homes by staff.It needs to be stopped.So many mistakes could have been avoided.Just like hospitals also.I have in the past reported my care home to the cqc and I'm glad.My main concerns were the safety and wellbeing of Service Users.I will do this again if I feel I have to.

  9. Comment by Michael Doyle posted on

    I think it would be useful to have hospital nurses liaise with care homes, that are failing. To help keep them up-to-date with current standards.
    Particularly nurses who have excelled in their chosen fields with a demonstratable background of good care delivery. With at least three years post-registration experience.

    It would also be useful to involve a social worker and various other members of the MDT teams, who could then make regular progress reviews of failing care homes, aiming to drive standards up and reassure the public in our care system.

    Giving these team special powers to put in special measures would also be advantageous.

    I understand this almost sounds like the sea CQC, but homes that need special measures and that actually be failing need structured management and support that is ongoing. And comes from a team of dedicated people that truly believe in change and fixing issues.

    Having such deadicated teams would also allow for a team working relationship to develop with staff and mutual trust to build. These teams could then assess other professionals and give feedback to the professional bodies of the individuals they are assessing and then to senior managers at government level.

    These groups should also have the power to have and unannounced inspections at any time of day or night.

  10. Comment by Lesley posted on

    My mother received poor care in two hospitals and a care home then she became a resident of Orchid View where her death was attributed to by neglect. I wrote to GP's Social Services and CQC and no one listened. A Coroners Inquest revealed institutionalised abuse, had I been listened to early on many people wouldn't have suffered as they did! Whilst I welcome the changes I wonder what places a home in "special measures" Orchid View had a glowing report early on but deep within its structure bad care was evolving. Closing care homes which are people's homes is devastating to the frail vulnerable in society and should not occur, many will die as a result of closing and moving them away from friends and familiarity. Take away the profit making organisations and privately run care homes! We should have NHS care cradle to grave run by non profit making organisations with highly trained skilled staff with all Nurses better trained to deal with the complex medical conditions of today. They also need to do extended training in medicine management as drugs used for these conditions are themselves becoming more potent and complex, Medicine Management at Orchid View was simply appalling! Carers need a regulating body, compulsory training with annual updates and career prospects with better pay. Ensure all who work in the care industry have an excellent command of English. Make all homes excellent there is no room for good/adequate when caring for the vulnerable in society! Gerry Robinson exposed poor care and good care on the programme " Can Gerry Robinson fix Dementia Care Homes" I suggest this training shown within this programme and it's implementation becomes compulsory in all homes registering to care for residents with dementia! These people deserve good care and they rely on us as a society to ensure good care happens! Laws need changing to protect the vulnerable who lose a voice when dementia takes hold. There needs to be one central complaints system in place there are too many helplines, bodies, organisations, healthwatch, etc etc etc people don't know who to complain to to be heard. This helpline should have highly trained individuals who can signpost all queries/complaints to the right party. They also need to know what constitutes an adult safeguarding issue and know when calls require urgent help. Organisations need to communicate and be aware when complaints about an individual or a care home are made to ensure common threads are picked up early and acted upon, let us not have another Orchid View! No one has been held to account for the misery inflicted on Orchid View Residents and where are all the Owners and share holders now? probably sunning themselves on their favourite holiday resort, having locked up their multi million pound home whilst there, they took the money from the vulnerable but didn't supply the goods, this is simply outrageous and must not be allowed to continue. These people are probably set up in business again causing chaos somewhere else! Whistleblowing needs to be encouraged and people rewarded for doing so and jobs protected. Nurses, managers and carers who standby and don't whistleblow when they know things are not right should be brought to task for not reporting poor care and given a written warning they are being watched by their regulatory bodies for not exposing poor care and not upholding their " code of conduct" in the case of registered Nurses. I found the care appalling in 4 different places for my mother and if we put all these places in special measures or shut them down, where are the vulnerable to go? Where are the teams of people who can come in and turn the homes around,what if the owners want to shut the home and people lose their place of residence. There are too many unanswered questions that need resolving before we agree this is the way forward. Where are the CQC going to get all the highly trained personnel to do the inspecting and re inspecting when things are wrong. We heard there were 75 care homes who were told to pull their socks up by the CQC, this is simply unmanageable without an awful lot of manpower. Simply giving the CQC the ability to put homes etc on "special measures" is not going to fix our care homes there needs to be a lot more thought going into this than that! Back to the drawing board this is simply not enough to change our Care Home System.

  11. Comment by Michal posted on

    I would also welcome special measures. Improvement in training, staffing levels and pay increase to the caring staff however a better and wider understanding of how dementia is progressing and often affecting people could actually prevent blaming the care staff or care home for the death of their loved parent or grandparent.
    It is upsetting what happened to the ladies father and I do not know all the facts but 9 years excellent care and then a six month period of poor ‘care’ resulted in his death from a severe aspiration pneumonia I would actually investigate whether that was poor care and negligence or maybe illness progression affecting swallowing and causing pneumonia.

