In the shoes of … Mike Ewins | working for a Local Authority on improving quality and safety in residential care

“One question we plan to include is to ask homes to identify the numbers of their residents who have no external visitors or contacts”
Great idea, Birmingham!!

I am excited returning today to our “in my shoes” series, looking at dementia from different perspectives. I see the blog as a big jigsaw and we are slowly finding the pieces and seeing how it all fits together. Today felt like finding a corner piece… safeguarding.

I love the randomness of the series – I think the posh word is organic, but it was certainly random when I got chatting with Mike Ewins at a recent workshop Anna Geyer (New Possibilities) and I ran together in  Birmingham. As Birmingham City Council is the biggest council in Europe and I have struggled to get a post fom a council (too busy!), I thought Mike would be another great “first time blogger” and he kindly agreed. Birmingham is also a Think Local, Act Personal (TLAP) ‘Making It Real’ site for personalisation and I am working closely with this programme developing an electronic version of the Whose Shoes? board game, so an exellent link.

Quality is an issue at the forefront of everyone’s minds, especially as Austerity pulls in her belt another couple of notches.  There are some probing questions on Twitter at the moment and I’m hoping people will also comment on  this blog. So many thanks, Mike, – as so often in life, it is the really busy people who make the time to share…

My work with Birmingham City Council includes monitoring the safety and quality of residential care that we purchase for citizens who need it, including many people with a dementia.

I’ve been reading the Winterbourne View Special Case Review to try to get my head round how public money ended up being used to fund the (very expensive) torture of extremely vulnerable people. Just like most Child Protection disasters, it is a story of missed opportunity and poor communication. Almost more chilling than the direct physical and emotional abuse of the residents was the way that their channels of communication with the outside world were systematically cut off. Family members, advocates and other professionals were kept away from their rooms and their living space, and when one resident rang the police asking for help, a member of staff took the phone off them and persuaded the police there was no need to attend!

Winterbourne View is a story of people with communication problems using their behaviour to indicate their feelings of unhappiness about the poor care they were receiving. In response they were restrained and medicated. Nobody seems to have tried to understand them or communicate with their families and friends who might have been able to interpret their behaviour.

Although the Care Quality Commission have the ultimate responsibility to regulate residential care, Local Authorities must know what is happening to the citizens whose care they are paying for, and to others who are funding their own care. In Birmingham, we are trying to get a better picture of the safety and quality of residential care in our area. We’ve been developing a set of self-assessment questions to be asked quarterly of all the Care Homes we do business with and which Birmingham citizens use. The hard bit is to decide on the key questions that will tell us useful things about resident’s experience of life in a care home.

One question we plan to include is to ask homes to identify the numbers of their residents who have no external visitors or contacts. We think this is important information because people with dementia who are living in residential care rely, just like people with a learning disability, on staff understanding their wishes, preferences & behaviours. In many homes, this will be done effectively and well by staff who are sensitive and considerate. But even in the best run homes, poor practice or even worse can lurk. An important fall-back protection is the contact the resident has with a family member or friend who knows them well, and knows how they react when something is wrong. Many residents will have the protection of this contact, but some won’t. Anyone with dementia living in a residential care who has no regular contact with a friend or family member ought to be considered as potentially highly vulnerable, and identified as such, both by the home and by the Council.

We hope that asking the question will encourage homes to identify those residents who don’t have an external contact, and, where possible, take steps to develop contacts for them – maybe through local advocacy groups or organisations, or building on any involvement the resident may have with people from external organisations visiting the home (for the purposes of faith, music, exercise or other activity). Where we identify good practice in this area, we will recognise and promote it. Data we collect from this question will also help us to understand the numbers of people in this particularly vulnerable situation and to look at what else we can do to protect them.

Sadly, the very next day after Mike’s blogpost was published, a shocking story hit the headlines: Abusive Pontefract care home workers caught on CCTV

Mike contacted us to add the following comment:

“I’m sure you will have seen this news item from yesterday  – I think it illustrates the point I was trying to make – Ivy’s family knew something was wrong even though she couldn’t tell them – interesting comment from the provider that they were shocked at what had
happened because the staff involved were well trained and experienced. The
home’s management and oversight hadn’t picked anything up. If Ivy hadn’t had
visitors she would have remained in danger”


About Gill Phillips - Whose Shoes?

Passionate about personalisation in health & social care. Creator of Whose Shoes? - an imaginative approach to helping people work together to improve lives.
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11 Responses to In the shoes of … Mike Ewins | working for a Local Authority on improving quality and safety in residential care

  1. Very good idea to highlight how much external contact people have. Generally residents fair better with input of loving, supportive family who are pro-active and have their best interests at heart. Sadly many people do not have families/friends involved, and they are undoubtedly more vulnerable, do not have the same quality of life due to more limited interaction, and are more at risk of poor care practices. However, having families involved still does not guarantee that a resident will be well cared for – in the last year of my father’s life he had no care review, and in the last months, care plans were made without any consultation with us, and directly against our expressed wishes. So even with families involved, bad management can still cause immense damage to a resident’s health and wellbeing. Care homes need very careful monitoring, and to be kept ‘on their toes’ with new and innovative ways to assess the quality of the care they provide and the quality of the lives of their residents as a result.


  2. begethers says:

    Many thanks for this blog. My own sense is that we continue to ‘look through the wrong end of the telescope’ in thinking about care (compliance) and that we must bring our focus more fully to compassion. Family and friends are not ‘external’ – they are what make us whole, they give us our sense that we matter, that we belong. Family life must be integral to the way we think about care giving. Families should not be viewed as visitors but instead as care leaders and care partners – the role of the care staff is to listen to the experts – those who love and care deeply about the well being of mum or dad, husband or wife. In my experience family members in care homes very often take on an informal including and advocating role for other residents who perhaps are not as connected to their families. I think we need to begin to integrate the best of person centred care into a ‘family and community’ centred model. Many thanks Andy, Frameworks 4 Change


  3. Whose Shoes? says:

    Thank you for your comments, Beth and Andy – thoughtful and pertinent, as always.
    Recommendation to readers: check out Beth and Andy’s own blogs and also their “in my shoes” posts in this series.

    Particularly relevant to this “safeguarding” post:
    Beth has just written about complaints:
    Andy has just written about moving from compliance to compassion:


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  5. That is an excellent and simple question that reveals so much. Every person in care should have at least one defined and named advocate if they wish or if they have a PoA in place.

    One thing on my mind is accountability to the wider community. Why do care homes not have the equivalent of governors that schools have?


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