Commissioner's Care Home Review Statement: Responses from Statutory Bodies
In November 2014, I published ‘A Place to Call Home?’ the findings of my year-long Review into the quality of life and care of older people living in care homes in Wales.
Whilst I found examples of great care and support being provided across Wales, and older people living in homes that truly lived up to the meaning of the word home, I also found that for too many older people their quality of life was unacceptable.
Alongside the publication of my Review report, I therefore wrote to all Local Authorities, Health Boards, CSSIW, Welsh Government, Care Council for Wales and care home providers outlining the action I expect to see taken to ensure that the best care and support I found becomes the standard for Wales. All of these bodies responded to me, detailing the action they would take to deliver the outcomes my Review focused on.
Through this statement I am today publishing my analysis, based on the evidence provided to me, and my assessment on whether the bodies who are subject to my Review will deliver the action allocated to them.
I am currently analysing the responses received from care home providers and I will make a statement in November that provides an overview of these responses, one year on from the publication of my Review Report.
Across Wales there was recognition that my Review report painted an accurate picture of life in care homes in Wales today. Despite my report making for hard reading, it was welcomed by all of the bodies subject to it and they gave a commitment to ensure that the outcomes and the changes that I called for were delivered.
Each body subject to my Review responded to specific Requirements for Action. In analysing their responses, my team looked for evidence that the outcomes included in those Requirements for Action would be delivered.
Local Authorities submitted clear information that has provided me with sufficient assurance that they are committed to meeting my Requirements for Action and delivering the intended outcomes by the deadlines stated. The majority of the responses to each Requirement for Action have been rated as acceptable, with no responses being rated as unacceptable. It is also positive to note that a number of Local Authorities submitted joint responses outlining how they will work in partnership with other Local Authorities and Health Boards to deliver the intended outcomes.
Responses to a number of my Requirements for Action (RfA) were particularly positive:
RfA 1.6 - Independent Advocacy – older people living in care homes that are closing as well as older people who are at risk of or are experiencing abuse will have access to independent or non-instructed advocacy.
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 6.7 - Annual Quality Statements – older people will have access to relevant and meaningful information about the quality of life and care provided by or within individual care homes, essential to create a more open and transparent system.
In a small number of cases, responses have been rated as partial, specifically in relation to dementia training (RfA 3.2) and using feedback from older people to drive continuous improvement (RfA 6.2). Feedback has therefore been provided that offers further guidance on how the Local Authorities can deliver the intended outcomes.
Health Boards have shown a genuine commitment to improving the provision of services, creating plans for change that provide me with sufficient assurance that they will meet my Requirements for Action and deliver the intended outcomes.
The majority of responses to each Requirement for Action have been rated as acceptable, with no responses being rated as unacceptable. It is also positive to note that a number of Health Boards submitted joint responses outlining how they will work in partnership with the Local Authorities in their area to deliver the intended outcomes.
Responses to a number of my Requirements for Action were particularly positive:
RfA 1.3 - Specialist Care Home Continence Support – older people will be better supported to maintain their continence and independent use of the toilet and have their privacy, dignity and respect accorded to them at all times.
RfA 3.5 - Information on the Use of Anti-psychotics – information will be published annually about the use of anti-psychotics in care homes, which can be used to ensure that people are not being prescribed anti-psychotic drugs inappropriately.
RfA 4.3 - Understanding Health Needs - care staff will understand the health needs of older people and when and how to access primary care and specialist services.
In a number of cases, responses have been rated as partial, specifically in relation to medication reviews (RfA 4.4), using feedback from older people to drive continuous improvement (RfA 6.2) and developing a nursing career pathway within care homes (RfA 7.3). Feedback has therefore been provided that offers further guidance on how the Health Boards can deliver the intended outcomes.
Care Council for Wales
Care Council for Wales has provided me with partial assurance that they will meet my Requirements for Action and deliver the intended outcomes by the deadlines stated as their responses were rated as either acceptable or partial. No response was rated as unacceptable.
Of the four Requirements for Action that the Care Council was subject to, two were rated as acceptable:
RfA 5.4 - mandatory induction and on-going training programme for care staff – improved induction and training will ensure that older people receive compassionate and dignified care that responds to them as an individual.
RfA 6.11 - national, competency based training programme for commissioners – older people will be placed in care homes that can meet their needs by commissioners who understand the complexities of delivering care and are able to challenge providers about unacceptable care of older people.
Two of the responses were rated as partial, specifically in relation to developing and implementing a programme to recruit and train future care home managers (RfA 5.1) and developing and implementing a standard set of mandatory skills and values based competencies for the recruitment of care staff (RfA 5.3). Feedback has therefore been provided that offers further guidance on how the Care Council can deliver the intended outcomes.
The response from CSSIW provided me with only limited assurance that they will meet my Requirements for Action and deliver the intended outcomes as their responses were rated as either partial or unacceptable.
Of the four Requirements for Action that CSSIW was subject to, three were rated as partial (RfA 1.5 - development of an explicit list of never events, RfA 6.2 - using feedback from older people to drive continuous improvement and RfA 6.9 – information about quality of life in the annual report) and one was rated as unacceptable (RfA 6.3 - using lay assessors as part of the inspection process.
Feedback has therefore been provided that offers further guidance on how CSSIW can deliver the intended outcomes.
The majority of responses by the Welsh Government to each of my Requirements for Action failed to provide adequate detail to assure me that the intended outcomes will be delivered.
The Welsh Government did demonstrate a commitment to developing a national approach to care planning (RfA 1.1), improving continence support in care homes (RfA 1.3), developing good practice guidance related to mealtimes and the dining experience (RfA 1.4) and developing new safeguarding arrangements that explicitly recognise emotional neglect as a form of abuse (RfA 3.6). However, it is extremely disappointing that of the 21 Requirements for Action that the Welsh Government was subject to, only these four responses were rated acceptable, with six rated partial and 11 rated as unacceptable.
Feedback has therefore been provided that offers further guidance on how the Welsh Government can deliver the intended outcomes.
The majority of the statutory bodies subject to my Review have provided me with the level of assurance I need that change will be delivered to meet the intended outcomes, clearly outlining the action they will take to improve the quality of life of older people living in care homes in Wales.
However, CSSIW and the Welsh Government have not provided me with the overall level of assurance I need and older people have a right to expect.
In my Review I made very clear the impact upon older people and the price paid by them if the required action is not implemented and the intended outcomes are not delivered. I am not prepared to see that price continue to be paid, nor should any of us in public service or our wider society.
I will stay focussed, for as long as required, on the delivery of this action and outcomes. Over the coming year, I will work in partnership with a range of professional bodies, key stakeholders and older people to continue to grow knowledge and share good practice across those areas where further improvements need to be made.
I will also undertake a further review in 18 months, which will be focussed on the outcomes I made explicit in my Review report. I will outline the scope and remit of my follow-up review in November, but it will again have the voices of older people at its heart. Through this follow-up scrutiny, I will be looking for evidence that the commitments given to me, reflected in this statement, have been translated into tangible and impactful improvements in the quality of people’s lives.
My Review was about people and the lives they lead, the value we place on those lives and the value we place as a nation on older people. My Review makes very clear the impact of failing to deliver systemic change and the price which is paid when failures occur. Those public bodies subject to my Review are accountable for the change that is required and through my on-going work I will hold them accountable to older people.