Safeguarding and quality in commissioning care homes

Partnership

Serious Case Reviews frequently find that agencies failed to work in partnership, to communicate well and to share the right information at the right time. Partnership working is essential to good safeguarding practice. It will involve clear lines of communication and accountability between the commissioner and:

• people using services and their carers
• providers - managers and frontline staff
• CQC
• the NHS
• safeguarding teams and social work staff
• police.

• Partnership working with providersOpen

  The primary key is the growth of a culture of trust across the commissioner-provider boundary, and an understanding that our dialogue about these matters must always include those people who are most affected – local people who need support.

  Tyson, 2007

  Good safeguarding practice in commissioning is dependent on good working relationships between commissioners and providers, including partnership working, trust and respect. Poor relationships between care providers and commissioners are all too common and can lead to poor outcomes for people using the service. There is, however, evidence that such relationships are improving (Matosevic et al, 2008) with most local authorities having a dialogue with providers and involving them with the improvement and development of services (Hughes et al, 2009). Every effort should be made to develop positive communication and to address differences and concerns, including those relating to resources that potentially affect service quality. Local authorities are no longer the main providers of residential care and expertise has developed in the independent and voluntary sectors - commissioners should acknowledge this shift in expertise.

  Partnerships should also include providers of nursing care and joint commissioning arrangements with NHS commissioners. Partnerships should ensure a continued focus on outcomes. As the Audit Commission (2009) found: ‘Organisations can usually describe how they now work better together but often not how they have jointly improved user experience.’

  See 'Key points for commissioners' above

  What others are doing – ideas you could use

  Hold regular forums with service providers

  The London Borough of Sutton holds regular forums for all local providers including those where placements are purchased ‘out of borough’. Providers are invited to set the agenda for future forums, ensuring topics are relevant and providers are fully involved. Safeguarding and training are standing items on the agenda. Sutton holds an annual Safeguarding Vulnerable Adults conference that is well attended by commissioners, social workers, providers and third sector organisations.

  Develop a strategy for managing the performance of service providers Caerphilly Area Adult Protection Committee has developed a Provider Performance Monitoring Protocol (MS Word)

  Resources

  • IDeA: Early messages from peer reviews
  • Social Care TV - Safeguarding adults: preventing abuse through community cohesion, communication and good practice
  • Social Care TV - Safeguarding adults: lessons from the murder of Steven Hoskin
  • In Control Commissioners and Providers Together: the Citizen at the Centre
  • Department of Health (2007) Commissioning framework for health and well-being

• Supporting the workforceOpen

  The failure of care delivery by low paid staff is often through a combination of poor leadership (including that of commissioners as well as service management) and ignorance, rather than malicious intent by care [workers].

  Bowman, 2010

  Frontline staff, in this case residential care workers and support staff including drivers, cooks and domestic staff, are vital to good safeguarding practice. They must be well trained and aware of safeguarding issues if they are to protect vulnerable people in their care.

  Commissioners and providers have a responsibility to ensure that social care and support staff are enabled to do their job well. Workers that are treated well are likely to provide better outcomes for residents. Studies into care work for people with learning disabilities (Thomas and Rose 2009; Bromley and Emerson, 1995; Gilbert and Osborne, 1989) have shown a direct correlation between staff behaviour (resulting from stress and low morale) and the quality of service provided. Furthermore, a positive working environment with an open and honest culture that avoids blame is likely to be safer for people using the service. The relatively high turnover of care staff as a result of these problems can be very costly. Retention of care work staff is critical to the quality of care provision.

  What others are doing - ideas you could use

  Provide free or subsidised safeguarding training for providers in your area

  Have a protocol in place for dealing with multiple alerts and allegations of institutional abuse.

  Reading Borough Council has developed a Protocol for Management of Institutional Safeguarding Adults Investigations

  The London Borough of Sutton offers safeguarding training free to all providers at three levels:

  • Level 1: online training for providers (can be completed at council offices if they are not online)
  • Level 2: a one-day course
  • Level 3: a two-day course specifically designed for managers and deputies, covering investigation procedures. This is the same training that local authority staff undertake.

  Resources

  • Bournemouth University and Learn to Care National Competence Framework for Safeguarding Adults
  • SCIE e-learning resource: Managing risk, minimising restraint: Challenges, dilemmas and positive approaches for working with older people in care homes

• Developing the marketOpen

  People want good quality local services - they do not want to have to accept poor quality service provision because there is nothing else available. Having no choice or control or having to accept poor quality services can be experienced as abusive. It is therefore important for commissioners to ensure the local market offers a range of flexible and diverse services. Evidence suggests that progress in this regard is limited (Hughes et al, 2009).

  To achieve this, and to meet needs identified in the Joint Strategic Needs Assessment, commissioners will need to work with citizens, local partners and user-led organisations to set up services and support new innovations responsive to identified and diverse needs. Commissioners will need to develop the skills and tools to assess the potential of new, unconventional service responses.

  Evidence suggests that small providers and user-led organisations are vulnerable to being squeezed out by large corporate ones (Hughes et al, 2009), resulting in an impoverished rather than diversified selection of care provision for the ‘consumer’. Commissioners need to actively ensure that smaller, flexible and user-focused services can survive such threats. Some authorities have sought to address these issues through market management (Drake and Davies, 2006).

  What others are doing - ideas you could use

  Explore ways to move away from block purchasing

  Hartlepool has taken a proactive approach to developing the market. They offered a development loan to an organisation that provided a day centre for people with Alzheimer's that had previously been block purchased. The organisation was given funds to develop the service to meet individualised needs with an agreement to pay the council back from individual contracts over time (Dittrich, 2008).

  Resources

  • SCIE Guide 36: A commissioner’s guide to developing and sustaining user-led organisations
  • SCIE At a glance 25: Commissioning to develop and sustain user-led organisations