In a CHP exclusive, Philippa Shirtcliffe, QCS’s Head of Care Quality, says the COVID-19 pandemic highlights the need for the CQC to readdress its complaints handling approach.
According to the Care Quality Commission (CQC) in 2019, there were 11,593 complaints, while in 2020, with the country in the grip of a coronavirus pandemic, the CQC received 12,263 complaints, a rise of 5.8%.
When asked, the CQC was unable to reveal what the most prominent complaints were, but it would appear that one of the most frequent raised by the public has been the ban on visiting loved ones in care homes. Also, it would seem there have been complaints over failures to implement robust infection, prevention and control measures.
In addition to complaints, there have also been a number of concerns raised by care home staff against their employers. The total number of safeguarding concerns reported to the CQC was 14,107, while the QCS received 7,819 from qualified whistleblowing contacts last year. In the space of just three months last year, between March and May, The Daily Express reported that whistleblowing rose by 66%. Not adhering to robust infection prevention and control policies was the most common concern.
I’ll return to whistleblowing later, but let me first focus on complaints. As the Head of Care Quality at Quality Compliance Systems, the UK’s leading compliance provider for social care, my team and I are in regular contact with care providers across a range of different settings. The care providers that subscribe to QCS – whether they be large residential homes or small domiciliary care agencies – have one thing in common; in utilising our platform, we aim to give them the tools they need to move beyond paper-based tick-box compliance and embrace a rich, person centred culture of quality care.
Outstanding providers receive fewer complaints
However, what does this have to do with complaints or whistleblowing concerns for that matter? It is by no means an exact science, but in my opinion care services that are able to demonstrate a strong culture of continuous improvement benchmarked against CQC standards, tend to score a higher CQC rating than those that don’t. There are of course exceptions to the rule, but in the main, outstanding providers, where continuous improvement is part of the staff DNA, also register fewer complaints.
We’ve also created whistleblowing policies and procedures. Having worked as a whistleblowing lead, I understand more than most the need to embed robust policies and procedures in a service.
But what should an outstanding whistleblowing policy look like? I agree with Kate Terroni, the CQC’s Chief Inspector of Adult Care. In short, whatever procedures are laid down, staff have to have the confidence to know that not only will their concern be dealt with internally, confidentially and quickly, but they can also report their concerns to a senior manager without fear of reprisal. This means that every provider should have a whistleblowing lead and a set of effective policies and procedures which every team member has access to.
Whether it be concerns raised or complaints made, it is not beyond comprehension that even some outstanding-rated providers have received complaints from service users and their families. While some complaints are no doubt justified, it is also likely that after substantial scrutiny by the CQC a large proportion may be upheld.
Let’s take visiting arrangements in care homes during the pandemic, for instance. The strict restrictions, which only allow limited access and sometimes none at all, have divided the public and the care sector. On one hand, every frontline care professional understands the need for residents to be able to see their families. That is a basic human right. But, on the other hand, care staff have seen this insidious, pernicious and deadly virus, which is often brought in by asymptomatic individuals, rip through their services. It happened in the first lockdown and now sadly it is happening again.
In my opinion, the media hasn’t helped. The passionate and forceful messaging that finds its ways into their articles about managers refusing access to care homes has often been used as a battering ram against them. The truth is that a compassionate person-centred approach to care is a fundamental part of every manager’s makeup. It’s why they do the job. However, what the media fail to report is that in these unprecedented times, managers must make difficult decisions – which constantly pit the head against the heart. Going forward, the media needs to provide a more balanced picture of what is happening on the ground.
To ensure that residents are in contact with their loved ones, a part solution has been to introduce outdoor visits. But this relies on services putting in place the temporary infrastructure for it to safely take place. Sadly, not every provider has the financial resources to construct coronavirus-proof visiting pods, which enable service users to meet their families safely. Many families have not had that luxury. Instead they have had to meet with their loved ones, standing six feet from a window in freezing conditions. This has, I’m told, led to many complaints. However, in my view, it is very unfair to lay the blame on care homes. The smaller homes simply don’t have the budget to build temporary visiting pods. Instead, all of their resources are being spent on ensuring the highest standards of infection prevention and control are realised, and on maintaining safe staff levels, which is every home’s most precious resource.
This brings me to under-staffed care services. During coronavirus, some service users and relatives have suddenly seen that, while a home might be providing a service that exceeds regulatory requirements, it isn’t providing the same level of care as it did before the lockdown due to the fact that half of its staff are shielding or self-isolating. In these circumstances, the care home cannot bring in agency staff and certainly cannot ask staff, waiting for a test, to return to work. Yet it still is expected by the government, the regulator and the public to run a normal service. The problem here, however, is not the care home or its staff. Instead the issue is the absence of a robust test, track and trace system. If it were better, fewer staff would be self-isolating.
Care home insurance premiums rocketing
I imagine too – but cannot be certain – that the CQC will have also received a number of complaints regarding care homes suddenly closing down. This can be devastating for service users and their families as it leaves residents, who often have complex needs, without the specialist care they so badly need. The question is, when a care home shuts down, is that the fault of the Registered Manager and owner? In the majority of cases, it isn’t. While I don’t wish to use the government as a punch bag, during the pandemic, care homes have been reluctantly shutting their doors largely due to its actions. This was partly due to care providers not being given indemnity by the government for COVID-related damages – a position that the government has finally reversed. This created a vicious circle, as without indemnity insurance premiums rocketed. In some cases, they have risen five-fold, or have been refused. As a result, many providers haven’t been able to afford the cost of the premium. The new state-backed scheme, however, should ensure that providers won’t be held legally responsible for the death of somebody in their care. It is not before time, as it wasn’t fair or reasonable to expect care providers to take all the risks. This didn’t help anybody. Now that the government has changed its position, there will be more care providers willing to alleviate the huge burden facing the NHS – both now and in the coming months. That can only be a good thing for the care providers, service users and their families. It should also ensure fewer complaints.
The skill of the regulator and inspectors at ground level when looking into complaints in a time of COVID is to pull every lever available to them. That means assessing the home in question, checking its rating history, carrying out extensive interviews by phone and carrying out a full face-to-face inspection if necessary. In a regulatory landscape, which COVID has made even more complex, the CQC’s strategy document, which provides a roadmap to the end of 2021, recognises this. It sheds invaluable light on how the CQC is likely to collate information regarding complaints in the future, and is a welcome step.
QCS also sought comment from the CQC. Kate Terroni, its Chief Inspector of Adult Social Care, said: “Everyone is entitled to safe, high-quality care – where this doesn’t happen we will take action to protect people and we have conducted over 2,271 risk-based inspections of Adult Social Care locations since the beginning of the pandemic, and we have also conducted over 850 inspections focussed on infection prevention and control, in order to ensure that people are receiving safe care. 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.
“Although in some cases we’ve taken action in response to poor care or inadequate infection control procedures, the majority of care providers that we have inspected have shown they are responding well to the challenges of infection prevention control during the pandemic and doing everything they can to keep people safe.
“We have also launched our joint Because We All Care campaign with Health Watch England to support people in care and their loved ones by encouraging people to share feedback on individual experience.”
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