One of the key messages coming out of the Mid-Staffordshire Inquiry Report was that patients’ voices were not heard. Francis reported that:
Trust management had no culture of listening to patients. There were inadequate processes for dealing with complaints and serious untoward incidents (SUIs). Staff and patient surveys continually gave signs of dissatisfaction with the way the Trust was run, and yet no effective action was taken and the Board lacked an awareness of the reality of the care being provided to patients. The failure to respond to these warning signs indicating poor care could be due to inattention, but is more likely due to the lack of importance accorded to these sources of information.
CQC picked up on this in its initial response to the Report. David Behan said:
Regulators and supervisory bodies must be much better at identifying and challenging poor care and in working together to improve people’s experiences of care. Boards, managers, care staff and commissioners must take responsibility. We must all listen to patients.
This is not just an issue for the NHS. When the Serious Case Review Report into Winterbourne was published last year, the then Chair of CQC said:
Good care starts with providers and their staff, relies on effective commissioning and safeguarding procedures, and is informed by the views of people who use services and their families.
The idea is firmly established in the regulatory framework. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 requires registered providers and registered managers to:
‘regularly seek the views (including the descriptions of their experiences of care and treatment) of service users, persons acting on their behalf and persons who are employed for the purposes of the carrying on of the regulated activity, to enable the registered person to come to an informed view in relation to the standard of care and treatment provided to service users.’
Social care providers have rightly protested at not being heard in the past. From a flawed quality rating system to its complete abandonment, from a pointless and time consuming re-registration process to unworkably low fee rates, the sector has understandably felt frustrated at not being listened to when raising these and other points.
However, it is right that providers should also be expected to listen to those who are most effected by their performance – service users and their representatives. Given the responses to Mid-Staffordshire and Winterbourne View, we would expect the regulator to take an ever greater interest in ensuring that providers are engaging meaningfully with their service users.
Listening involves a complaints policy that is used constructively and any allegations of abuse must of course be reported in accordance with local procedures.
Listening starts, however, with individualised care plans. Are providers asking their residents how they would like to spend the day and what they liked doing before they moved in? Do providers not only capture this information but then use it to offer meaningful and personalised activity choices that truly reflect how service users want to lead their lives?
Low fee increases (if any) that barely (if at all) cover inflation pose challenges to doing this well. Providers may need to be inventive to meet that challenge, for example by engaging with local schools, churches or voluntary organisations. If done well though, engaging meaningfully with service users can change a service dramatically. Residents are not simply lined up in a square in a living room but are leading active lives, as should be the right of all people.
Many providers will already be listening to their service users and will be responsive to their individual needs and complaints. No providers, however, should be complacent about being able to evidence it to inspectors and others. Views of residents must be actively and systematically sought and recorded. Providers may, for example, regularly seek views of residents through questionnaires, meetings and suggestion boxes.
Listening is the key to avoiding institutionalised care and there can be little doubt that CQC will sharpen its focus on it. Be prepared.
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