Healthwatch National Report on Residential Homes Affirms the Need for Feedback.

A surprising finding from this Healthwatch publication about care homes, based on national 'Enter & View' reports is that despite feedback being a strong CQC theme, with assessments based largely on stakeholder feedback, too many care homes are not actively seeking feedback for themselves, or they fail to act on feedback or be transparent and open about findings. Healthwatch really focus on the importance of feedback; they introduce it as a central theme; they include it in the 8 Quality Indicators; they emphasise the need to seek out and respond to feedback and they include it as one of the key lessons for carehomes. 

But what do they mean by feedback? We all have our internal feedback loops enabling us to adjust and tweak our way through life; but some people try to extrapolate this mechanism as being OK for an organisational setting: the old " I talk to my staff; I know what's happening in my home" approach. But care homes are complex organisations regardless of size and this native, organic approach to feedback is simply not adequate.

The feedback loop is classic recommendation for good management; and care homes require a multi channeled approach to feedback with robust and consistent mechanisms that exploit opportunities for feedback whenever possible. Moreover the feedback system needs to be embedded into the organisational culture and used as a platform for communications and engagement.

In this example, standing processes for 'Suggestions' and 'Complaints' are in place. These form subject matter for the monthly staff meetings and the quarterly residents and relatives forum.

Similarly the normal daily interactions with both residents and staff, whilst informing immediate behaviour can yield interesting insights that may warrant further discussions at staff meetings and the forum. These therefore become essential parts of the organisations communication process and become the platform for engagement and involvement, really improving management and leadership, better decision making and supporting any change or improvement initiatives.

The foundation stone for this process is the annual bench-marking activity. This lets you measure opinions and levels of satisfaction giving you a performance indicator; it tests assumptions and theories and lets you measure what people are really thinking, giving a metric for ongoing improvement. 

What really makes this process work is quality communications and sustained use of the process; people know about the suggestion scheme and they know that ideas will be examined and discussed; they know how to make complaints and that any complaints will be discussed and dealt with effectively. They know that staff meetings are taken seriously, that the forum is a legitimate place for discussions, that they will take place when scheduled, that the management really value their input. 

Multi channeled feedback system.JPG

The annual bench-marking exercise also needs to test opinions across the breadth of stakeholders and be consistent and reliable. The Care2improve quality audit system elicits feedback from care users, from relatives, from staff and from other professionals; it tests opinions against all of the key quality outcomes outlined by CQC and delivers both quantitative and qualitative analysis. It creates an excellent platform for an embedded, robust QA system. 

Initial findings CMA study shouldn't make care providers feel persecuted.

Whilst referencing funding pressures in so far as they impact upon the market's ability to meet future demand, initial findings seem to focus more on short comings of care homes.  The findings highlight the following concerns:

  1. People are struggling to get the information they need to make informed decisions about care
  2. Complaints procedures are not functioning well
  3. Some care homes may not treat residents fairly and certain practices and contract terms may break consumer law
  4. The sector is not in a good position to attract the necessary investment needed to build for the future.

Looking in more detail, it's important that care providers don't get that sense of being persecuted. 

Yes, the buck stops with care providers in some areas. It's up to individual providers to engage with stakeholders to make sure that their complaints processes are transparent and robust. See 'Love Your Complaints'.  It's  a simple customer care principle.  

Plus if your care home is in breach of consumer law then that must be fixed; that is your individual responsibility; get your contracts assessed by specialist lawyers in the sector.

Care2Improve Surveys can help with these things. We target residents and relatives directly with structured questions; they help to elicit feelings of discontent, or a sense of not knowing how to complain; they also specifically ask about contract terms. They let you know so you can take action. 

But as for points 1 and 2, it is hard to see how a distributed market of diverse providers can take responsibility. 

The Care Act puts responsibilities for market information onto Local Authorities. Are they the organisations to have this? If you process map the care journey, it is the health sector which has all of the points of contact for individuals as they step further and further away from independence. This is where that body of knowledge needs to reside.

And as for finance and investment? A whole market overhaul is necessary, funding, of council rights and responsibilities, of central government responsibilities, tax and benefit structures if this old house isn't going to fall down. lets wait and see what the CMA does next? With Social Care high on the agenda, perhaps it won't do a Dilnott?

Congratulations to Poppy's Home Care Ltd. First 'Outstanding' Home Care provider in North Somerset

Huge congratulations to Alistair Milton and his staff at Poppy's Home Care Ltd for their recent 'Outstanding' CQC assessment. This is a remarkable achievement, the first in North Somerset, and Poppy's is now one of a very select group of home care providers to have been assessed as overall Outstanding!

Here at Care2Improve, we aren't surprised; as one of our very first clients; Alistair Milton's commitment to his clients and his staff, and his drive to constantly improve performance and maintain quality has always been very evident. His approach to our service has always been that it is part of his quality strategy, using it to provide essential performance feedback and also to support marketing and PR activity. 

