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. 

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.

Recruitment and Care Worker Shortages

The monumental demographic changes that is seeing an inexorable rise in the numbers of old people and the equally inexorable rise in their need for care, means that the need for care workers is not going to slow down any time soon. And if, as a proportion of the population, the numbers of people in the work place is reducing, that isn't good news for recruitment in an industry that suffers from bad press and poor pay and conditions, particularly in some areas where unemployment is very low. Indeed, 'Skills for Care', the workforce development body for the sector says that recruitment and retention is the 'number one issue'. The problem is compounded by a 25.4% turnover rate in staffing in adult social care.

So what can be done? Some of the issues appear to be:

  1. The perception of the work as low value, unappreciated.
  2. The perception of the sector as a bit dodgy given the scandals that beset it.
  3. Perception of the work as badly paid with poor working conditions.
  4. The perception that there is no career path to be had, no training or transferable skills to be developed.
  5. Do care sector management have the right management and recruitment skills?

Care2Improve collects considerable feedback from stakeholders in the sector and can show that for the people receiving care and their families, the value of the care provided by social care workers is immeasurable. The number of Care Awards that are in place also testify to the fabulous work done by the army of carers. Hertfordshire Care Awards, Care and Support West in association with the local councils have an award system in place which has become the flagship of the organisation. 

Skills for Care are tackling the poor perceptions and have two schemes: the I Care Ambassadors scheme which allows enthusiastic front line staff to go out to colleges, schools, job centres and employment agencies to talk about and be an advocate for a career in adult social care. Their Social Care Commitment is an attempt to increase public confidence in the sector and to improve the quality of the workforce by getting providers to sign up to the "I will" commitment on key standards.

The quality of leadership and investment in staff in an organisation is a direct influence on the quality of staff and  turnover rates. In an industry where traditionally, people rise through the ranks and have a practical caring back ground, the level of traditional management skills may well be lacking and looking at experts outside the sector can bring in fresh thoughts about recruitment and retention. For example this humorous  blog from Talent Management and HR gives the Ten Best Ways to Lose Your Best Staff. Salutary information for any sector! Care2Improve can give the provider a good indication of how satisfied their staff and one of the critical indicators they use is whether the employee would recommend you as an employer.

There is no escaping that pay in the sector for front-line staff is poor in comparison to other areas, and the funding issue is not under discussion here, but personal satisfaction can be very high in care. Flipping burgers may pay more but it won't deliver that 'feel-good' factor and we all have stories of accomplished people finding huge satisfaction in helping others. (My mother in law's carer was a research chemist by training). Managers can increase job satisfaction in the way they structure the work, the way they enable and empower staff. 

Some councils  accept that they are part of the solution; schemes in place include Hertfordshire county council working with the Hertfordshire Care Providers Association on a Good Care Campaign and a Facebook campaign that linked to a recruitment site run by HCPA. Importantly they are providing funding, supported by the NHS, recognising the role of social care in prevention, to ensure working conditions are good and supporting failing providers. Oxfordshire county council are adapting the market structure, using direct intervention: a smaller number of providers, controlling conditions through contracts, adding training in Value Based Recruitment, implementing a health and social care apprenticeship scheme and a strategy for career development 

A pundit on a recent radio news program suggested that the immigrant crisis was good for Britain as it would refresh the workforce with much needed younger people. Research says that the sector is trying to recruit more older empathetic staff with more experience and we know that poor English leads to poor communication skills and older people find this difficult. So young immigrants may not be the  immediate panacea; they may help but there is a high training cost involved. 

Social Care Alphabet: Easy as A B C?

This little riff from the Guardian Social care network caught our eye:

A is for advocacy, B is for budget, C is for citizen...  it's the #SocialCareAlphabet! A list compiled by @clare_horton & @ruthhardy22 with suggestions from the social community, which together results in a funny, inspiring and thought-provoking A-Z of the sector. Read the full list here.

We particularly liked:

E = Evidence-based Approach

L = Listening & Learning

Q = Quality

T= Transformational


It''s definitely not as easy as ABC, but we can certainly help with the C = Compliance, D = Diagnosis, M = Management and S = Success in CQC inspections!


Independent Review or Heath Robinson-esque Tinkering

Amidst the funding problems of the living wage, auto enrolment and squeezed LA funding, a Guardian article predicts that a major care provider will fail in 2016 and that we could see the strange rebirth of directly provided social care as councils find themselves forced to act as provider of last resort. The article suggests that determined leadership is required and new models of health and care. 