    I had a look on line to find evidence of the above comment and this what I found.

    Eating and weight loss
    Most people with dementia lose weight in the later stages of the illness, although occasionally people eat too much and put on weight. Weight loss can affect the immune system, making it harder for the person to fight infections. It may also increase the risk of falling and make it harder for the person to remain independent.
    It is important to ensure that the person is getting enough food and liquid. They may need help and encouragement with eating and drinking. Problems with chewing and swallowing are common in the later stages of dementia due to the person's muscles and reflexes no longer working properly. These problems can cause the person to choke on food or develop chest infections, so it is important to seek help.
    The GP or community nurse may wish to refer the person to a speech and language therapist or to a nutritional specialist. Nutritional specialists can advise on a special diet or, if the person is unable to eat or drink normally, they can carry out an assessment to see whether or not having foods or liquid through a tube would be beneficial.
    Information from: http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=101

    METHODS: The autopsy reports were studied on all patients (n = 524; 55.3% females; median age 80 years) with a clinically and neuropathologically diagnosed dementia disorder who underwent a complete autopsy at the University Hospital in Lund, Sweden, during 1974-2004.

    RESULTS: The two most common causes of death were bronchopneumonia (38.4%) and ischaemic heart disease (23.1%), whilst neoplastic diseases were uncommon (3.8%). In a general population of elderly studied for comparison, bronchopneumonia accounted for 2.8%, ischaemic heart disease for 22.0%, and neoplasm for 21.3% of the deaths. Amongst the demented patients, circulatory and respiratory system diseases were the causes of death in 23.2% and 55.5% of the Alzheimer patients, respectively, whilst the corresponding figures were 54.8% and 33.1% for the patients with vascular dementia.

    CONCLUSIONS: In patients with dementia, pneumonia as the immediate cause of death may reflect a terminal stage in which patient care and feeding is difficult to manage well. Knowledge about what actually causes death is of value in the terminal care of patients with dementia disorders.
    Information from (http://www.ncbi.nlm.nih.gov/pubmed/19170740)

  12. Comment by Pearl Baker posted on

    This is great news, but what about LA Care and Support service Contracted out to Private Management Companies not registered with the CQC. This will be the next 'storm' to hit the media headlines. Evidence confirms these Companies complete their own CQF questionnaire for the LA, and not open to Public viewing by the LA.

    The same CQC questionnaire is used for the above purpose, and often the response overlaps into the 'essential' service regulated by the CQC, so why are the CQC not regulating the above ?

    If there is to be equality for all vulnerable individuals you must address the issues above.

    This type of accommodation is on the increase as it not only avoids Independent Inspections, but avoids financing an adequate 'Care Package' for some patients, including others placed into this type of accommodation subject to a COP Order in the name of DOLS and 'Property and Finance'.

    These very vulnerable individuals currently have no 'safeguards' against an abuse of the current system

    I recently attended a work shop in Surrey discussing the Care Act, where the question of 'safeguards' was discussed, there was also a serious discussion with the concerns of unregistered, unregulated Private Providers.

  13. Comment by Dave Lee posted on

    My main feeling is that a private company should not be used for providing essential services as the name of the game will always be to maximise profits - quality will always come second. Also have the regulators considered the absolute fear and distress it will cause not only the patients but the relatives if their care home is placed in special measures? I am not sure that this is the best way forward, obviously checks must be carried out - help must be offered if homes are failing but maybe not in this way - As a tax payer I could find myself paying 'twice' for a care home that is below par while paying extortionate fees? The government should be finding a way to provide these essential services, thus ensuring that they are well run, that staff are fully trained to a recognised standard and paid a living wage - take the profit making element out of the equation and we might start to see care services improve - Emphasis needs to be on quality and care and not profit.

  14. Comment by Hajrah Abdulla posted on

    I attended a Work Force Summit on 16/07/14 and agree with special measures and more pressure on the Provider to support the managers and be able to retain competent staff.
    People who understand care should be the only ones to work in care. We needed a recruitment strategy in place to ensure the right tools are used to check competency.