The CQC report remarks on how well Poppy's involve staff and clients and how their feedback is acted upon.

'' People benefited from a provider who involved them in the running of the service and used their feedback to drive improvements. The provider was continually striving to improve whilst putting people at the heart of the service''

We were delighted to see that the report actually quotes the results of the Care2Improve independent surveys as evidence of quality:

''The independent survey questionnaire that was sent out in June 2016 contained a section with eight questions about treating people with dignity, respect and involving them in their care. We saw that 41 people and 5 relatives completed the survey. The overall satisfaction rate across all questions was 98%. When asked whether the carers were caring and compassionate there was 100% satisfaction. Again, when asked whether people were treated fairly regardless of age, race, and gender there was 100% satisfaction.''

We would also like to say Thank you to Alistair because he has supported Care2Improve over the years and has helped us to hone and develop our questionnaires, a testament to his commitment to quality and support.

Thanks too, to the team for their ongoing support for my own mother; they certainly pass the "Mum" test!

Congratulations again to Alistair and his team.

Is Integration a Costly Distraction?

Ashleigh McDougal (AM) of the National Audit Office said today that the Better Care Fund which aimed to deliver £0.5billion in savings had not delivered better outcomes, had not reduced hospital admissions nor reduced problems releasing patients back to the community, had not saved money. 

Is it then another doomed experiment? AM says No. That the 'direction of travel' is the right one but that integration takes time , that it is better to share information and work in an integrated way, but that this alone is not going to deliver the financial benefits anticipated, that expectations must be managed down, that other mechanisms need to be brought into play to resolve the immediate problems.

Niall Dickson CE of NHS Confederation confirmed this. Evidence from pilots are showing great improvements but that a lot is left to do. He cited the need to improve funding, to build up community services. He said that organisations needed to work differently and collaboratively to accept that patients move across services. These services therefore needed to think differently,  to avoid fragmentation. "We need a 21st century system to cope with the huge increases in demand..... There is a huge leadership issue.... " 

Skills For Care tell us that leadership is everyone's business, that it is individual operations working better at the margin, working better with colleagues and other agencies that deliver improvements. Care2Improve surveys tackle this; they ask the questions: How well do you work between agencies? How well is the service managed? Can you contribute and make improvements? Are there regular meetings? Are you motivated by your manager? 

You can give us a call to discuss how Care2Improve surveys can help your care business

Is the Care Market a Fair Market?

The Competition and Markets Authority study into the Care Market was launched in December 2016 : with a brief to examine consumer protection issues, ie contract terms, fees, services offered or withdrawn, contract protection;  explicitly NOT the quality of care.

The CMA press release has an implicit assumption that the Care Market can be described in traditional market terms of the relationship of supply and demand, purchasers and sellers, where relative quality and price be set by the market. The statement does not recognise the role of LAs as described by the Care Act.

Seventeen responses from interested organisations were uploaded in January; we looked at those from Age UK, Care England (CE) and the National Care Association,(NCA)  looking for the key themes and commonality.

The first and major theme that emerges from the responses we looked at is a sense of power differentials and a skewed market. The responses all implicitly underline the relative powerlessness of clients; their vulnerability and their need for stability and person centred care. They all cite underfunding as a major hamper to creating a healthy sustainable market.

The second theme is poor commissioning practice and behaviours, person centred care needs person centred commissioning and funding and this simply does not happen with commissioners lacking appropriate skills.

The third theme is poor and inadequate information available to clients about the local market, local provision, costs, top ups, contract terms; none of which is directly within the power of providers to influence.

There is a focus from two of the respondents on the importance of a robust complaints and feedback processes saying these elements that are within the control of providers and they need to be open, transparent and seen to be effective. Age UK claiming that used effectively, these can drive systemic improvement.


Knowing how hungry people are: Starvation in the midst of plenty

The words come from Florence Nightingale but are appropriate to recent findings highlighted in a post

"The HSCIC report of the Personal Social Services Adult Social Care Survey, England 2014-15 showed that whilst 64 %, that is 43,638 of the 68,185 people surveyed, felt that they had all the food and drink they wanted when they wanted it, ....... 1%, that is 681 people receiving social care, said that they did not always get enough food. This to the extent that they thought there was a risk to their health. Statistics can be made to say almost anything. And 1% in any survey might appear insignificant; 681 hungry people is not. "

The post goes on to talk about a person centred approach to the use of a dementia care map and the importance of paying attention to people who 'are no bother' because they will have needs that you won't see unless you pay attention. 

