Care Quality Commission Archives

Chance to feed into CQC review of the use of do not resuscitate decisions during COVID-19

Jan 052021

Copied from: Reviewing the use of do not resuscitate decisions during COVID-19 | Care Quality Commission (cqc.org.uk)

In October, the Department of Health and Social Care (DHSC) asked CQC to review how do not resuscitate orders were used during the COVID-19 pandemic, building on concerns that we reported earlier in the year.

Person-centred, advance care planning enables people to have conversations and make informed decisions about their future care and what matters most to them. Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders can be part of this planning and to allow people to make their wishes clearly known ahead of time.

Since the announcement we have been working with people who have experience of this issue to help shape our approach. The valuable insight shared by stakeholders, people who use services, and providers, means we can focus our attention on the things that matter to people.

What will the review look at?

By talking to a wide group of people with experience in this area, we have been able to hear examples of good practice and where decisions or processes do not appear to have been person-centred.

The review will take a national view of how these decisions were made in and across different types of services – including hospitals, GPs and care homes – using all the information available to us. By doing this it will inform national learning and support good practice development as the nation continues to respond to the pandemic.

It will include examples of best practice in this complex area, as well as times when procedures may not have always been followed so that any mistakes are learnt from.

How will the review be carried out?

We are currently analysing what we know so far from initial conversations with people who have been affected by this issue and other stakeholders, concerns raised with us, and the existing literature and guidance on this sensitive topic. Interim findings from this work will be reported later this year.

The interim findings will also provide a base for fieldwork that we will carry out in seven local Clinical Commissioning Groups across the country. This will focus (but not exclusively) on the experience of older people and people with a learning disability or autism. Doing this will allow us to explore how primary, secondary, social care and system partners have worked together in an area – including the impact of commissioning arrangements.

As well as taking into account the information shared with us, these CCGs have been selected to cover a cross-section of areas and a mix of demographics so that the lessons we learn will be of value to people in health and social care across the country, wherever they are working.

To look at a range of ways of working and experiences, the seven areas we will be looking at are:

NHS Birmingham and Solihull CCG
NHS Bristol and North Somerset CCG
NHS Cambridge and Peterborough CCG
NHS Morecambe Bay
NHS Sheffield
NHS South East London CCG with a focus on Greenwich
NHS Surrey Heartlands CCG with a focus on East Surrey

We expect to start fieldwork later in November and publish a final report in early 2021. We anticipate this will include recommendations on how people can be properly supported in this area and support good practice that protects people’s human rights.

How you can help

This work is being developed and carried out at pace during November, December and January. We are keen to hear from people who would like to share their experiences.

If you would like to tell us about your experience, or that of a loved one, we would be grateful if you could get in touch. Please let us know using our Give Feedback on Care service, or by contacting our National Customer Service Centre.

Survey on do not resucitate orders during the coronavirus pandemic

We’re using this survey to hear the experiences of people who have had a DNACPR or had one reviewed since the start of the pandemic in March. Share your experience of DNACPR.

Care Quality Commission lie about their competence

All Posts, Disability Rights, Social Model Comments Off

May 312012

With thanks to https://www.kingqueen.org.uk/archives/70

For letting us repost- pop over for some more brilliant stuff!

The Care Quality Commission (CQC) has come in for somewhat of a bashing recently. But I didn’t think they would lie as well.

In response to a recent documentary exposing care home abuse, CQC said the following in their media statement:

CQC carries out an unannounced inspection of every care and nursing home in England every year – more often if we believe people may be at risk. This system of regulation can and does identify poor care which CQC then takes action to tackle.

What?!

A quick look at the five care homes I’d stayed in in the last year revealed last inspection dates as follows:

Summer 2010 (in response to a specific incident, last “proper” inspection November 2007)
January 2009
November 2009
February 2011 (in response to specific allegations)
December 2009

Not one was inspected in the past 12 months. 0%.

Personal experience with looking for care homes for a relative confirmed the impression that most care homes have gone well beyond 12 months without an inspection.

I smelled a rat. So I asked CQC how many homes it had indeed inspected. The response came. Answering a slightly different question, CQC admit they did 13,082 inspections of care homes over the last 12 months. There are 17,756 care homes. So at least 26% of homes didn’t get inspected. I say “at least” as where CQC identifes problems at a care home they conduct more than one inspection. (hence why I think their FoI response is disingenuous.)

Let’s look at these once again.

“CQC carries out an unannounced inspection of every care and nursing home in England every year – more often if we believe people may be at risk.”
Of the 17,756 English care homes, CQC did 13,082 inspections over the last 12 months.

Is it me, or do the figures not add up?

Where did this come from?

The sad thing is we always knew CQC would be an appalling, incompetent mashup.

It was formed from a merger of the Healthcare Commission, the Commission for Social Care Inspection (CSCI) and the Mental Health Act Commission a couple of years ago. Having worked with CSCI, who were at least trying to do things right, me and other service users raised the concern that it would follow the sad precedent of the subjugation of disabled people’s rights following the Disability Rights Commission being subsumed into the Equality and Human Rights Commission. Sadly, we were right. Our concerns that social care would always be lower priority than healthcare were realised.

It didn’t help that the new body was given new, overarching registration standards. These same standards applied to all bodies registered – from acute hospitals, to dentists and care homes. The result being the emphasis on residents rights was lost, and the regulations simply weren’t specific enough for the situation. We lost rights in the change.

Then CQC sacked 70% of its inspectors so that it could register dentists. They adopted what they acknowledge as light touch regulation. They ceased grading care homes, and largely stopped inspecting them. The majority of care home reviews became based on self-declaration by care home managers. Inspections became very rare. Now, precisely which poorly performing care homes would state this to the regulator do you think?

