Why you should be worried about the future of care homes

The Care Quality Commission’s annual ‘State of care’ report tells us a lot about adult social care – and it’s not good news, says John Kennedy.

England’s social care regulator, The Care Quality Commission (CQC), published its annual State of care report recently, and it didn’t read like good news to me. So what are we going to do about it?

This is the seventh ‘new’ inspection methodology that I have encountered in my 30-year career in social care. Is this one any different? Well yes, it is. It feels like a more in-depth and comprehensive approach. Has the bar been raised? Yes. Is this a good thing? Yes. I don’t think anyone would argue that high expectations for care homes is a bad thing.

It’s not perfect, but as a measure of how care homes are performing, it’s all we’ve got so we should take heed.

From my trawl of the CQC website, I estimate that roughly 20 per cent of care homes for older people have now been rated. So far the outcomes have been:

Good: 53 per cent

Requires Improvement or Inadequate: 47 per cent

Outstanding: 0.004 per cent

It seems that some of the ‘good’ ratings are solid ‘good’ but many others are still falling short on one or two of the key questions.

There are certain essentials that need to be in place for a care home to be solidly ‘good’, never mind ‘outstanding’. They must have:

  1. a good manager – managers who are well supported, developed and encouraged are absolutely crucial to high-quality care;
  2. adequate resources, either from adequate fees or charitable subsidy. Funding matters. Let’s stop pretending it doesn’t. Adequate funding is necessary to provide ‘outstanding care’ but it is not sufficient in itself;
  3. a vocational organisation, where people and care are the priority.

Hospices have achieved much higher ratings than care homes – almost 95 per cent ‘good’ or ‘outstanding’. Why? Because they typically have 1, 2 and 3. Shouldn’t we learn from this?

I welcome the spotlight that the new rating system brings. It clearly shines a light on the challenges; and offers a clear opportunity and impetus for change.

In my care home inquiry report, published one year ago, I argued for a radical reform of the system surrounding care homes. We need to:

  • declare the care sector a ‘sector of primary national strategic importance’ for the country, the economy and ourselves. Raise its status, make it important within our society and recognise its fundamental importance to our society and economy;
  • create a national professional body for care home managers, setting standards and providing professional development – and, crucially, providing a voice at national policy level;
  • regulate the market. Regulate the system – workforce pay, skill levels, tariffs and commissioning. Regulate for success.

Above all, we must move towards a more supportive, valuing and nurturing system around care homes, as we do around hospices. If we want care homes to be ‘outstanding’ then how we support them should be ‘outstanding’ too. If care homes are to be kind, the system around them needs to be kind.

I hope we can use these new ratings to recognise this, honestly; as a catalyst for change, not just as another salvo in the never-ending circular firing squad.

We must stop ignoring the fundamental barriers that currently prevent commonly ‘good’ care.

If we don’t, we will continue to fail, and I remain anxious about what is going to happen to me if I need care. So should you.