Making a difference

Andrea Sutcliffe, Chief Inspector of Adult Social Care at the Care Quality Commission

This week the Chancellor will make his Autumn Statement. I don’t know what he will say but I hope he has heard the multitude of voices highlighting the pressure in adult social care — not least our own in the State of Care report. We warned that adult social care is approaching a tipping point — with increased demand, limited resources and a lack of resilience within the sector impacting on the quality of care and the quality of life for people dependent on that care.

Poor care

But it’s not just about the money — what we do with the resources we have matters too. On Monday evening we witnessed yet again poor care that no-one should ever experience. The Panorama footage was not shared with CQC in advance so I watched like everyone else. It was distressing. Two moments in particular made me despair — the nurse dismissing a resident as “not right in the head” and using morphine to inappropriately manage her distress; and the utter lack of humanity displayed by the care assistant refusing to hold the hand of a frightened, anxious woman dying of dementia who was crying out for help and scolding her for being naughty. How many of us shed a tear at that moment? That could have been your Mum or mine. No-one should ever be treated like that.

Morleigh Group

Although we had not seen the footage, Panorama had raised their concerns with us, the Morleigh Group who runs the homes and Cornwall Council towards the end of October. The statement we released last Friday provides details about our previous inspections of these services and the action we have taken since we received the safeguarding concerns. In summary — these are services we have been worried about for some time; we had kept them under close scrutiny, inspected regularly and set out what they needed to do to improve through our reports and enforcement action. 
 
We had already inspected two of the Morleigh Group nursing homes immediately before we received information from Panorama and brought forward our planned inspections of the two where the filming took place. In all four we identified a serious decline in quality.

CQC Role

There is righteous anger directed at the Morleigh Group who bear the responsibility for this failure in care. But it is not unnatural when dreadful things happen in the sector, that the role of the regulator is subject to scrutiny too. People have questioned our actions with these services and the impact of our regulation in general.
 
As the regulator, we set clear expectations for how people should receive safe, effective, high-quality and compassionate care. CQC did not ignore the problems at the Morleigh Group, they were kept under close scrutiny and we responded to concerns raised with us. We worked hard to identify the problems the provider needed to address and with support from Cornwall Council and NHS Kernow, some improvements were made. But ultimately these improvements were not sustained and the failure of the owners to do so, despite support from Cornwall Council and NHS Kernow, has been appalling. CQC has a clear pathway to act and the path to the firm action we are now taking — like we do in other cases — had already started before Panorama shared their findings with us and reflects the significant deterioration in care we discovered.

Improvement

Our objective with the Morleigh Group had been to get them to improve their services and this is what we do across the country week in week out. There are a lot of good services with dedicated and caring staff but about a quarter of adult social care services are rated as Requires Improvement and a further 2% are Inadequate. In these services we are clear about the improvements that are required and we know that real improvements are being made by services. The figures were set out in the State of Care, as you can see here:

We also hear from people using services about the impact of our inspections — here’s an extract from a recent letter to an inspector:
 
 “I thought I should give you a resident’s viewpoint about what’s been happening here since the publication of your report. I think the initial response was a state of shock. For whatever reason I don’t believe senior management had realised how bad things had become here. Once recovering from that shock there has been nothing but constant effort to put things right everywhere…the effort has been impressive and enthusiastic…A real effort is being made to right the wrongs here and this would not have happened without your report.”
 
It can take a real effort to put things right but if providers are prepared to do that it can happen, as this blog from Steve Allen, Chief Executive of Friends of the Elderly shows.

Action

Where services are Inadequate and fail to improve, and people are at risk, we take enforcement action which can and has led to the closure of a service. This is not a decision we take lightly as residential and nursing homes are people’s homes — closure will lead to disruption and distress for them and their families. But I am clear, poor capacity is no capacity at all and when it is necessary to force or facilitate closure, we will do that. So far this year we have taken action to remove 110 adult social care providers from the register — all due to CQC initiating enforcement action and we are currently in the process of cancelling the registration of another 100 care homes nationally because they have failed to demonstrate sustainable improvements. 
 
But, however hard we work as the regulator (and we will), we are only one part of the solution to secure good quality care for everyone using adult social care services. Commissioners in local authorities and the NHS need to consider how their resources are being used to deliver quality and providers need to focus their efforts on the people they support, not cutting corners and doing the bare minimum.

Way forward

I am sorry that the people living in the nursing homes run by the Morleigh Group have been let down so badly by the service and treated so poorly. Their experience strengthens my resolve for CQC to be clear about our expectations, rigorously monitor services, conduct thorough inspections and take firm and fair action when necessary — to play our part in improving care. I know the team at CQC are committed to this too but we cannot do it alone. It’s time for all of us to focus on the needs of the people using adult social care services and make them the priority they ought to be.