Earlier in the week, there was a very popular guest blog from Mike Ewins, talking about practical ways in which Birmingham City Council is monitoring the safety and quality of residential care that BCC purchases for citizens who need it, including many people with dementia. As this is such an important and topical issue that all #dementiachallengers want to see improved, we invited Alan Rosenbach to write a guest post …… as you do! 🙂
Sincere thanks to Alan for responding so quickly and with such an interesting, informative contribution to our “in my shoes” series…
Care and support for people living with the dementia: the CQC role and contribution by regulation of providers of care
Ageing is something that must be celebrated, as we are all of us living longer more productive lives, For the majority of us that means enjoying more of what life offers, more time with our families and friends and for me the trials and tribulations of being an Arsenal supporter. Basically we can enjoy more of the things that make life what it is. However, as people live longer and our population ages, dementia is one of the most important issues we face in our society. Although the risk of developing dementia rises with age, it is not a natural, automatic part of ageing and it must be remembered that a significant number of younger adults develop dementia earlier in life.
The Care Quality Commission (CQC) is the regulator for all registered health and social care providers in England and has a distinctive and unique role to play. Providers of care registered by the Commission are subject to the essential standards of safety and quality which we inspect against.
We know that people living with dementia are more likely to require a range of support and care from across health and social care services as their needs change over time. It is estimated that around 66% of people in care homes in the UK are living with dementia, and that at any one time 40% of people in hospitals have dementia. Most people living with dementia live in their own homes cared for by family and supported by regulated home care services.
CQC is now committed to carrying out at least one unannounced annualised inspection of all care homes, NHS providers, and Independent Hospital Services. We are currently delivering a programme of themed inspections for home care services.
Given this remit, our inspectors are not only crossing the threshold of dementia specific services but are inspecting a wide range of generic providers that people living with dementia are still likely to use. By April 2013 we will have registered all Primary Medical Services and so GP provision will be in our regulatory remit. Of course GPs are often the first point of contact for people concerned about their memory or other symptoms related to dementia.
Our inspections of care homes and hospitals focus on ensuring that providers are involving people living with dementia and their families in shaping their care needs, that they provide meaningful, appropriate and stimulating activity, that nutritional needs are being met, services are integrated around the needs of the individual and that people are appropriately safeguarded against abuse.
People living with dementia may be potentially at higher risk of various forms of abuse. Some of the main concerns regarding safeguarding include the unnecessary or over prescription of antipsychotic and sedative medication. Other forms of potential abuse include physical restraints such as furniture which can disable or restrain the free movement of the person. People living with dementia may also be more vulnerable to abuse by other people using the service, who may themselves have dementia or other complex needs.
CQC has, with the help of the Bradford University Dementia Group, developed and designed the short observational framework for inspection (SOFI 2) now in its second iteration to be used by inspectors specifically for gathering information about the person’s direct experience of the services they use, where that person would otherwise find it difficult to communicate verbally with our inspector. This can be a particularly valuable tool for gathering relevant evidence where people have difficulty with communicating because of their dementia.
And where we are carrying out themed inspections, such as with the home care services and the dignity and nutrition inspections of 500 care homes, we always include, where possible, an expert by experience and professional advisor as part of the team. The exception to this is the homecare themed inspections where the professional advisers are providing guidance and support rather than as a member of the inspection team. This approach to our work is described in the first dignity and nutrition inspections we undertook for care of older people in acute hospitals and with the recent inspections of 150 learning disability services across England. (Editor’s note: please see earlier post by Sheila Merriman about the importance of good nutrition)
Ultimately, the regulated providers of care services have a responsibility and duty to meet the needs of people living with dementia whom, as we know, can find themselves in some of the most vulnerable circumstances in the care system. Providers must make certain that they have the appropriate structures, processes and staff to oversee the delivery of caring, quality services. CQC will inspect the providers against the standards that the government has given us to work with and where we find care that falls short of those standards for people we will take the appropriate regulatory actions and enforcements.
Footnote: I’m sure readers will have seen the shocking news story about “Abusive Pontefract care home workers caught on CCTV” which appeared on Wednesday, the day after Mike Ewins’ blog. We have added a comment from Mike at the end of his blogpost if you’d like to take a look.