When I published my Care Home Review in November 2014, I set out six Requirements for Action for Care Home Providers to improve the quality of life and care of older people living in care homes in Wales.
In analysing responses from Providers, I was looking for evidence that would provide me with assurance that the change that older people living in care homes want and need to see will be delivered.
Overall I have been pleased with the level of engagement from many providers, who have clearly taken time and put thought into their responses to me.
Many care home providers have assured me that they will take the action needed to improve the quality of life and care of older people living in care homes.
Responses to a number of my Requirements for Action (RfA) from these providers were particularly positive:
RfA 1.2 – Welcome Pack – all older people receive a standard ‘Welcome Pack’ upon arrival in a care home that states how the care home manager and owner will ensure that their needs are met, their rights are upheld and they have the best possible quality of life.
RfA 3.2 – Dementia Training – all care home employees undertake basic dementia training as part of their induction and all care staff and care home managers undertake further dementia training on an on-going basis as part of their skills and competency development.
RfA 3.3 - Befriending – older people will be supported to retain their existing friendships and have meaningful social and/or cultural contact, both within and outside the care home.
RfA 5.5 – Dementia Champions – all care homes must have at least one member of staff who is a dementia champion.
These providers have a shown a real commitment to delivering the change needed, not only providing detailed information through their responses, but also by attending the good practice seminars I have held in partnership with other key organisations working within the care home sector.
However, I am disappointed that a number of Providers did not fully engage with the Review process: some providers did not respond, while others did not provide further information when requested. I therefore cannot be assured that these providers will deliver the change that older people living in care homes want and need to see. It is important to note that this is not a reflection on the standards of care provided. My Review did not look at the standards of care provided against the National Minimum Standards as this is the role of the regulator and inspector of social care in Wales (CSSIW).
Despite the good practice I saw, my analysis shows that there are clearly areas where further work and support is needed if the outcomes of my Review are to be delivered. This does not take away from the commitment amongst many Providers to continually improve, but demonstrates the scale of the challenge ahead.
To support Care Home Providers to deliver the change required, I have delivered good practice and learning seminars throughout Wales, in partnership with key organisations such as My Home Life Cymru and Care Council for Wales.
The seminars, which included presentations from experts working in the care home sector and a number of workshop sessions, allowed Providers to learn more about key themes including dementia, listening to residents and staffing.
The seminars were attended by hundreds of Care Home Providers who are clearly committed to making a difference to older people’s lives. This commitment was demonstrated by the pledges made during the seminars, which included promises such as:
"To recognise, publicise and encourage the ‘little things’ that matter in Care Home settings for staff, residents & families i.e. simple/kind gestures, acts of kindness."
"To develop life, love and laughter becoming the care in creating our organisation and staff to care about people each and every day."
"To provide the framework and support to allow our residents to lead a full and rewarding life that they are in control of."
"To make at least 5 people smile each day."
I will continue to work with a wide range of organisations, such as the RCN, Royal Pharmaceutical Society and Care Forum Wales, as well as with care home providers directly, to continue to grow our thinking, knowledge and good practice. In addition, I will continue to share the learning from my Review and associated work with statutory organisations and professional bodies to support them in playing their role in delivering the outcomes I expect to see.
Public Bodies Delivering Improvements for Older People
My statement today is also an opportunity for me to reflect upon the improvements delivered by public bodies across Wales since the publication of my Care Home Review Report one year ago today.
I am pleased to note that Local Authorities and Health Boards have already provided me with examples of good practice that will underpin their delivery of my Requirements for Action.
For example, Blaenau Gwent County Borough Council has developed a questionnaire that will be distributed to care home employees in the Local Authority to assess current and future dementia training needs so that training can be organised to improve staff skills and competencies to ensure that the needs of residents living with dementia are fully understood and the care provided meets their needs.
Aneurin Bevan Health Board is looking to develop an innovative volunteer befriending scheme, working with the Soldiers, Sailors, Airmen and Families Association (SSAFA) and the Police Coordinator for Police Cadet Volunteering to provide befrienders to older veterans and retired police officers living in care homes. Whilst still in its early stages, this initiative has real potential not only to tackle loneliness and isolation – which is a significant issue within many care homes – but also to create stronger links between different generations.
Hywel Dda University Health Board has recently commenced the delivery of comprehensive Oral Health Training to staff working within care home settings, with Oral Health Champions being identified in all care homes who will have extra training and resources so they can train new members of staff. Each home will be provided with a Resource Box that includes oral hygiene resources along with documentation to meet national requirements and the Health Board will undertake 2 annual Quality Assurance Visits, reporting outcomes to Dental Quality and Safety Group. There will also be the facility for a visit from the Dental Clinical Team to provide treatment where possible and sign post to other Dental Services, with Clinical Sessions being allocated to Dentists and DCPs within the Community Dental Service.
Welsh Government Response
I am unable to provide a further update in respect of my assurance around the Requirements for Action allocated to the Welsh Government as they have not provided further information in respect of the action they have underway or planned to deliver the change required.
I have written to the Minister expressing my disappointment and indicating my continued willingness to provide both advice and support, where appropriate, in the taking forward of the required action.
In August, I made clear my intention to undertake a follow-up review in 18 months’ time to ensure that the action promised by public bodies and Care Home Providers is underway – essential to deliver the outcomes for older people that were set out in my Review report.
The follow-up review will be structured around the quality of life model included in my Framework for Action 2013-17 and will be looking for evidence that the action underway across Wales is ensuring that older people living in care homes:
- Can do the things that matter to them
- Feel safe and listened to, valued and respected
- Live in a place that suits them and their lives
- Can get the help that they need
As part of this Review, I will also be looking for evidence that a national plan is in place to ensure the future supply of high quality care homes and that Wales has the right care home staff, with the right skills, to deliver the best care possible to older people.
In the interim, alongside my work to share knowledge and good practice, I will be meeting with the statutory bodies subject to my Review so they can provide me with updates on the action they are taking to deliver the outcomes set out in my Review.
As Commissioner, I have been clear that my Review is fundamentally about the lives that people lead in the place that they should be able to call home. Whilst accountability to improve practice and support people’s right to a good quality of life sits with the bodies subject to my Review, I will continue to support them to improve our care home system, growing their knowledge and understanding, and highlighting good practice that can be rolled out more widely to ensure that older people living in care homes in Wales can have the best possible quality of life.