Report 41: Prevention in adult safeguarding - Emerging evidence
Croydon Council: Supporting care homes to prevent abuse
Vincent Docherty, Safeguarding Adults Coordinator from Croydon Council, shares the work going on to support care homes in Croydon. The Council has led on three major initiatives – a support team, training and a bimonthly forum for care homes – to improve practice in care homes as a key way of preventing poor practice and abuse which leads to safeguarding investigations.
Croydon has more care homes, nursing homes and private hospitals than any other London borough, and a significant number of safeguarding referrals relate to care provided in these homes. Because of this, the local PCT (now Croydon NHS), acute trust (South London and Maudsley NHS Foundation Trust) and Adult Social Services department (Croydon Department of Adult Services and Housing) joined forces to fund a Care Home Support Team (CHST). The team – two nurses, a community psychiatric nurse and a social worker – provide support to care and nursing home providers in order to help avoid crises and institutional abuse. A care home may self-refer to the team asking for advice on care planning or risk enablement. In cases involving abuse, the chair of a serious case review may decide that institutional abuse has occurred and refer the care home for support to implement safeguarding plans.
In order to be able to prevent abuse in care homes more effectively, Croydon Council wanted to gain a better understanding of the local risk factors. First, they examined all the homes that they'd placed on suspension to understand common local risk factors for abuse. They also looked at the academic work of Caroline White (University of Hull) who developed ways of identifying institutions that are at risk of developing abusive practice. From this, they were able to identify a range of factors that local care home providers need to explore in order to prevent abuse. They then developed a training course for local care home managers on how to identify whether their institution is at risk of developing abusive practice.
Croydon Council conducted interviews with providers who have been subject to suspension. Many said that they felt angry that they had reported their concerns and then received a suspension. This felt like punishment and was a huge disincentive. Therefore, instead of immediately placing a suspension, the council try to intervene earlier to prevent abusive situations from occurring. This means that support is proactive, not punitive.
Croydon Council also established a Care Home Forum, a bi-monthly meeting of local providers. Meetings take place at the local council chambers. Members are updated on and discuss the latest safeguarding issues, such as the deprivation of liberty standards or the latest guidelines from CQC, and attendance is very good.
The Care Home Support Team needs significant investment. This includes initial staff secondments – and now permanent staff costs – office space and infrastructure support. However, the costs are shared amongst organisations and address a large number of cross-cutting agendas. The team is seen as a good solution to a number of issues, providing value for money and making the system more preventative.
The resources needed to develop the training include:
- time to put together the key messages that providers need to hear
- funding for an independent trainer who understands the issues
- materials for people to take away, such as handouts
- time to facilitate post-training peer support
The resources for the Care Home Forum include:
- venue costs, including refreshments if possible
- staff time to develop clear terms of reference, develop agendas, identify speakers and communicate with attendees.
What's worked wellOpen
The Care Home Support Team has been evaluated by independent researchers Lawrence and Banerjee, whose findings appeared in the journal Aging and Mental Health (2010). They found strong evidence of effectiveness and impact, such as reduced rates of readmissions to hospitals and fewer suspensions of homes, increased awareness of safeguarding issues among care staff, and improved staff morale and communication. There were only two zero star rated homes (out of a total of 187) when the ratings system was in place in 2010.
According to Vincent Docherty, the training 'has helped stop staff getting the important things wrong'. These are often the fundamentals, such as not taking medication home at the end of a shift.
The Care Home Forum has meant that homes are supported to work together to drive up standards, leading to a greater consistency of standards across the borough. Croydon Council has also developed a strong relationship with CQC and this means that they are able to intervene early when concerns are raised about a provider.
Some local providers feel that the state is subsidising and supporting weak and poor performing providers. This feeling is understandable. However, the local authority has a duty to ensure that service users are not subject to abuse, regardless of how they are funded or where they live. The aim of this intervention is to empower care homes to improve their own practice, thereby preventing abuse. To maintain good relationships with the best performing providers, they need to be reassured about their status and value.
Advice for othersOpen
For pragmatic reasons, staff from the Care Home Support Team predominantly have a nursing background. In retrospect, it would be better to include other disciplines such as occupational therapy or community pharmacy.
To establish a Care Home Forum, Vincent Docherty says it is important to:
- be clear about the terms of reference from the outset
- make sure you know who all your providers are
- spend time putting together a flier that outlines all the benefits of attending
- get as many proprietors and managers involved as possible, and make it clear that they will hear challenging messages.
Croydon Council would like to roll out the training to two new staff groups: firstly care managers who make and review placements, and secondly, contract compliance staff. They would also like the training to be more sophisticated so that it responds to the support that providers are asking for. Vincent and his team hope to develop the training into peer-support groups that can be organised by members themselves. However, because providers are natural competitors, this needs to be facilitated carefully. Finally, Croydon Council are planning to use the results of three serious case reviews into the deaths of service users in care homes to inform the support services that they provide to such homes.
Vincent Docherty, email: Vincent.Docherty@croydon.gov.uk