Abuse

All this came to a head during the very sad and distressing Panorama documentary of the systemic abuse of people with learning difficulties at Winterbourne View. CQC became a very public whipping boy, held accountable for a lot of what happened. Much criticism resulted, including a select committee and the PM criticisng CQC for reducing inspections. Many made a comparison with the seminal Silent Minority documentary exposing the “care” of people with learning difficulties in institutions in the early 1980s. (Documentary available to view online – very distressing too.)

Meanwhile, there’s been blood on the carpet and accusations of gagging orders on staff etc. CQC has become a toxic brand. It’s been desperately attempting to reinvent itself, so far (in my view) failing miserably.

Consequences

If it wasn’t so serious, this would be funny. The reality is, though, that people are suffering as a result of this disgusting shambles. Care home residents are some of the most vulnerable, most disadvantaged, most disempowered people in this country. Abuse is the norm, not the exception in my experience; it just varies in degree. Without an effective regulator, the thousands of people in care homes up and down the country suffer even more abuse, poor treatment, curtailment of life opportunities.

CQC are ineffective, stuffed up, an ineffective regulator who lie about themselves to try and stop the torrent of legitimate criticism aimed their way. They are beyond redemption and need replacing.

(With grateful thanks as always to the wonderful Crippen for his inciteful cartoon

Open Letter to Minister for Disabled People – Winterbourne View Hospital

Letters 5 Responses »

Jun 022011

An open letter to the Minister for Disabled People, Maria Miller, from the Acting Chair of the United Kingdom Disabled Peoples Council, Julie Newman.

Source: UKDPC website

Dear Minister,

I have just seen the BBC Panorama investigation into the abuse that was inflicted upon residents of a privately run ‘hospital’, Winterbourne View Hospital for People with Learning Difficulties. It was with horror that I watched the investigation unfold, and the systematic bullying and assaults that were inflicted by the staff members.

Aside from the appalling treatment that was portrayed, there were interviews with the Regional Director of the Care Quality Commission (CQC) responsible for that area and it was clear from these that the CQC is unfit for purpose. I was shocked to hear of the lapses that had occurred on the part of the CQC after the situation had been reported to them on more than one occasion by a former member of staff. It is unthinkable that this was not progressed and acted on to ensure that such treatment was stopped and the perpetrators brought to justice.

The CQC were portrayed as inept and incapable of responding fully to the questions that were directed to them about the events at Winterbourne View, and it is clear from this that similar situations will currently be occurring across the country. In the body of the Draft UK Initial Report on the UNCRDP, paragraph 119, the CQC is referred to as the independent regulator with powers of enforcement, and as such they carry a duty of care. While it was stated by the CQC that mistakes had been made, there was no indication of how they had been investigated and what actions followed. Although the details of criminal investigations would be respected as confidential, there was no stated revision of practice or operational review to ensure this could not be repeated. UKDPC would like to know what measures will be taken to address these questions.

The damage that has been inflicted on the recipients of this ‘care’ will be immeasurable in relation to their future wellbeing. Systematic abuse and stated ‘torture’ is documented as leading to Post Traumatic Stress Disorder and this is not recorded as being diminished in People with Learning Difficulties; indeed, it may be exacerbated. As a former mental health professional myself, I can assure you that the long-term effects of the abuse on the Winterbourne residents will not be remedied by simply rehousing them without specialist intervention.

The programme was not clear about what support was made available at the time. Nor do there appear to be any national guidelines about what support should be put in place following the discovery of such barbaric treatment, despite this being far from the first time that abuse on this level has been uncovered within a residential care setting. UKDPC would like to know what measures have been put into place for the residents to have access to appropriate support, and what plans there are for national guidance for future situations?

We would also like to know why the Expert Inspectors – people with learning difficulties and direct experience of social care – who had been trained under the Commission for Social Care Inspection (CSCI) have not been retained and their employment in undertaking inspections has not been extended. The CSCI Experts by Experience groups clearly identified that disabled people would not disclose the reality of their lives within residential care unless they could speak directly to other disabled people about these. The Panorama programme also illustrates the fact that, even when disabled people do disclose abuse, many professionals and family members fail to believe them and take appropriate action.

Article 15 of the UN Convention on the Rights of Disabled People states that disabled people should not be subjected to torture or to cruel, inhuman or degrading treatment or punishment. These rights are also enshrined in the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. The Panorama programme clearly showed that the Convention was being breached on a daily basis at Winterbourne View.

The Draft UK Initial Report paragraphs 134 and 135 state clearly that disabled people have the rights to exercise choice and control to live independently. It speaks in some detail of how this is exercised and how involvement in the development and design of services are key elements towards inclusion in society.

Additionally, Article 19 of the CRDP supports the rights of people to live independently in the community, and as you are aware the UK has ratified this without reservation. This does not exclude People with Learning Difficulties. Within the body of the BBC programme, an expert in the field stated there was no reason why the people featured could not live within the community with appropriate support. These locked wards and ‘hospitals’ have no place in our modern day society.

However, local authorities are actually appearing to opt for more placements into ‘residential care’ settings which are very similar in role and function to the institutions of old. These places are deemed attractive in relation to budget balancing, as they are funded through the NHS not local authorities due to institutions such as Winterbourne View being categorised as ‘hospitals’. UKDPC strongly urges the Minister to initiate an immediate review and to consult actively with disabled people’s organisations to move towards the closure of these institutions as quickly as possible.

I look forward to hearing from you shortly.

Yours sincerely,

Julie Newman, Acting Chair, UKDPC