Doug Paulley's blog

disability, data protection, activism and other such

CQC lie about their competence

Posted on by Doug Paulley

The Care Quality Commission (CQC) has come in for somewhat of a bashing recently. But I didn’t think they would lie as well.

In response to a recent documentary exposing care home abuse, CQC said the following in their media statement:

CQC carries out an unannounced inspection of every care and nursing home in England every year – more often if we believe people may be at risk. This system of regulation can and does identify poor care which CQC then takes action to tackle.

What?!

A quick look at the five care homes I’d stayed in in the last year revealed last inspection dates as follows:

  • Summer 2010 (in response to a specific incident, last “proper” inspection November 2007)
  • January 2009
  • November 2009
  • February 2011 (in response to specific allegations)
  • December 2009

Not one was inspected in the past 12 months. 0%.

Personal experience with looking for care homes for a relative confirmed the impression that most care homes have gone well beyond 12 months without an inspection.

I smelled a rat. So I asked CQC how many homes it had indeed inspected. The response came. Answering a slightly different question, CQC admit they did 13,082 inspections of care homes over the last 12 months. There are 17,756 care homes. So at least 26% of homes didn’t get inspected. I say “at least” as where CQC identifes problems at a care home they conduct more than one inspection. (hence why I think their FoI response is disingenuous.)

Let’s look at these once again.

  • “CQC carries out an unannounced inspection of every care and nursing home in England every year – more often if we believe people may be at risk.”
  • Of the 17,756 English care homes, CQC did 13,082 inspections over the last 12 months.

Is it me, or do the figures not add up?

Where did this come from?

The sad thing is we always knew CQC would be an appalling, incompetent mashup.

It was formed from a merger of the Healthcare Commission, the Commission for Social Care Inspection (CSCI) and the Mental Health Act Commission a couple of years ago. Having worked with CSCI, who were at least trying to do things right, me and other service users raised the concern that it would follow the sad precedent of the subjugation of disabled people’s rights following the Disability Rights Commission being subsumed into the Equality and Human Rights Commission. Sadly, we were right. Our concerns that social care would always be lower priority than healthcare were realised.

It didn’t help that the new body was given new, overarching registration standards. These same standards applied to all bodies registered – from acute hospitals, to dentists and care homes. The result being the emphasis on residents rights was lost, and the regulations simply weren’t specific enough for the situation. We lost rights in the change.

Then CQC sacked 70% of its inspectors so that it could register dentists. They adopted what they acknowledge as light touch regulation. They ceased grading care homes, and largely stopped inspecting them. The majority of care home reviews became based on self-declaration by care home managers. Inspections became very rare. Now, precisely which poorly performing care homes would state this to the regulator do you think?

Abuse

All this came to a head during the very sad and distressing Panorama documentary of the systemic abuse of people with learning difficulties at Winterbourne View. CQC became a very public whipping boy, held accountable for a lot of what happened. Much criticism resulted, including a select committee and the PM criticisng CQC for reducing inspections. Many made a comparison with the seminal Silent Minority documentary exposing the “care” of people with learning difficulties in institutions in the early 1980s. (Documentary available to view online – very distressing too.)

Meanwhile, there’s been blood on the carpet and accusations of gagging orders on staff etc. CQC has become a toxic brand. It’s been desperately attempting to reinvent itself, so far (in my view) failing miserably.

Consequences

If it wasn’t so serious, this would be funny. The reality is, though, that people are suffering as a result of this disgusting shambles. Care home residents are some of the most vulnerable, most disadvantaged, most disempowered people in this country. Abuse is the norm, not the exception in my experience; it just varies in degree. Without an effective regulator, the thousands of people in care homes up and down the country suffer even more abuse, poor treatment, curtailment of life opportunities.

CQC are ineffective, stuffed up, an ineffective regulator who lie about themselves to try and stop the torrent of legitimate criticism aimed their way. They are beyond redemption and need replacing.

(With grateful thanks as always to the wonderful Crippen for his inciteful cartoon 🙂

The Voice of Disabled People?

Posted on by Doug Paulley

Amongst the various other things that annoyed me about yesterday’s shameful treatment of disabled people courtesy of the Lords (et tu, Lib Dems?) was a vomit-inducing self-congratulatory homily by Lord Low, who spearheaded this (admittedly influential) report on the withdrawal of mobility allowance for people in residential care.

