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| Hard times ahead for grey expectations |
The Care Quality Commission lacks ambition says BOB FERGUSON and this is putting those driving through improvements in the sector into reverse
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Caring Times, February 2010
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The physical standards produced for care homes have a depressing echo of days gone by, says Bob Ferguson So the commissars of the Care Quality Commission (CQC) have chickened out. For all their lofty rhetoric, they have set the bar for environmental standards so low that only a deep-sea diver could find it.
How can people who have a statutory duty to improve services settle for yesterday's benchmarks?
By cementing the second-rate into the system, they have guaranteed that the poorly served will always be with us.
The relative standing of physical standards within the overall provision of residential care has been debated ad infinitum. But no one can deny that the quality of the environment is a key element in a care home setting; it enhances privacy, dignity and general wellbeing.
In which case, should not a commitment to high quality apply equally to physical standards?
Adequacy is essential, but in this context an entitlement to adequacy is not enough. Yet that's all care home residents are being offered by the compliance guidance.
Granted, the yardsticks deal solely with 'essential safety and quality', but they also form the launch pad for future improvement, on this evidence, more damp squib than space rocket. For existing homes, the Commission has mined the past with all the enthusiasm of an antiquarian, recycling what should have been allowed to slip quietly into obscurity.
Bedrooms that scraped through in 2002 - including miniatures from long-ago - will still be acceptable this year, and conceivably forever.
And it's the same with new build, where the awesomely uninspiring minimum suggests regulators may have been seduced by the optimistic twaddle that predicts baby boomers will do their job for them and lick home owners into shape. Fat chance. In truth, the influence of individual choice as a force for the better has been greatly exaggerated, particularly by those in government.
A gift given only to private funders, it is restricted by what is available locally and can, in consequence, be meaningless. Inclination.
While council commissioners have the muscle to move mountains, they have shown scant inclination to push at the boundaries of quality in physical standards.
Most are content to take whatever they can get - particularly if the price is right or a bed-blocking fine is being waved under their nose. If, as seems likely, more and more people are going to come under their wing in future, demand side power, such as it is, will be in even worse shape.
Unlike care practice, the physical environment cannot readily be modified in response to consumer pressure. It is inelastic, a given.
As a result, progress in the sector is driven by new developments, reflecting the parameters set by the regulator. They put down the markers that, given sufficient spare capacity, existing homes must hit if they are to remain competitive.
That makes the Commission the key, and perhaps the only effective player. Yet this last man standing has declined the opportunity to press the case for real advancement, going along with a set of baseline standards that is a relic of historical compromises.
Even more damning since CQC is the first national care watchdog to be able to set its own calibration scale for assessing compliance with registration requirements.
For heaven's sake, there's not even a mention of en-suite facilities, notwithstanding the example set by the new generation of NHS hospitals, which, never forget, are temporary transit stops. Whatever happened to the Commission's duty to promote individual privacy and dignity?
Nor for that matter is there any recognition - not even in the myriad supporting publications listed under Outcome 10 - of the important role the physical environment can play in meeting the demands involved in looking after people with dementia in a residential home.
The broad expectations in the generic guidance have not been converted, as one might reasonably have expected, into explicit criteria for the residential variety of dementia care.
Those who look for expectations that are targeted specifically on the design of these settings will do so in vain; no references to features like colour, signage, and circulating space, which together create a physical environment that enables people to move around freely but safely, to live their lives with dementia.
In view of the sharp focus provided recently by the national dementia strategy, these are quite extraordinary omissions. The drafters' general failure to understand how measurements transfer from the page to a floor complete with furniture and all the paraphernalia of everyday living argues they have lost sight of a basic truth of residential care: that each room is someone's home, not simply a place for social care to be delivered.
They could have been so much more empathetic; no need to go as far as the plucky celebrities whose attempts at sampling the life experience of rough sleepers took them onto the streets, equipped only with cardboard duvets and HD-ready makeup. CQC had the power to take the vagaries of choice and commissioning out of the equation altogether by embedding a high-quality environment into the base of the system, enabling everyone - not just those with fat wallets - to enjoy it, as of right. Instead, its lack of ambition has put the dynamics of improvement in reverse, damning residents with faint-hearted entitlements.
In the military that would be called dereliction of duty. Barbara Young has already fallen on her sword for unconnected reasons. Cue firing squad for the rest.
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