  15. Comment by Gill xxxxxxxxxxxxx posted on

    As a provider I welcome the prospect of special measures being introduced to regulate care services.
    But I also think that regulators need to consider the financial constraints providers are already under to increase training in the health and social care sector.
    I would highlight that there are good care providers who already provide a really good standard of training and show compassion and respect to their service users in a very tight arena.
    But what the commissioners need to consider is that their needs to be some consulatation as to how providers can provide extra training when they are already suffering from very tight budjets.
    As an existing provider we have taken a decrease in fees in the last few years, where competitive pricing of contracts has been a major factor. I think the commissioners should quite rightly focus on awarding contracts to good service providers, instead of awarding contracts, based on pricing. Those of us who provide excellent CQC and commissioning reports should be rewarded and feel comfortable in providing a good service and not feel disadvantaged because of unscrupulous providers, especially as we are dealing with the most vulnerable people of society.

    • Replies to Gill xxxxxxxxxxxxx>

      Comment by Steve Moore posted on

      Look back in time. Abuse in care facilities has been in the public domain since the 1960's, care homes and hospitals and others. The authorities carry on tinkering with organisational artefacts (See Schein) and to this day providers where abuse has been found are told to provide training, have care plans, have policies, have procedures, have supervision, comply with standards, and most of them do, or strive to. But its still happening, we've seen it on film, viz Winterbourne, Oban House etc. I saw abuse in hospitals in the 80s as a student nurse, the 90s as a charge nurse and hospital manager, I've seen it in the 13 private sector care homes I have worked in over the years, I still see it when I am involved in the local autority safeguarding response, several times a month since 2000....30 years and little has changed...and I have recently completed PhD research that tells me its still happening, its rife! And remember quality and risk of abuse do not necessarily lie on the same continuum...think about it...let us wait for the first occurrence of abuse in a home rated as 'high quality' by CQC...just like it happened before...remember star ratings are not new! The answer, in part, is to find the staff who actually care about those in their care, who value them, rather than valuing the transient rubbish our society tells us to value. But where do we find then?

  16. Comment by Jenny (relative & informal carer) posted on

    Great idea in theory and long, long overdue but where will the resources required to dramatically increase the number of staff needed to carry out meaningful, comprehensive reviews of all the thousands of care homes - both big and small - and all the home care services? The government must put their money where their mouth is on this one if its going to have a genuine impact on service users' & their relatives quality of life. I hope its not just a cynical sound bite just done to grab headlines.

  17. Comment by Becca Lawther posted on

    Thank you for your comments.

    The Department of Health, CQC and the sector will work together to explore possible models of support for social care providers, including how the most useful of these resources might be pulled together into a resource package that would help providers address inadequacies under each of the five CQC key questions.

    We will be working closely with a range of organisations who provide information, advice and tools to help providers focus on improving aspects of their care and their organisational capability such as recruitment, retention and workforce development. They include Skills for Care, the Social Care Institute for Excellence and National Institute for Health and Care Excellence (NICE).

    All care home and home care providers have to be registered and will therefore be covered by special measures.

  18. Comment by Tim Fisher posted on

    Does these special measures include council run day centres?.
    We have had 3 safeguarding alerts put in for my son in one month at my sons day centre.
    I have tried a number of time to get things put right in this centre not just for my son but the others that use this centre and keep hitting a brick wall with my local council.

  19. Comment by Carol posted on

    I work with a small team of health and social care staff who monitor the quality of care homes and work with those who are struggling to improve the quality of care. It is a collaborative approach which has included providing leadership training and other clinical education, 1 to 1 support where appropriate and developing support mechanisms such as a peer group action learning sets and a dignity champions network. It's early days but we have already seen improvements in th quality of care and the ability of providers to respond proactively when concerns arise.

  20. Comment by Jenny Junpier posted on

    This Simply doesn't make sense to me! As you have descried, there are countless third party organisations that are called to correct schools and health services! So why is it that elderly care, which has been under the scope for half a decade seems to have absolutely nothing done for them apart from consistent talks about improvements. This genuinely concerns me as one day I may be unfortunate enough to end up in a care home! this report shows the amount of care homes that have failed there CQC inspection: http://www.caringhomes.org/quality-of-care/

    If there are that many care homes with poor standards, this will only add to the stress of the families who are looking for care not to mention the experience of the person being cared for!

    What simply confuses me is how action are handled so quickly and effectively in other sectors. Its almost like care homes are purposely being neglected?

    • Replies to Jenny Junpier>

      Comment by Jenny Junpier posted on

      To add to this, more resources need to be publicly available to the public to really get an understanding of the quality of care in certain care homes. Not only will this put them under the microscope from a reviews perspective but this will also make the general public more aware of red flags!

  21. Comment by Macy Fizer posted on

    I agree with you that a culture shift is needed in such institutions. By thoroughly addressing the needs of patients and the people who take care of them, changes can be implemented to improve the quality of services of care institutions. These changes will greatly help care homes in Surrey, especially those who have a lot of residents. Our policy makers need to thoroughly evaluate the existing system and study the aspects that need improvement. Click Here: http://www.paxhill.co.uk/care-homes-in-surrey.html