Healthcare Features
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- Written by: Sean Clement
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Regulatory action in the last 12 months led to the closure of 34 care homes and eight agencies providing care in people’s homes, the Care Quality Commission (CQC) has revealed.
Some 700 elderly people and younger adults with a disability were found alternative care homes as a result.
The CQC issued legal notices to close six of the services, while in the other cases the owners either shut down or sold their operation after the regulator’s enforcement action.
The Commission said its concerns had included:
- verbal and psychological abuse of residents
- medicines not being managed safely, leaving people at risk of not receiving vital medication
- lack of medical and nursing care
- staff not legally able to work in the country
- poor sanitary conditions
- lack of staff training
A further 51 services – including 39 care homes, 11 agencies providing care in people’s homes and one agency providing nursery care – closed voluntarily after they were handed a “poor” rating by the CQC. In these cases the CQC had demanded improvements but not taken enforcement action.
The watchdog stressed that the vast majority of the 24,000 services in England provide good care and are responsive to its recommendations for improvement.
The CQC’s new registration system – under the Health and Social Care Act 2008 – launches tomorrow (1 October), bringing with it new standards of quality and safety. All care homes must be registered with the commission from this date.
The Commission insisted that the new regime would be tougher on poor care. Its wider enforcement powers include on-the-spot fines, warning notices and suspension of registration, as well as prosecution and closure.
Cynthia Bower, CQC’s chief executive, said: “Standards across the sector are improving year-on-year, so people are getting better care than in the past. In order to keep this trend going, we need to address the worst services that just cannot or will not improve to an acceptable level. This is where we’ve been focusing our attention over the past year as we get the sector ready for a new registration system that will be even tougher when care is not up to scratch.”
She insisted that closing a care home was not a decision taken lightly, but said that, in some cases, the necessary improvements fail to materialise. “It becomes clear that the only way to properly protect residents is to close the home and move them to others where care is of a better standard,” Bower said.
The CQC chief executive warned that services where problems have been identified “can expect frequent inspections”.
The new registration system will bring the NHS, private healthcare and adult social care providers under the same inspection regime and standards for the first time. NHS trusts registered in April this year and private healthcare and adult social care will join from tomorrow.
Dentists and private ambulances will register from April 2011, while GPs will need to register from 2012.
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The 'Big Society' appears to offer great opportunities for the third sector to become more involved in the delivery of public services. However, it is in the early stages of its development by the coalition government and so far there is little detail to help boards plan their response. Ian Hempseed looks at what the Big Society will mean for the Third Sector.
We take the lead from the publication of the White Paper Equity and excellence: Liberating the NHS. This intends a plurality of providers in health by enabling commissioners to contract with the new concept of 'any willing provider' which could be a state, private or third sector enterprise. This is the time for third sector organisations to check that their business, governance and operational models are sufficiently robust to satisfy commissioners in what will be a competitive market.
'Localism' is likely to be a major driver in assessing 'willing providers', which raises its own challenges. National charities may need to show that they are already operating effectively in the locality and have the capability to engage with local stakeholders. On the other hand, the issue for some small local community organisations is that their business model and systems may never have been tested in delivering contracts, or contracts of the size which are to be commissioned. Whether there will be funds available to capacity build those organisations to make them fit for delivery could be a key concern.
Payment for services will be directed away from full cost recovery towards, especially in health, payment by results. Boards will need to watch how this concept develops. The concern would be that the contractual results are difficult to measure or can only be assessed a while after completion of the services and therefore, in addition to possible uncertainty of payment, this could create cash flow problems, particularly for smaller organisations which may not have the reserves or working capital to tide them over.
We can also take a lead from the proposed spin out from the public sector of new delivery organisations. The Department of Health has recently announced the second wave of 'Right to Request' where employees of Primary Care Trusts can request to set up a social enterprise to run public services. Also, on 12 August the Cabinet Office announced the first wave of public sector workers establishing 'John Lewis-style' employee-owned organisations to deliver public services. Boards of existing third sector organisations should be considering the implications. These new organisations could become their competitors.
However, in the immediate term there may be opportunities for existing organisations to provide support as the fledgling enterprises may need to fill skill gaps in management and business planning. Those organisations which have developed transportable models of governance, financial and accounting services, stakeholder engagement and specialist service delivery could offer a form of social franchising. In return for a fee, they could provide an agreed set of know-how and services under a brand with the recipient agreeing to adhere to quality standards.
The relationship could be expanded into a closer collaboration under which the franchisor could become a member of the organisation or make its expertise available through representatives on the board. Through closer collaboration, the franchisor might negotiate 'step-in' rights in exceptional circumstances of a serious service failure to ensure the viability of the franchisee and continuity of provision for users.
The NHS White Paper proposes consortia of GP practices commissioning on a statutory basis the great majority of NHS services. Many providers over the years will have built up good relations with managers at Primary Care Trusts. These new GP consortia will require legislation but in the meantime we strongly recommend that providers should be identifying and making contact with any Practice Based Commissioning Groups of GPs which have already been set up in their area. The new GP commissioning consortia will have a duty of public and patient involvement and therefore third sector organisations will have a key role to influence the design of services where GPs do not have the expertise in areas of care.
Ian Hempseed is a partner and head of third sector at Hempsons. He can be contacted on 020 7484 7530 or via i.hempseed@hempsons.
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Specialist mental health courts lead to stronger cooperation between health and criminal justice agencies when it comes to working with offenders with mental health needs, research for the Ministry of Justice has suggested.
Two court pilots were run in Brighton and Stratford in East London between January 2009 and January 2010. The schemes have continued since the pilots ended.
Specialist mental health courts operate either as a dedicated session dealing with the sentencing of offenders who have mental health problems or learning disabilities or within a normal case list in a magistrates’ court.
The work is tailored to meet this type of offender. The courts:
- Identify relevant defendants through screening and assessments conducted by a dedicated practitioner
- Provide the court with information on a defendant’s needs to enable effective case management
- Offer credible alternatives to custody to ensure offenders are supported, whether that is with a community order with a supervision requirement or mental health treatment
- Provide enhanced psychiatric services at court
- Implement regular reviews of orders, and
- Direct individuals not suitable for the mental health court community order to mental health and other services that can appropriately address their needs.
The study conducted for the MoJ suggested that the pilots “focused minds”. It said: “Many agencies became involved in order to create solutions to long-standing problems, such as information sharing to support sentencing which had formally created barriers to identification and provision.”
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The Pennine Acute Hospitals NHS Trust has launched a £1.25m tender exercise for legal services.
The five-year contract will cover four areas:
- Healthcare law (accounting for 36% of the trust’s annual expenditure on legal services)
- Employment law (48%)
- Contract & Commercial (4%), and
- Property law (12%).
The trust, whose headquarters is at North Manchester General Hospital, has not fixed the number of potential providers. It could therefore award the contract to a single provider or award a number of individual contracts.