Readers may remember that this nasty proposal was born out of invented assumptions that people in residential care have all their mobility needs met by their funding authorities, that they are similar to people in acute hospitals who don’t have mobility needs and (we suspect) due to an assumption that this seldom-heard and severely disempowered group would be unable to defend themselves. Others cynically (though perhaps correctly!) suspected this was the sacrificial clause designed to enable the Government to save face on the remainder of their cripple-kicking, disempowering, undemocratic and lying Bill.

Disabled people were naturally incensed. People from all sorts of backgrounds put in a huge amount of effort to point out the “inaccuracies” in the assumptions inherent in the proposal, and the dramatic negative effect this would have on residents’ lives. Some examples include Bendy Girl’s radio interviews, my oral and written evidence to the Joint Committee on Human Rights (PDF file), and our home’s residents who got our MP to visit to correct his assumptions and to raise our concerns. And these examples are a drop in the ocean compared to the huge amount of effort put in many different ways by a lot of disabled people to make the Government change its mind.

Yet in this extraordinary speech (with supposed false modesty!) Lord Low claims responsibility for the U-turn on behalf of the secretariat (provided by two charities for, not of, disabled people) and the other half for Members of Parliament’s common sense! Shamefully, he made no mention of the work done by disabled people up and down the country to overturn this odious proposal.

There is more joy in heaven over one sinner that repenteth than over 99 just persons who need no repentance. For that reason, I greatly welcome the Government’s decision to drop their proposal to withdraw the mobility component from those living in residential care. I have been given some credit for bringing this about with the review that I was asked to lead by Leonard Cheshire Disability and Mencap, but I think, in all honesty, I must disclaim this. Half of that is because I had a very good team working with me, supported by an extremely able and hard-working secretariat from both organisations; and half because I think Ministers, to their considerable credit, largely came to their decision of their own accord. Perhaps I may have provided a little cover for a U-turn-if so, I am glad to have been of service.

Pass the bucket.

Lord Low, as a disabled person himself, should be ashamed for continuing the traditional disempowerment of disabled people by continuing the enforced misapprehension that they cannot speak for themselves, that their words and actions don’t have power, that other people can more effectively speak for them. His lack of acknowledgement of disabled people’s actions yesterday is a breathtaking rebuff of the Disabled People’s Movement.

I know I shouldn’t be surprised as this sort of behaviour is by no means new. After all, as ex-chief of the Disability Rights Commission Bert Massie says, we shouldn’t expect publicly funded charities that act as proxy providers of public services to bite the hand that feeds them. (I’m looking at you, Leonard Cheshire Disability and Mencap, who provided such vital secretarial support to the Low report.)

He pointed to the “superb” Responsible Reform report – published this week by disabled activists – which accused the government of misleading parliament over disability living allowance reform, as a demonstration of why the voluntary sector’s independence was so important.

He said that any charity that decided it was unable to produce such a report because of the risk of annoying the government had immediately been “compromised” by signing a contract to provide services.

But Lord Low’s speech is such an inexcusable, self-congratulatory, brown-nosing, odious homily to disabled people’s disempowerment, I couldn’t resist this rebuttal.

Unreasonable Residents or Unreasonable Management?

Posted on by Doug Paulley

“Unreasonable” residents

Being in residential care, we often get labelled as “unreasonable”. We get told it’s “unreasonable” to want the toilet at short notice, “unreasonable” to expect assistance to access the community, “unreasonable” to want to get up at a certain time, etc. etc.

Whenever and wherever there’s communal living, and particularly where there’s communal care, there obviously has to be a certain amount of give and take and consideration of other residents to oil the social wheels. But in “care land“, (a different place with apparently very different social rules, norms and expectations from the rest of humanity), there’s a lot more expected. Unreasonably, in my opinion.

Sometimes these are quite extreme – e.g. being told it’s unreasonable to want to go to the toilet instead of using the bed (video, see V Elman’s story), or to have a comfy bed and be able to get out of it occasionally,

One memorable Christmas day, a care worker told me it was “unreasonable” to want a shower. It wasn’t fair on the other residents, as staff should be spending time with them, unwrapping their presents. This last one shows a relatively common element: psychologically blaming residents for being “unreasonable” to other residents.

