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The journey to quality
A long and winding road

Reflecting on the sector during his long career, Des Kelly OBE considers the long journey that has been necessary to improve the quality of services, the role of the community within this and how current initiatives and future developments can keep care homes moving forward.

I was involved in a major research and development programme to improve residential care services in the early 1990s. This Department of Health-funded programme had the title The Caring in Homes Initiative (CHI) and was part of the Government’s response to the publication of Residential Care: A Positive Choice (generally known as the Wagner Report) in March 1988.

The programme and projects that made up the CHI were independently evaluated by academics from Brunel University, which was subsequently published by Her Majesty’s Stationery Office (HMSO) as Raising Voices: Ensuring quality in residential care by Penny Youll and Chris McCourt-Perring in 1993.

Terry Philpott produced an excellent summary of the various publications and reports that followed on from the Wagner Report in Residential Care: A Positive Future, which was produced to mark the 20 years of activity to promote residential care services and was jointly published by The Residential Forum and CMM.

You may wonder why I make these references as my introduction, particularly as they are almost 30 years ago. However, I do so in order to highlight the long journey that has been necessary to improve the quality of services in residential care settings. A journey which arguably is yet to reach its final destination.

A Window in Homes

The CHI included a series of overlapping and interrelated projects which explored and developed best practice in residential care settings. These were through the following themes:

  • A quality assurance system.
  • Effective information.
  • Learning, training and professional development, particularly for frontline care workers.
  • Complaints procedures.
  • Community links.

This last CHI programme around positive links between residential care homes and the wider community, was the one that I was responsible for managing. It had the title A Window in Homes and was primarily concerned with local community involvement and its value to improving care practices.

A Window in Homes had a simple premise that the best care homes invest in relationships with their local community. The metaphor of window was intended to symbolise an outward-looking perspective as much as a view inside the home from the community.

The three programme objectives were:

  • To promote contact between residential establishments and local communities.
  • To stimulate involvement by residents in the life of the home and its outside activity.
  • To create more feedback on standards of care.

Links with the community

I still firmly believe that this notion of a care home as part of its local community, integrated and connected, is correct and should be one of the primary safeguards of standards. The Wagner Report referred to it thus, ‘It should not even be necessary to speak in terms of “links with the community” – residential establishments should so clearly be a part of the community they exist to serve.’

Such a view of residential care acknowledges that those who live in care homes continue to be equal members of the community and should, therefore, enjoy the same access to the full range of community facilities. Surely, this is as true today as it was in 1988.

When lots of people – relatives, friends, local groups as well as a wide variety of professionals – visit homes regularly, they are well-placed to ensure that what happens in the home is open to scrutiny. They are more likely to have a good idea of what it is like to live there, the quality of relationships and the way people are treated.

It is not a substitute for regulation and inspection, or even contract monitoring, but it could certainly enhance it. The ethos and openness of a care home and its staff directly affects the extent to which continuing community involvement, in a variety of forms, is a useful additional safeguard. It is about creating the conditions for such community involvement to flourish.

Care Home Open Day

This premise was also the reason for supporting the introduction of the Care Home Open Day (CHOD) initiative in 2013. Last year, around 4,000 care homes across the UK, together with care homes in countries as far away as Australia, participated in CHOD by putting on events and encouraging people from their local community to visit.

The different activities that residents, staff and communities hosted were truly inspiring when the themes were ‘the arts’ and ‘valuing staff’. There was a lot of live music including a variety of different bands, musicians and singers…even Elvis. Schools, colleges, churches and various community groups and volunteers participated. Art competitions, fancy dress and an assortment of animals were involved plus lots of tea, cake, food and drink.

In England last year, thanks to the continuing support and leadership shown by the Care Quality Commission’s (CQC) Chief Inspector of Adult Social Care, Andrea Sutcliffe, 157 inspectors or staff from CQC visited 168 care homes on the day. Given the important role that the regulator has in promoting quality and continuous improvement, CHOD is an excellent opportunity to showcase care home services and facilities. The support of the regulator demonstrated that the contribution of care workers is important and valued. There was also major support from key sector bodies such as Skills for Care and the Social Care Institute for Excellence. CHOD was mentioned in a debate in Parliament and 56 MPs visited at least one care home in their constituency.

CHOD has a single aim, which is that the best care homes are well connected to the community they serve. They are likely, therefore, to be ‘open’ and welcoming every day of the year. By having a single day in which all care homes are opened to the public, it offers an opportunity for people to get a better understanding of what happens in care homes, day-in-day-out.

In a survey conducted after the event, of over 300 providers who participated in CHOD, 72% said that they thought that taking part had a positive impact on their care home and the local community. Five care homes reported that they had received more than 100 visitors on the day.

By challenging the misconceptions and perceptions that are so often associated with care homes, a more positive understanding of care home services can hopefully be portrayed. There were, for example, over 160 local newspaper reports of activities in care homes and 23 stories in regional lifestyle magazines. The Guardian celebrated the care home sector with a picture feature. Radio coverage from 27 regional interviews reached an estimated audience of almost four million. Social media was especially impressive, with the Twitter hashtag #CHOD2015 trending on the day and for two days afterwards with a total of over 3.5 million mentions.

CHOD takes place on Friday 17th June this year and, in recognition of the 90th birthday of The Queen, has a theme of ‘celebration’. We want CHOD 2016 to be the biggest ever, with the highest level of engagement. Check out the website for information and ideas, activities and resources, and do participate in and promote the event. It is a wonderful opportunity to demystify what care homes do and allay fears that some members of the public have about the quality of care services.

A vision for care homes

I have a vision of care homes, not just as part of the community but valued as community resources. A focal point for delivering quality, integrated services including information and advice, day provision and outreach, occupational therapy, pharmacy, GP input, linked to housing and offering access to meeting space or leisure activities.

Care homes increasingly offer short-stay provision, intermediate care, rehabilitation, ‘step-down’ or ‘step-up’ from hospital, or respite care. This diversification of care homes seems to me to be an inevitable result of changing commissioning – both for local authorities and for those people funding their own residential care.

An aim of care homes should be, at least in part, to support people in the community in such a way as to prevent, or at least delay, the need for longer-term residential care.

Coming back to quality and how quality care is perceived, I am reminded of a comment by Wolins, M. and Wozner, Y. writing of ‘revitalising residential settings’ in 1982. They said, ‘Much has been written about institutions of various kinds. The reader may find stringently analytical and warmly romantic narratives of a positive or negative flavour about any type of institution. Such assessments, of course, reflect the judgement of their authors, but in part they are dictated by the temper of the times.’

There it is, the journey to improving the services of care homes is about attitudes and perceptions as much as it’s about standards, rigorous assessment and quality ratings. Involving the community in this is a real way to challenge local perceptions, but is it a journey that never ends?

Des Kelly OBE is Executive Director of the National Care Forum. Email: Twitter: @DesKellyOBE


Care Home Open Day 2016 – Celebration

Care Home Open Day 2015 – Connecting Caring Communities

Care Home Open Day 2015 – CQC

Care Home Open Day 2015 – mentioned in Parliament

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