Serious Concerns and what we do about them

On Wednesday I attended Suffolk’s Health Scrutiny Committee meeting when we looked at the recent damming report by the Care Quality Commission (CQC) into the newly opened Mildenhall Lodge Care Home by Care UK. Of course if you’ve read my blog you know that the replacement for Suffolk’s very old and not fit for purpose care homes is something I led on in my time as Cabinet Member of Adult Care Services. So the report which followed an inspection 6 weeks after opening the first of 10 new Care Homes across Suffolk, in Mildenhall, was doubly disappointing given the work Suffolk put into finding them as a partner. Equally it’s bizarre given that they are investing £60 million into the new homes that they would fail to keep their eye on the ball sufficiently to deliver a quality of care in this the first, which of course should be, was promised to be and was commissioned to be commensurate with the quality of buildings they are delivering.

At the start of the agenda item, Care UK apologised unequivocally for their failing and it was welcomed, but the point was made to them in no uncertain terms that an apology without an action plan and proper implementation was…well just words.

A colleague on the committee demanded to know why the failing had taken place, I rather thought and then said the reading of the CQC report clearly indicated a common thread of low staff numbers and to be fair Care UK did seem to recognise this and were putting in place the sort of actions that were demanded of them and promised by them during the commissioning process we originally undertook. This was built on the back of the work I and my officers found during the initial thinking about the issue we had before us, namely the longitudinal study by Birmingham University as Birmingham City Council closed all of their 26 care homes and rather than re-provide into new facilities, they dispersed their residents to the existing private sector care homes in the city. The study looked at the most effective ways to help people move homes and how best to support those transitions.

The point about provider and commissioner is an important one I’ll comeback to in this blog. Across Suffolk far wider, that the small percentage of the private total market that Care UK represents and in the number of beds Suffolk provides for those who need a residential Care Home but are unable to provide for themselves. Suffolk County Council purchases (commissions) on the basis of good care and inspects to make sure good care is provided. No distinction is made and no excuses accepted.

During the course of the scrutiny a couple of things emerged. At the start of it we had a presentation from CQC about the robust nature of its new inspection regimes and I reflected on the difference between the organisation and the initial thoughts when the coalition government came in, I recall a meeting between myself and my officers with the then local CQC team announced they were moving from a full time care inspection organisation to more of a light touch registration organisation and beyond our shock as such a move, for our part we began thinking about how we needed to react to this with our own inspection regime and how we went about our working relationships with the Care Homes in Suffolk. From the presentation we saw the conclusion of a quiet transformation of that organisation into a sort of OFSTED for Care. Those of us who watch this sector closely of course know this has been happening over the past couple of years firstly with the surprise recruitment of David Behan the former Permanent Secretary to the Care Minister to tis CE role and the well-respected Andrea Sutcliffe to head up its care sector. All, I have to say, brought about by a Government that properly recognised the significance of the likes of the Panorama TV Programme’s shocking investigation into care and a concerted efforts of Local Government and other care organisations as reported in the national press, to seek to rise the issues of care standards up the national agenda.

What also emerged from the scrutiny was that this Tuesday, the second of Care UK new homes has a ‘stop to new admissions order’ instigated not by CQC but by Suffolk County Council’s own team, equally the original suspension of Mildenhall Lodge by the same team was before the CQC inspection. These are important points because despite officers informing the committee that the department was reviewing if it needs to have more people inspecting Suffolk Care Homes in addition to the CQC work, actually they did pick up the failings before CQC and the robust quality of the Suffolk County Council team working with care providers, despite the close relationship they have with Care UK as it replace the Council’s former homes, the relationship of commissioner and provider is in place and Suffolk County Council are already properly holding them to account.

Equally I was really proud to sit on the Health Scrutiny on Wednesday as it robustly did its job. Last week I was in Scunthorpe and one of the things I was tasked with doing was to meet with the Chairman of their Health Scrutiny Committee, as we considered as a part of the LGA Adult Safeguarding Peer review if we thought it was fit for purpose (which it is). Such important consideration follows on from the Francis Report into Mid-Staffordshire Hospital where one of the system failing highlighted was the lack of robustness of that County Council’s Health Scrutiny to ‘shine a light into dark corners’ and hold a provider to account, in that case, the NHS trust which failed to keep people safe in that hospital.

