Short-notice care home closures
Intelligence and information sharing
Information gathering and information sharing are essential components of commissioning activity. They should be both proactive - to help anticipate and ideally prevent closure or discontinuity of service provision; and reactive - to share concerns and ensure a coordinated and coherent response to difficulties.
- Economic and environmental pressures may cause market failure resulting in closure, or service disruption, and may be outside of the control of the commissioner.
- Enforcement action by the regulator may be the consequence of system failure or enforcement reflecting concerns about the quality of care and/or the need to safeguard vulnerable adults.
In both cases, the processes of gathering information and disseminating it effectively should lead to more satisfactory outcomes for the individuals affected by service cessation; for the care workers and owners of facilities providing service; and for the diversity and choice of the marketplace.
You've got to understand the local market - its strength and weaknesses, where gaps are - act on information received and alert each other to potential problemsCommissioner
- Commissioning processes should be addressing a number of key questions to ensure a robust understanding of the market and its potential weaknesses, and enable appropriate action to be taken.
- Commissioners and their contracts department should hold information sought from a basic questionnaire on the legal status of an organisation, its capacity and contact data on the owner etc.
- Commissioners should maintain a list of organisations and the roles in which they should be collaborating, including receivers and HMRC
- Reciprocal arrangements and cross-boundary agreements need to be in place.
- Commissioners need to understand the local market and RAG-rating for risk based on:
- safeguarding alerts
- occupancy levels
- risky contract models - e.g. single purchaser, monopoly provider
- building viability
- fitness for purpose of the business
- age profiles
- hospital admissions
- strength of competition
- financial viability/financial data
- validating the data (i.e. in cases of suspected under-reporting)
- using the market itself to add to intelligence
- allowing the market to develop based on shared intelligence
- Commissioners should develop (and regularly update) multi-agency Escalation Plans and Resilience Plans
- Protocols for extra resources need to be agreed and regularly adjusted, particularly if the scale of market retraction is considerable and will have a commensurate impact on the commissioner's budget.
- Analysis of complaints data and reports on what is done with it need to be used to continually monitor the ability of providers to meet standards and contractual requirements.
- Commissioners need an understanding of plans for the development of new build and the data upon which speculative development is based.
- Commissioners must feel able to establish whether care homes have their own continuity plans
See examples and tips for more information.
Acting on intelligenceOpen
It is important to act on intelligence gathering and information sharing if they are to contribute to preventing service failure from either systemic abuse or market failure.
Communication with CQCOpen
Clear lines of communication with the Care Quality Commission (CQC) (at a regional as well as local level) need to be maintained in order to ensure it is able to fulfil its requirement to inform local authorities of providers in breach of regulation at the point an appeal has been exhausted.
System failure and enforcementOpen
Closure due to enforcement action because of poor quality of care which has been subject to scrutiny by the regulator may also be related to the economic pressures that can cause market failure - for example, when a local authority's policy to reduce price or the number of placements contributes to a fall in occupancy levels below what is viable. Reduction in the number of referrals and the reputation for poor quality are often interrelated.
Institutional abuse is often a different matter altogether. The regime in a home where abuse is occurring may 'go under the radar' until such time as clear evidence emerges or a whistle-blower alerts the authorities. Commissioners may well be in ignorance of concerns about the standards of care until notified at an advanced stage by CQC.
- Concerns about institutional abuse may come to light in a number of ways:
- adult safeguarding units may note patterns of abuse from reporting data
- staff undertaking placement reviews
- contract monitoring arrangements
- health care professionals attending to residents
- family or friends
- NHS Serious Untoward Incident reviews concerning people receiving NHS funded care.
- Agreements between key agencies on information sharing and communication must be in place in order to deal effectively with accumulating concerns relating to the operation of, or quality of care provided in, a registered care home.
- In all instances where abuse is suspected, following initial enquiries, safeguarding protocols and the relevant information sharing arrangements should be followed.
- Commissioning arrangements should be used to reduce the risk of abuse - for example, use of person-centred contracts, placement monitoring and review.
- Mechanisms need to be established to link information from different sources (e.g. care managers, CQC, complaints officers, contract monitoring functions, primary and secondary care staff) with agreed information exchange protocols.
See examples and tips for more information.
Adult safeguarding procedures should include procedures for detecting and responding to suspected abuse within care home settings.
Examples and tips
Examples of what others are doing plus materials they have developed and useful tips.
Tools and checklists
Key points from policy and research
A 2006 report by Age Concern - 'Rights for real - older people and human rights' shows how the Human Rights Act (HRA)1998 provides the principles, practice and policy to safeguard older people and ensure they have good quality services from a range of providers. The report also highlights risk areas where older people may not be covered under human rights legislation, such as privately self-funded clients and people managing their own care arrangements.
Exploration of the changes needed by public services to meet the independence and wellbeing of older people and support to carers, considering the various strategic alliances that need to be formed across health and social care (Audit Commission 2004).
Research into the protection of service users who are receiving care from non-public organisations offers guidance on contracting for services in light of the HRA 1998 (Department for Communities and Local Government 2005).
For those in local government involved in asset transfer to the community sector, a practical guide on how risk can be managed and minimised, drawing on successful case studies and examples, is available. Whilst concentrating on cashable and tangible resources, there is evidence that a smooth transfer can be facilitated for the benefit of all affected (Department for Communities and Local Government 2008).
The personalisation agenda set out by the Department of Health in 'Putting people first' defines the market and consequent contractual relationships in a more personalised approach to care provision (Department of Health, 2008).
The work of the My Home Life team sets out those elements of care that are the cornerstone of quality of life for residents and maps out service specifications for both providers and commissioners, My Home Life website.
Where market failure is due to lowered income streams through lower occupancy levels or low prices, providers and commissioners may consider using a toolkit designed for professionals involved in negotiating care home fees (Joseph Rowntree Foundation 2008).
Earlier work on a similar theme was issued as 'Guidance on unfair terms in care home contracts', Office of Fair Trading 2003.
What the regulator says
In the event of threatened or imminent emergency closure, commissioners should make contact with the Care Quality Commission (CQC) at the earliest opportunity. CQC will provide information under its information-sharing protocols indicating any action which it is taking