At the same time we we see three former health ministers calling for an independent cross-party commission into Health and Social Care, supported in an open letter to David Cameron from more than 40 prime independent organisations in the sector.

Norman Lamb, Stephen Dorrell and Alan Milburn warn that more than 25% of the population will be over 65 years old in 20 years, more than 3 million people will be 85 or older and warn that some predict a £30bn funding gap by 2020. They call for an integrated review so that public services are more flexible, reliable and focused on preventing illness rather than resolving health crises. Taking evidence  from the public, health staff, and other interested parties they aim to propose a new funding settlement. 

The supporting organisations include luminaries such as Care England, MacMillan Cancer, Independent Age, Marie Curie, Mencap and the MS Society. They ask for a Health and Social Care System that is fit for purpose; they ask for bold, long term thinking about the size shape and scope of services and an honest debate about how we pay.

These are not new issues, integration and funding are the two main elements of current debate. But have we not had some independent review? Dilnot was accepted and then shelved? Is there a political will to take this forward and create something remarkable or will short term responses to problems result in a structure that is more Heath Robinson than fit for purpose?

But.. being optimistic, assuming a commission goes ahead, what would you tell them? What evidence would you give? What suggestions would you put forward? Let us know!  


Will your staff tell you the truth?

At a hearing last week, a care worker from Fraserburgh was facing a ban from working in the profession primarily for lying about an incident of poor care, prompting a social media discussion about how you can ensure your staff tell you the whole truth.

Would registration of staff be the answer? Would mandatory signature on a Duty of Candour form do the trick? People ask about the role of the manager here and what about other people? Had they not seen the incident in question? Why did they not highlight the issue?

So what is the answer? It's a complex question with more than one answer. There are two critical issues here: leadership and feedback. 

Strong leadership, with a balance between a 'no blame' culture and an expectation that people will always do their best in a caring and compassionate way, will engender a sound environment where people know what is expected of them, where they can reveal problems or issues without fear. People need to know that feedback will be treated with respect and acted upon. A signature on a document as part of a solid induction could help build that confidence but without that leadership fillip, then it won't make people tell the truth. 

Evidence of activity can be generated in a number of ways; essentially the care provider needs a robust performance quality feedback loop. There are many ways to do this: NHS Choices, or the new Trip Advisor style website launched by the government; you can use CCTV surveillance, peer reviews,  forums, focus groups, stakeholder surveys. A care provider needs both instant 'crisis' feedback and longer term 'benchmark' feedback. They need measurable information and they need insights. More importantly, they need confidence that the feedback they get is honest.

Care2Improve won't give you the instant crisis feedback and it won't give you the insights delivered by focus groups. What it will give you is a process that actively solicits feedback from a wide population that includes your staff and your service users. Care2Improve gives you a dashboard of useful metrics and themed qualitative comments. What's more important in the context of truth, as an independent service with anonymous responses, care providers can have the confidence that the feedback is honest. 

And even more importantly, by using a process like Care2Improve as an integral part of a management cycle, by sharing the results and by getting buy in to the action plans it generates, care providers embed a sense of leadership and honesty into the culture of the business.

QSBD: What to do if you are faced with a Special Measures order

QSBD Solicitors A practical perspective on CQC Inspections and Enforcements was introduced by Mei-Ling Huang. Highlighting the business impact of a poor inspection, Mei-Ling suggested that providers should

Prepare thoroughly:

  • PIR is essential. prepare well and keep a copy.
  • Prepare an information pack with all your evidence against the assessment criteria
  • prepare your staff so that they answer with confidence about the standards and their role
  • Try "Mock Inspections" to remove the fear factor. (Care & Support West have an Independent Service Review Template that can help with this)

Seek legal help if:

  • a draft report is not accurate
  • you are on the 'cusp' of a rating
  • you have any 'inadequate' ratings
  • you receive a warning notice, notice of proposal to cancel registration, or notice about special measures.

Manage any judgements / enforcement notices proactively

  • seek help
  • assess the judgement against reality: look for uncorroborated hearsay and ensure that the assessor has evidence to support conclusions
  • gather evidence to refute judgement
  • prepare an action plan for improvement
  • manage your approach to CQC staff: DON'T get angry and defensive