Today was a minor one – staff strongly implied it was unreasonable of me to get up early so I could go to Church, and that it was particularly unreasonable for me to expect to get up at my own normal pace, as the people who normally get up at that time were waiting and being inconvenienced. (I should immediately point out that of course I didn’t take this lying down [pardon the pun] and that the situation has since been largely resolved; also that whilst my experiences are common it’s worse in other care homes and it’s not all care staff…)

 

Why are residents “unreasonable”?

It’s my experience that residents are branded as being unreasonable for the following main reasons.

  1. For perfectly reasonable behaviour that would be expected outside “careland” e.g. wanting to get up in time to meet commitments, to go to the toilet
  2. For “being unreasonable” as a very understandable reaction to the situation they find themselves in – common example: residents wanting the toilet several times an hour as it’s the only way to get attention or stimulation; residents “playing up” to get a reaction out of boredom or frustration, “challenging behaviour”
  3. For “being unreasonable” / manipulative, as the only way to regain some control in this very disempowering situation e.g. raising the stakes / threatening complaints to the Regulator  so that I can have a shower on Christmas day!
  4. Because they are unreasonable wankers. You get them in all sections of society.
(By the way, in case you were wondering, I think like most people I’ve been every one of the above at various points, though I’d like to think the first is the most common! Some tend to one of the reasons more than others…)
 
 

Scrabbling for resources

What particularly gets me about this situation is that residents are routinely blamed and labelled as “unfair” for daring to use scant resources that other residents need. It is very rare the scarcity of such resources (esp. staff time!) or the management responsible are identified as the culprit!

The illustrious home in which I live (far better than most…) charges £1,000 per week for me to live here. This is based on a costing model assuming I need over 40 hours of care (I use the word advisedly) per week. Anybody who knows me would know that’s ludicrous, I’m fiercely independent and don’t need anything like as much support as they charge for. Yet if I (somehow) were to receive all the care hours paid for, the following would happen:

  • The home would cease to function as a viable unit. Particularly if all the other residents were to get the care they paid for! The total would be several times the actual staff hours employed.
  • I would be accused, once again, of being unreasonable, demanding, and unfair on the other residents.

It does lead reasonable people (and the Council, who are doing an enquiry!) to wonder what, precisely, us residents get for the money.

 

J’accuse!

Given the above, it sticks in my craw that over the years staff and management have accused me many times of being unreasonable, to other service users’ detriment, including:

  • being responsible for another resident attempting suicide through jealousy of the staff attention I receive
  • intimidating and making staff scared of me and my complaints, such that they jump me up the queue above other, less articulate / empowered residents
  • unreasonably disrupting handover and jumping getting-up queues so that I could be up in time to meet voluntary commitments
  • putting my need for the toilet above their need to complete paperwork
  • wanting a bath on another resident’s bath day on returning from a week’s camping.

I could give hundreds of such examples.

I don’t generally think this is the front line care staff’s fault.  In most cases, I find that they are a hard-working, caring lot, doing their best for people whilst working in difficult circumstances, with inadequate facilities / resources / time / staff, huge responsibility, unsociable hours, poor pay and very little recognition. It’s no wonder things occasionally snap.

 

It’s all different in Care Land

But why, in care land, is staff’s inability to meet every residents’ wants or needs reinterpreted by staff (some) and management (some / many) as residents being unreasonably demanding and unfair to other residents? In many other high-paying service industries the Customer is king and customer services would be shocked at any such suggestion being made.

Imagine staying in a hotel charging £1,000 a week. A chambermaid accuses you of being unreasonable and unfair for having a lie-in, delaying her and affecting other residents’ room cleaning services! Reasonable people (and faceless sales droids) might rightly complain at such treatment and perhaps suggest there aren’t enough staff to do the job in a more “reasonable”, customer focussed fashion.

 

Sod that!

Next time staff accuse me of being “unreasonable” or selfish for wanting assistance I may suggest they are being unreasonable by not providing what I’m paying for. In other words, they should take their blaming emotional blackmail and put it where the sun doesn’t shine.

But given the impossible situation the staff are in, I would be being unreasonable…


With grateful thanks as always to Crippen / Dave Lupton Cartoons: www.crippencartoons.co.uk for his wonderful cartoon!