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!

NHS Learning set day

Yesterday I attended the 3rd plenary day of the NHS Learning set as we design products, that’s briefing papers to you and me on emerging best practice and what each group thinks about the Health and Well Being Boards.

The first session was with my Learning set B2 – Collaborative Leadership to discuss the day and who would be doing what, I agreed to man the stand for a stint, where I talked to cohorts members about the products we are developing around top tips for people from the former PCT s, for Doctors about Councillors and for Councillors about Doctors; sounds simply but a lot so hard work went into the design of what to say and what not to say from each side of the fence.

The opening plenary session was opened by Cllr. Gareth Bernard to give t that LGA link, I know Gareth from my early days as a Councillor when we were both on the Leadership Centre Next Generation Year 1 programme together. He was joined by John Wilderspin National Director of HWB Boards Implementation who I had a long chat with a couple of weeks previous at the Kinds Fund event looking at a self-assessment tool for HWB Boards. Next up was David Behan, Director General of Social Care, Local Government and Care Partnerships – Department of Health, what a title. I have met with David a couple of times when a group of us meet with him and Paul Burstow MP to lobby about the vital nature of the Dilnot proposals. It can be quite a small world somestimes!

David spoke about the learning that was emerging and one of the things that truly stuck in my mind was his comment that it would be easy for the HWB Boards to slip into a comfortable scrutiny place rather than the place where true reform and change is driven; It struck me  how very true this is and I have spoken of the need for Healthwatch and upper tier authority Health Scrutiny function to fulfil those roles and for the HWB Board to ban anything that looks remotely like it from their agenda’s!

The rest of the day was a string of workshop sessions about the learning across the county and it struck me that on each subject area there was a genuine desire to succeed and a common thread to effect real change. Not to just become another committee of the upper tier authority, this is the real challenge before us to actually redesign the most sensitive eco system in this country!, no small order at all.

The future of adult social care and support: a roundtable discussion

As a part of the Department of Health’s ‘Caring for our future’ engagement exercise yesterday I attended a conference to discuss the up and coming Social Care white paper with such leading lights as Lord Norman Warner who was a co-author of the Dilnot Proposals, David Behan CBE the Department of Health’s Director General of Social Care. and Paul Burstow MP the Care Minster amongst others.

Lord Warner opened and spoke of the need for structural reform to the NHS and Social Care.

When you think that in Suffolk the Health System spends more that £4.5Billion it puts into context the figures he quoted such as 75% of NHS spend is for those with long term medical needs and that over £50% of the total spend is in the Actue Hospital Sector.

Interestingly he spoke of the Kidderminster effect where an independent won a Parliamentary election seat about saving a hospital that should have shut as a part of structural change and how there is much that MPs and the public alike will need convincing off.

He went on to say that without fundamental reform you won’t get the financial services industry to come up with the insurance and financial planning products; nor integration of the Social Care and CHC care assessment and you won’t get true portability.

He concluded that “There isn’t really another structural show (Dilnot) in town”

In answer to a question about how to drive integration of Adult and Social Care Assessment he said that in his opinion you have to define what integration means in legislation to make Health Services engage.

Next up was Frances Patterson QC who spoke about the recommendations of the Law Commission Report and right on the middle was perhaps the most significant element of al before the Social Care bill, if it results in a new care assessment process and the bar is set too ‘low’ then the costs will frankly bust local government in a one swoop!

The David Behan shared some of the latest thinking about the Social Care white papers and In answer to a question about Health and Well Being Boards David Behan said people keep asking can we do it and we have said all along that you don’t need permission.

However it strikes me that in my experience we accept we don’t need permission but Health do they need it is writing in triplicate to do anything.

Next came round table discussions and David Behan sat in on my tables and I was able to expand on the Suffolk Flexicare approach to helping shape the Care and housing markets, As Caroline Tapster the Chief Executive of Hertfordshire was sitting next to me throughout the morning I did have to acknowledge that I somewhat shameless stole their initial work on replacing Sheltered Housing with Extra Care Housing and expanded on it to drive forward Suffolk Flexicare.

Then came a session with the Care Minster Paul Burstow MP and a number of searching questions were put to him including one from me about the need to have it legislated to allow monies to shift around the system if savings are made and that if this meant that Acute Hospitals wards closed as a result the Heath and Well Being Boards have a Leadership Role to play in explaining to Residents why this was a great step forward as a more intelligent spend of the systems monies rather than cuts. David Sprasons my fellow regional Chairman of the Lead Member Group form the Midlands made the point that if we could shift 1% of the money by making improvements to long term care needs, getting older people out of the acute Hospitals wards and into Residential Care with medical supervision, a far better place to rest and recover and find new ways to better support people and prevent them presenting to the Acute’s in the first place we could pay for all of Andrew Dilnot’s Proposals without any need for additional monies to come into the system.

In answer to both of these Paul Burstow welcomed the thoughts and said this was in part about creating the framework to allow these things to happen and he hoped the Social Care White Paper would address these points and it was in part about MP’s and the General Public understanding what we are about.

After the sandwich lunch we then had a meeting of the Chairmen of the Regional Networks to discuss the morning and action points we could take away to discuss with our respective MPS to lobby for the Changes the system needs, the changes older people need, the changes we all need.

Now just leaving to go back to London for the very first meeting of the National Learning sets ministerial launch event for Health and Well Being Board early implementers, as I am Suffolk’s lead on this, but more of that later.

Panorama last night – An Ageing Society

I thought the Joan Bakewell peice last night really got to the heart of the issues we, as a county face, in dealing with our aging population, clearly she understands the subject fully and what I though was very interesting is that she did not seek to present nayone route as the soultion to all our problems.

What pleased me most, if that is the right way of putting it, in all the issues around this difficult subject is the approach we are taking in Suffolk. Suffolk Flexicare has as one of its objects is to create an enviroment here in Suffolk where both private companies can come in and develop significant care villages and more local RSLs can build more and more Extra care albeit on a lesser scale but perhaps more routed in comunities.

We are also, through our Home First service, a national lead on re-enablement stratergies I recall going to a the first Department of Helth Conference on this about three years ago at the Oval, it was actually a bit boring because we were already doing the thinks they were talking about doing.

Today, Suffolk Home First  is such a success that those we provide it for, and we provide the service free to the people of Suffolk, we have over a third of people do not need an on going service. Simply put this saves the Council a considerable sum of money and is better for the customer as well.

The only thing I though that was not quite right last night was that beyond extra care a residential nursing home for those people you are very frail and for higher end dementia is most appropriate and serves an important function in our community. Unspoken was nursing care facility at the heart of the Extra Care Charity home in Birmingham, which on a smaller scale would not be achievable on site.

Provision of the right type of variety of housing, care and support that remains in place during these difficult times and the Royal Commission on how we pay for it all, is most timely or as Ms. Bakewell rather intimated that politicans talk and people just get older, we need to begin to reach conclusions and start implimenting policies now!

Unlike last time, just as with Labours redicous green, white and the staggeringly uncosted ‘Free Care at Home Bill’ we will not be seeking to make our voices heard on the front page of the Times, but rest assured in the background I know a number of Portfolio Holders are  trying to help influence policies for our aging residents that are of real benefit.

I look forward to David Behan and the Care Minister Paul Burstow MP presenting the findings of the Royal Commission and their thoughts but unlike the farcical situation of the lack of finanical figures, and the embrassed looking David Behan announcing dates that were constantly missed and deadlines disappearing that dogged Labours Care Green paper; this future paper will have figures attached so we can all clearly see how and who will need to pay for it.

Fingers crossed!

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