Of course we all want Care UK to just keep to their end of the bargain and deliver the quality care they promised. From the Health Scrutiny Committee point of view we have charged them and the department’s officers to keep us up to date on the action plan and its implementation that they have learnt their lessons and the opening of each new care home will go as we want it to and I know we all hope these actions can be of comfort to worried residents, loved ones and families as they transfer into their new home.

The CQC and the NHS

Poor Standards, cover-ups and scandal seem to be swirling around that most beloved institution, the NHS.

One of the most fascinating thing I have been involved in over the past few years is learning about this thing called the NHS, for it is not one thing but a vast collection of organisations often competing with itself and local government, it is extremely complex and ‘eats’, after welfare, more of our nation’s money than anything else and more than the entire cost of Defence, Local government, Home office costs and overseas aid put together.

The latest scandal is of course the Care Quality Commission (CQC) cover-up and its interesting watching David Behan, it’s new Chief Executive, a former local Government Director of Adult Social Services and latterly chief civil servant to successive Care Ministers deal with the political and public fall out. Somewhat less visible has been the organisation’s new chairman David Prior, which is a surprise given his political background, it’s interesting and such a small world that he lost his North Norfolk seat to one Norman Lamb in 2001 by just 483 votes, who of course is now the Care Minister.

I recall a few years back the reformed CHC coming to a meeting in Endeavour House, Ipswich and telling us of the scope and scale of the organisation going forward and how the new regime was about simple registration of Care Homes and Health organisations and how this process would ensure standards. I and officers left that meeting ‘gob-smacked’ at what was being proposed and perhaps what we are seeing today is a direct result of those decision taken then, in essence I think we have seen an organisation trying to step up but with extremely limited resources. I have met with David Behan on a number of occasions, particularly around the challenge of the Dilnot reforms and if anyone can move that organisation forward it is him, provided he is given the resources with which to do so.

Indeed if, and I have, you have ever read one of their reports it is clear that the process is far from robust and often anecdotal at best. There are some commentators who are saying that one regulator going forward who covers social care, primary care, dentistry and hospitals is ridiculous. I don’t agree with that but do say that what is ridiculous is the level of funding provided to carry out their function. To say they are thin on the ground would be something of an understatement, in Suffolk they have two part timers covering the whole system, a system that employs tens of thousands of people and spends a collective £1.5Billion. How do two part timers hope to meaningfully report.

So what we have is a swirling bubbling pot, add to the truly shocking Francis report about hospitals and the clear blueprint he proposes for change both in our hospitals, their accountability to patients and indeed the role of Local Government Scrutiny; next add in the new Healthwatch organisations and Health and Wellbeing boards and it is difficult to see what we will get, how do we create a robust system of monitoring and checking not only to make sure our hospital and health system is safe but actually drive forward improvements.

Sometime ago at the creation of Police Commissioners I blogged about the notion of Health Commissioners, the care and health system is vastly more complex than the police service, vastly more important to most people’s daily lives, collectively it spends, in Suffolk alone, about 1000% more than the police service and yet is for the main part at the local system level is essentially democratically unaccountable. I think to improve and move forward an important element must be meaningful local democratic accountability. I continue to pounder that a Health Commissioner would have the democratic mandate and accountability to pull all of this vast complex system together at a local level for the better. Mind you what a job!

Worth the wait – not!

So for the past three weeks there has been an  interesting exchange on blogs and twitter as we have questioned if the Lib Dems were going to bother to produce a manifesto or not for the Suffolk County Elections and finally yesterday 22 days to go they seemed to have cobbled something together.

Was it worth the wait – I think not!

Reading through it I struggle to find an actual policy, now I know Labour and we Tories both like to take the ‘mickey’ out of the Lib Dems about not being able to decide to have a cup of tea or coffee without forming a committee but what they have put up on their web site is unimpressive even for them.

I am going to do this first blog about the area which has been my honour to have the political responsibility for over the past 4 years – Health and Adult Care.

Their document at point number 2 starts with: ‘Appropriate Care provision, for all who need it’

Yes I quite agree with that and I sort of thought that was exactly what we are doing with our policy called ‘Supporting lives, Connecting Communities’ for which we have received national interest about the way we are involving communities in the design of our care services.

Next comes: ‘’Care’ has been the Cinderella service of this Tory council.’

