The Care Quality Commission (CQC) has been accused by the Registered Nursing Home Association (RNHA) of making the solid progress achieved by nursing homes in meeting essential standards of care feel like a setback.
Commenting on the CQC’s latest State of Healthcare and Adult Social Care report, published last week, the RNHA’s chief executive officer, Frank Ursell, said he and his colleagues were vastly disappointed at the negative focus of the regulator’s public statements which, he claimed, risked demotivating tens of thousands of hard-working nursing home staff who strive round the clock to meet the needs of some of the country’s most vulnerable older people.
“Given that overall levels of compliance with care standards have risen year on year, it is difficult to comprehend why the CQC should pepper its press statement with negative after negative,” he said. “Were the CQC responsible for monitoring the performance of Premier League football clubs, I wouldn’t be surprised if they had only bad things to say about Southampton even if, in only that team’s second season in the ‘top flight’ of the sport, they went on to win the title.”
Drawing on data from within the full CQC report, Mr Ursell highlighted improvements which, according to inspection outcomes, nursing homes had made between 2011/12 and 2012/13 across five key areas of activity – a 6% improvement in safeguarding and safety; a 9% improvement in care and welfare; a 3% improvement in respect and dignity; a 6% improvement in the suitability of staffing; and a 4% improvement in monitoring quality.
“All of these findings are signs that nursing home performance is moving in the right direction,” said Mr Ursell. “Nationally, compliance with standards in these five areas is recorded at between 82% and 88%. Whilst there is clearly still room for further improvement, I would have expected some acknowledgement from the CQC that measurable progress had been achieved, rather than the doom and gloom story painted in its press release.
“All this has been achieved against the backdrop of a 2% real terms decrease in expenditure by councils on social care for adults and a reduction over the past five years in the proportion of adult social care spending on services for older people – a point buried away in the bowels of the main report but totally ignored in the CQC press release.”
He added: “In addition to the marked imbalance in CQC’s public pronouncements about its own report, there is a critical lack of contextual detail in the report itself. For example, it is perfectly possible that a particular nursing home could be found not to have complied with medication standards because, on a single day, a form had not been correctly filled in about a specific medication administered to an individual patient.
“Of course, the home should be striving for 100% perfection in its record-keeping, but with nursing home residents each receiving an average of about eight different medicines or drugs every day, it means that a home with 40 residents may be dealing with 320 medicines a day, over 2,000 per week and more than 8,000 per month. So let us please have a sense of perspective on some of these issues.”
Citing an example of the continuing efforts of nursing home owners and managers to drive up medicine management standards, Mr Ursell said the RNHA had been collaborating with several other organisations, including the Royal Pharmaceutical Society, the Royal College of GPs and the Royal College of Nursing, to develop a free resource pack for care homes on best practice.
This, Mr Ursell argued, underlined the commitment of nursing homes themselves to raising their game. But, he warned, it was dispiriting for the regulator to focus disproportionately on the bad news rather than the good. “We’d all like to see the CQC raising its game on this point,” he concluded. “At present it seems as though the regulator thinks finding fault with care providers wherever and whenever possible is a greater sign of its usefulness to its political masters than helping providers to achieve and maintain improvements in their services.”