By Philippa Shirtcliffe, Head of Care Quality, QCS
Every week, QCS’s Care Quality team receives a raft of questions from frontline care professionals. During Covid, our panel of specialists have received hundreds. We try to answer all of them and we publish the most insightful questions in the ‘Ask the Care Specialists’ section. Normally, the Social Care Content team, which, collectively writes 100-plus policies and procedures each year, and updates thousands more, can provide a quick and thorough response – no matter how complex the query.
But every so often, we are sent a question that stumps us. A few weeks ago, for example, I received a question from a care worker that read, “In a time of Covid, when day staff are stretched, is it okay to wake a service user at 5am in the morning to bathe?”
Providing an answer was simple enough. Of course it’s not okay to take such an action. The only time when it would be permitted, is if the person in question was an early riser and had given specific instructions to be woken up at that time. If a care professional did not seek their permission, it would be a clear affront to their dignity, their privacy and their human rights. A much harder question to answer, however, is why is an experienced care professional posing such a question and what does it say about the service they work for?
It left me feeling concerned that a compassionate, person-centred culture hadn’t been embedded in the care home. Nor was it likely that the service was meeting its core responsibilities across at least three of the five key questions – Well-led, Safe and Caring – and also the KLOEs that underpin them. It was probable too that the provider was also failing on its safeguarding responsibilities, as well at its ability to create an open culture where staff feel safe to raise concerns. Of course, I accept that I may be wrong in my assumptions, but if an outstanding culture of safeguarding had been instilled, no care staff member would feel the need to consider the question, let alone ask it.
Not an isolated case
Sadly, it appears that this may not be an isolated case. Since the beginning of the pandemic, the CQC confirmed that it has carried out “2,271 risk-based inspections of Adult Social Care locations”.
To the CQC’s credit, it has been fairly proactive in creating open communication channels between itself and care staff, service users and family friends to share feedback. By launching the ‘Because We All Care’ campaign with Health Watch England it says it is “supporting people in care and their loved one by encouraging people to share feedback and individual experience”. And this campaign has been further strengthened by Kate Terroni, the Chief Inspector of Adult Social Care at the CQC, who told QCS: “It is vitally important that information of concern is shared with us directly – we will use all the information we receive to inform our regulation of services and take action where necessary. Where we are aware of a risk to people in care we will continue to take action to ensure their safety and drive forward improvements in care.”
But despite the CQC’s promise to act on safeguarding feedback, anecdotally at least, there seems to be some big challenges on the ground. Earlier this month I attended a Skills for Care webinar. One of the panellists revealed that due to Covid some providers had actually shelved improvement action plans. Some had even stopped training staff. It is not clear exactly how many providers have taken this route, but it is one that I cannot advocate. Why? Because, no matter how challenging life has become in the pandemic, demonstrating outstanding safeguarding practice while providing training staff to recognise concerns are inextricably and intrinsically linked. Indeed, it’s absolutely crucial that providers have embedded a robust training framework within their organisations during a pandemic. More vital still is that the framework is constantly updated to meet the varying challenges of the crisis – whatever they may be, and that training is cascaded down to frontline staff, as and when they need it.
Holistic thinking required
The danger of failing to properly adapt safeguarding procedures to cope with the multi-faceted demands of Covid don’t bear thinking about. Firstly, not doing so, demonstrates a complete lack of understanding of safeguarding, service users and their relatives. More than anything else, safeguarding requires Registered Managers to think holistically. It’s not just about observing and monitoring if a person is eating, taking in the correct amount of fluids, it’s about ensuring that that person is enjoying the best quality of life possible and are at the heart of the service. Even in the grip of a pandemic that means continuing their hobbies and meeting loved ones. Of course, the pandemic is likely to place some challenges on how those pastimes are carried out, but the litmus test for any provider is to find safe and innovative ways to engage service users. At the same time, safeguarding actions need to be evidenced, records logged and key learning points shared virtually – especially if it is considered unsafe to feed-back to staff in a class-based environment.
But, it can be challenging and a little overwhelming to create new policies and procedures and tweak old ones. At Quality Compliance Systems (QCS), as a leading provider of content and guidance for the social care and healthcare sectors, we understand this more than most. We recognise that safeguarding is a wide and nuanced field and we’ve created a suite of curated policies and best practice content that QCS customers can download and tailor to their requirements. Guidance is anchored to the NICE guidelines, the Care Act 2014 and the six core principles, which are outlined in the Local Government Association toolkit on safeguarding.
Shedding light on hidden safeguarding issues
The LGA document is highly informative and I would recommend that Registered Managers, working in every care setting in England, read it. What sets it apart is that it shines a light on many of the wider societal problems that lie beneath the surface, and might not be easily spotted. Problems such as domestic violence and coercive control are issues that domiciliary care staff should be particularly vigilant of. Safeguarding is not just limited to service users, however. Managers should also observe staff to ensure that they are not victims of domestic abuse too.
However, there are also problems outside of the sphere of the care sector that present potential blind spots to professional care staff. To properly reveal them requires providers to embrace co-production and co-design when they build services. Take radicalisation for instance, or county lines drug trafficking networks. Both present a growing safeguarding risk. Some, in the intelligence community, for instance, see care homes and domiciliary agencies, as future potential breeding grounds for radicalisation.
Registered Managers, who suspect a care worker might be indoctrinating a service user should follow their local safeguarding procedures to ensure that the Prevent process can be followed. Domiciliary care providers should also have close relationships with their local authority if they suspect that an organised crime gang has infiltrated a person’s home to use it as a base to sell drugs. While it is rare, it is vital that care workers are fully equipped to recognise the signs of ‘cuckooing’ as it is called, or radicalisation, and know who to report it to.
Finally, as a former safeguarding lead, the inherent value of supervision should never be under-estimated. It is really important that a culture of regular supervision is deeply embedded in a service. Managers should operate an ‘open door’ policy, and champion a ‘safe. Open’ environment where staff know they will always be listened to. Managers should also be able to join the dots. They should ask themselves if they are dealing with an isolated concern, or if it is part of broader safeguarding theme that runs through the organisation. If it is part of a wider trend, managers should ask themselves if training programmes and policies need to be changed, or more supervision session offered.
If Registered Managers do nothing, they risk staff bypassing them and reporting their concerns directly to the CQC. Last year the CQC received over 16,000 complaints from whistleblowers. In my experience when staff become whistleblowers, they do so for a number of reasons. Firstly, they are worry that the service is simply not safe. Secondly, they don’t understand the whistleblowing policy in the care home or home care agency, and thirdly, often due to a culture of bullying, they are afraid to report the concern to the Registered Manager for fear of retribution.
But there is also another theory worth exploring. A rise in whistleblowing should not always be considered a bad thing. It demonstrates, for example, that the regulator has been highly successful in in communicating to care professionals that it is okay to report and escalate concerns. When it assesses an organisation, the CQC sees safeguarding as a fundamental part of its risk profiling process. Its view is that a rise in whistleblowing – providing it is not widespread and systemic – can be a positive development because it shows that a provider’s processes are sensitively tuned to pick up on concerns and address them. Indeed, they say that complaints offer a window into a service’s performance. What better way to improve it further by listening to the concerns of staff and working with them to put them right?
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