Quality of care in care homes damaged by paperwork requirements

Research carried out by the Joseph Rowntree Foundation (JRF) has concluded that the quality of care in care homes is undermined by a paperwork ‘industry’.  The report highlights that commissioners, regulators and safeguarding agencies duplicate requirements while fear of blame drives managers to prioritise paperwork over care.

The research examined the practical impact of paperwork in care homes for older people and made suggestions for its improvement.  The JRF reported of little cooperation or coordination between different regulators and commissioners leading to duplication of information when they request similar information, but tailored to their individual needs.  Such requests can place an extraordinary burden on care homes.

The research identified more than 100 separate items of paperwork that were required to be completed regularly in care homes in response to a range of regulatory and commissioning requirements.

One manager interviewed during the study reported spending 20% of their time on paperwork rather than on leadership activities to help ensure high-quality care for residents.  Meanwhile some staff reported that they increasingly feel themselves judged primarily on their ability to produce quality paperwork rather than quality care.  However, the report suggests that if used in the correct way, paperwork can help contribute to better quality care relationships and strengthen resident’s voices in the care process.

Improvements suggested by the report include an alignment of national inspection criteria across agencies such as the CQC, NHS and local commissioners and increased sharing and use of information between inspectors of care.  The report also suggests longer-term systemic improvements, for example, residents and providers should develop measures of quality so that the right things were measured by paperwork.  It also suggested that inspectors should focus less on compliance in judging homes and more on observing the way care is delivered and the relationship between staff and residents.

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