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Safeguarding in care homes: the importance of open culture

20 December 2023
By Claire Webster, SCIE Practice Development Consultant

Last month I received a call from my team manager (Vijay) to ask whether I would be willing to be interviewed for a BBC Panorama investigation into a care home for older people, in Gateshead. Due to the nature of the investigation and undercover reporting, we were given limited information, but understood it related to safeguarding practice.

Within a few days I was in London, sitting in a living room with lighting and cameras, and presented with a series of questions to answer. It became quickly apparent that the story related to issues of poor care, safeguarding, understaffing and profit margins. The footage of a drag lift being used, staff sharing information on low staffing rates and verbal discussion about a resident sustaining a broken hip, painted a picture of a care home with safeguarding concerns alongside exploitation of staff (predominantly from overseas). Staff were shown feeling unable to raise concerns with management owing to their reliance on their employment to secure residence in this country. My interview didn’t make the final edit, however we continued to work with Panorama to provide guidance on safeguarding practice information.

Image of SCIE employee Claire Webster

The programme set out the impact that a care home owner seemingly focused on profit margins, has on the staff he employs and the residents. Through restrictive contracts, the apparent ignoring of understaffing concerns, and a closed culture, we see how residents are harmed through neglect (multiple safeguarding alerts, missed medication, poor manual handling practice etc). The closed culture developed by the owner made it that much harder for management and staff to whistleblow.

There is sadly a continuity in the themes and messages drawn from other investigations into residential settings including Whorlton Hall (an independent registered hospital supporting autistic people or people with a learning disability), This was also subject to a BBC Panorama undercover investigation which exposed abuse and poor care. Our safeguarding adult review, commissioned by Durham Safeguarding Adults Partnership, detailed a number of findings which were discussed by the Coalition for Change including:

  • failing to listen to and act on concerns raised by individuals and families;
  • regulation and commissioning failing to recognise or respond effectively to the warning signs of abusive cultures becoming established;
  • weaknesses in short-term commissioning with no effective means of assessing the quality of care or outcomes being delivered at many high cost placements
  • challenges in the system’s ability to hold the directors and shareholders of care organisations to account.

At Addison Court, we saw how overseas staff were taken advantage of therefore becoming part of the closed culture, we know open cultures are ones where organisations involve and listen to, residents and relatives. They are transparent in their practice and raise concerns with the commissioners and relevant health organisation. They invest in, and ensure staff are trained and supported to provide good care in line with what is expected, and staff are given information about external support agencies to contact for advice and guidance. In such settings residents and staff thrive.

At a time when a number of care providers are relying on overseas staff, it is vital that there is clear guidance on how such staff are recruited. Allied to that it is important that consideration is given not just to the standard induction training and support that would be provided to local staff, but also what is needed in terms of supporting staff to understand expectations, the different statutory and regulatory frameworks and the code of conduct under the respective professional body.

We know there are a number of care providers who focus on providing good person-centred care. They will own up to mistakes and learn from them. Evidence, including from the Care Quality Commission, shows that good leadership and a strong culture that values and listens to staff, and gives them time to listen to and work with residents, are essential to deliver better and safer care. Every care home needs to review their safeguarding practice on a regular basis, and we urge them to seek help when they need.

We at the Social Care Institute for Excellence are here to help any care home or provider requiring support to improve in this area, and we urge all support organisations to help shine a light on the need for open, not closed, cultures..

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