The Care2Improve surveys let care users whether at home or in a care home, and their relatives answer specific questions about their food, about their personalised care. They also ask staff specific questions about the quality of care they are enabled to give. The questions are all positive statements about what good care is; they don't just ask "Is care good?" they ask: 

  • Do I get enough to eat and drink
  • Is the food appropriate to my care plan
  • Is the care given appropriate to the care plan
  • Is hydration monitored

Care2Improve gives you detailed feedback about crucial issues because less than 100% in these areas mean that someone could be starving in the midst of plenty.

Is Social Media a Fair Way to Monitor Performance?

Apparently, social media will provide 'anecdotal evidence' of poor performance that could trigger assessment activity according to a BBC news item reporting that the CQC intend to monitor social media

Social media has a place in the world but surely it is not the place to garner substantive, factual feedback on which to manage business performance? A business can use it as part of a feedback mechanism for their business where they can have a degree of control over access and can moderate posts. But there are too  many examples of bogus postings, and malicious postings, where people can hide behind anonymity. 

The Local Government Ombudsman's recent annual review of care makes the point that providers should be using good feedback measures, should be encouraging feedback, complaints and all as mechanisms for learning. Surely CQC should be supporting this approach and not encouraging complaints via social media? 

Your thoughts?

Love Your Complaints

2014 - 2015 saw an 18% increase in the number of complaints to the Local Government Ombudsman about social care*. Horror!! Or is it?

Complaints are an opportunity to learn; they are an essential part of a feedback mechanism, so an increase could be indicative of improved feedback mechanisms rather than deteriorating service. The Ombudsman reports that 37% of complaints were referred directly back to the providers or commissioners because they hadn't had an opportunity to respond.

According to the Ombudsman, the learning points for the industry are:

  1. Tell your stakeholders how to raise a concern.
  2. Have an open and transparent, simple, clear complaints procedure, with stages and timescales for response.
  3. Tell your stakeholders where and how they can get redress; signpost them to the Local Government Ombudsman.
  4. Have an open door approach: if a complaint comes to you, even if it isn't your fault or your domain, deal with it. Contact the relevant people and try to coordinate a response; don't leave the end user trying to navigate a complex maze of multi agency support.

What is your complaints procedure? Feedback  mechanisms are our business; for help with managing stakeholder feedback, contact us on 

*LGO Annual Review of Adult Social Care Complaints, published November 2015. Reported in CMM Dec 2015.

Fair Price For Care: Do Local Authorities Get it Right?

The Care Act Programme Office (ADASS, DH & LGA) work in partnership to support the implementation of the Care Act. New duties in the Act say that the social care market must offer choice that delivers outcomes that improve well-being. The Act expects commissioning bodies to:

  •  Be cost effective: value for public money
  • Understand the costs of differing care and support
  • Understand the business environment and take actions that ensures market sustainability

Research indicates that this is a growing area of concern for local authorities given austerity and the financial imperative to save money set alongside the desire to provide excellent services.

It is certainly an area of concern for care providers. Care is not a homogeneous product; care users and care providers are infinitely diverse. Whilst there are common principles, the market relies on large numbers of smaller providers often offering niche services to small groups of people. The market is structured so that private businesses provide the service; private businesses can only continue if they see a return on investment. This pluralism needs to be nurtured if the well-being agenda is to be met.

The Chartered Institute for Public Finance have been commissioned to establish practical guidance too help. This is sorely necessary as new tendering and contracting frameworks are causing huge turbulence on the ground. They are asking for examples of good practice in costing and pricing that commissioners can share. Let's hope that new models have well-being at the heart of them, not a residual outcome after cost savings.

Delivering Integrated Care for Older People with Frailty

Care Talk, with the Kings Fund are hosting an exciting conference on 15th March looking at innovative ways to provide integrated health and social care to frail older people. This seems to be particularly relevant to the domiciliary care sector as we try to keep people at home and independent as long as possible.

As someone who is trying to coordinate integrated care for an elderly relative with multiple morbidities, I am keenly aware of the tensions between dignity and choice on one hand and keeping someone safe on the other.  I saw good integration in so far as the response in an acute episode was superb; the health care and social care has been excellent. Thereafter I have seen little evidence of integration and several examples of poor communication, one a visit from a social worker who knew nothing of the intervening activity resolving the acute health issue, and another where blood tests commissioned by the district team were not checked by the GP team. No criticism here, both teams have been superb, but clearly a communication and integration issue.

The day looks an exciting opportunity to share good practice and find useful ways to deal with this growing problem. The programme includes a presentation looking at ways in which the NHS are looking at new models of care and service redesign to embrace people with frailty. There is also a presentation around acute care for people with frailty. There will be presentations describing innovative new projects: a frailty pathway and the role of the voluntary sector; followed by an opportunity to work together in breakout streams and a closing panel session. I can't go but I certainly hope that the papers and outcomes from breakout sessions will be published. Innovation is certainly needed.