Does that make me the fairy godmother or one of the ugly sisters! I get called many things so that’s OK but Conservatives have and will continue to focus resources and priority to protecting and supporting the most vulnerable in our society. Adult Social Care is the biggest single spend of the County Council, there is nothing ‘Cinderella’ about the service it is a serious business staffed by professional social workers who spend literally hundreds of millions of pounds here in Suffolk looking after the most vulnerable in our society. During the course of the past 4 years I have met many very vulnerable people and I have witnesses the professionalism and care exhibited by our social workers in supporting them.

Next we have their new catchphrase ‘enough is enough’.

This in many ways does sum up their so-called manifesto’s nebulous claptrap. Enough of what? 0% Council tax increases, ever more efficient services, I could go on……

Now to the ‘meat’ or lack of it, of their manifesto commitments on Health and Adult care:

‘Liberal Democrats will: Make sure the Tory divestment of our Care Homes does not produce a worse service’

This is of course an interesting one, they are not saying it will produce a worse service but merely implying it might – so let’s look at the facts.

Our 16 not fit for purpose care homes were transferred to Care UK had 526 beds in a total market place of 5,500 beds so we were a little under 10% of that market place. Care UK will be increasing the bed capacity to 638, a little over 10% of the total market, with a £60M investment in 10 new state of the art Care Homes. Adult social services supports 2,300 people in the private sector some 40% of the total market. So the facts of the matter is that the vast majority of those we support we have been supporting in the private sector for many years, this will continue. We have a long established relationship with private Care Homes both in terms of our working relationship with their trade Association, the latest of their meetings I attended just a couple of weeks ago, and through our social workers who support people when they are making the decisions about going into a residential Care Home, this will also continue. We will continue to work with private Care Homes and the Care Quality Commission to see the highest standards of care delivered here in Suffolk just as we have been doing.

‘Liberal Democrats will: Support Family Carers with fast, targeted, assistance, recognising they are the bedrock on which the county depends!’

Simply could not agree more that’s why we Conservatives have entered into a Strategic partnership with Suffolk Family Carers which means not only do we recognise that they are one of the bedrocks on which the county depends, it means we provide them with funding and they design the services to meet our jointly agreed outcome objectives of, you guessed it, faster, more targeted, assistance.

‘Liberal Democrats will: Scrutinise the impact of the Suffolk Circle and, work with local organisations to develop new ways to help vulnerable people.’

It seems extraordinary that of all the voluntary organisations we work with in Suffolk they have decided to scrutinise and pick on one in a manifesto. Firstly surely scrutiny is the role of the scrutiny committee, which recently has scrutinised Suffolk Circle, not a manifesto pledge which is meant to be about future policies; secondly, and more importantly I would suggest anyone have a look at the Suffolk Circle website www.suffolkcircle.org.uk to see the great things this not for profit organisation get involved with. They are one of literally hundreds of voluntary organisations that through our Conservative strategy are commissioned to provide support to those in our community who need it. And on the second point in this pledge I can only refer them back to our Supporting Lives, Connecting Communities policy which is agreed, approved and being implemented working with local organisations to develop new ways to help vulnerable people. please see http://www.thesuffolkcongress.org.uk/files/health-subgroup/2012-11-15%20Suffolk%20Adult%20Care%20presentation.PDF

The next two manifesto pledges I could not agree more and that’s why we are doing those very things. We recognise the links between education, transport, nutrition and health and we are delivering on the new public health responsibility of the council. From the public health documents that have been published and the recent Health and Wellbeing Strategy document again agreed, approved and being implemented. I have to say it’s quite bizarre to see your strategies being quoted in another party’s manifesto, of course again the implication is you are not doing those things and perhaps an inconvenient truth that we are, please see http://committeeminutes.suffolkcc.gov.uk/meeting.aspx?d=29/Jan/2013&c=The%20Cabinet then click Agenda item 8 -Appendix.

All in all, I have seen some weak opposition manifestos in my time, indeed I thought the Lib Dems 2009 one lacked substance but with this one they have truly surpassed themselves.

No wonder so many lib Dems are turning away from them, no wonder they can’t find enough people to stand in each seat and no wonder so many of their supporters are leaving to join the greens, at least they have actual pledges in their manifesto, however wacky.

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