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'Stark' regional variations in care home quality revealed


The North West is the region with the highest proportion of poorly performing services, according to research highlighting “stark variations” in the quality of care home provision across the country.

A report, published today by charity Independent Age, found the region contained seven of the 10 local authority areas in England with the highest share of homes rated “inadequate” or “requires improvement” by the Care Quality Commission.

“No one should be forced to live in an unsatisfactory care home”

Simon Bottery

These included Stockport, which had the highest proportion at 62.9%, followed by Salford, Tameside, and Manchester City.

Exactly half of Kensington and Chelsea’s homes were rated “inadequate” or “requires improvement” by the health and social care provider regulator. Oldham, Liverpool City, and Trafford, followed by Hackney and Bradford City made up the rest of the top 10.

When performance was looked at regionally, there was a partial north-south divide. Overall, a third of care homes in the North West were found to be performing badly, followed by Yorkshire and the Humber (32.2%), the South East (28.2%), and the North East (25.6%).

Meanwhile, the highest proportions of care homes performing well were found in London, the East of England (20.8%) and the South West (21.1%).

Three local authority areas – Council of the Isles of Scilly, Islington, and Rutland – had no poorly performing care homes in their areas, while Richmond upon Thames, and Thurrock Council had 2.3% and 2.9% respectively.

“The way in which services are run by providers is the most critical factor in ensuring a high quality of care”

Linda Thomas

Independent Age director of policy Simon Bottery said the research showed central government and councils were not giving the problem of poorly performing care homes “the attention it deserves”.

He said: “The government has an opportunity to address this in its upcoming green paper on social care but, in the meantime, councils must demonstrate that they understand the reasons for care home failures and are working to resolve them.”

“No one should be forced to live in an unsatisfactory care home but our analysis shows this is the grim reality in some parts of the country,” he added.

Linda Thomas, vice chair of the Local Government Association’s community wellbeing board, said the findings were a “concern and something councils take very seriously”.

She said: “This report looks at all care homes, and although councils commission a significant proportion of places in care homes, nationally more than 40% of places in care homes are purchased by individuals not councils, and not all care homes have contracts with councils.

“The fees councils pay, the contracts they manage and the support offered all contribute to performance levels,” she said. “But crucially, it is the way in which services are run by providers that is the most critical factor in ensuring a high quality of care.”

Ms Thomas added that the report highlighted the need for an urgent review of social care funding.

Margaret Willcox, president elect of the Association of Directors of Adult Social Services, said 71% of social care services were rated as “good”, but highlighted the CQC’s warning that the sustainability of the care market was approaching a tipping point.

She said: “Reductions in funding, increased demand by people living longer and with more complex needs, and the cost of the national living wage, while welcome, are putting significant pressures on councils and providers who are finding it hard to recruit and retain staff, especially in home care in those areas of high employment.”

Care Home Performance Across England, as of January 2017

 Region % of homes rated ‘inadequate’ or ‘requires improvement’
 London  20.3%
 East of England  20.8%
 South West  21.1%
 West Midlands  22.8%
 East Midlands  24.2%
 North East  25.6%
 South East  28.2%
 Yorkshire and The Humber  32.2%
 North West  33.6%



Readers' comments (2)

  • It really is imperative that NHS Senior Managers be regulated and checked in a proper manner - beginning yesterday! And it is up to the government to implement this fast or they display themselves very clearly as inhumanely determined to diminish the NHS at all costs.

    What I observed 2 years back in Salford seemed to me obscene and deliberate. My feedback then complaints were dealt with in a totally inappropriate and/or punitive manner by the entire NHS and LA network with whom I had contact. My complaints were disregarded by Alan Campbell at Salford NHS because I did "not have Power of Attorney Welfare".

    I still wake at three in the morning tormented by the lack of care my mother received there whilst detained by the state in a Salford "care" home.

    In my opinion the inquest which finalised at the end of last year at Bolton Coroners court was a farce. I regard the efforts of the Coroners Police there to be appallingly unintelligent and disengaged. There was no written record available to identify the Relevant Person's Representative and yet the MCA/DoLs Co ordinator was not called as a witness despite this. There was a safeguarding issue re lack of timely medical treatment for a pressure ulcer which was disregarded.

    The CPN who was aware of my concerns about pressure sores made no attempt to check the home's records or she would have seen that many wound dressings were frequently required with occasional antibiotics and she would have had a duty of candour to report it.

    The Psychiatrist stated that the patient "lacked capacity" to make her own decisions. Quite true - I believe she lacked capacity because of excessive and inappropriate use of anti depressants with sedative properties because she was understandably non compliant with the treatment she was subjected to but whether or not she "lacked MENTAL capacity, we'll never know.

    The histopathologist's post mortem report measured only in metres and kilograms and lopped about 12 inches off the height of the deceased, initially recording a weight of a woman who had shrunk to about 5' 2" as the equivalent of 3 stone 9 lbs but months later stated it was a "typo." Nevertheless, despite claiming to recall the weight for correction she was unable to describe fully the covering on the pressure sores which she had originally described as "bandages" which by definition are made of cloth and I believe would not be the proper treatment for the pressure sores. The AREA of pressure sore on the sitting bone was described, oddly, as a bedsore and no measurements using the Braden Scale or any measurements at all, width or depth, were supplied for it or the pressure sore on her shin or the sole of her foot. Everything was done on a visual basis although I had requested a diligent enquiry because of my concerns about her care and standards in the home. There was no toxicology report despite the fact that the CQC had found a lack of evidence that medications were being administered in a way that would prevent doses being given too closely together. No tablet residue was observed - not surprising as only liquid medicines were given because she did not want them - and they appeared to have been given without an appropriate DoLS authorisation or the protection from an RPR.

    I should add that although for example, a concerned relative has the right to be represented at post mortem examination by their own pathologist, contrary to court rules, I did not receive this information until after the post mortem.

    The GPs from Salford Care Homes GP Practice failed to take on board that although she was described as difficult and non compliant with care staff, the hairdresser had been able to wash and style her hair which is quite a long care intervention, without problems. The GPs continued to prescribe the anti depressant to her although I allege that with person centred care and appropriate skin treatment to prevent sores and infection, it would have been unnecessary. They did this despite the fact that the level of sedation reduced her ability to take fluids, despite the fact that she had 3rd stage kidney disease and the drug could cause kidney damage and despite the fact that it could cause skin irritation and her broken skin, described as skin flaps because she scratched herself, frequently required dressings.

    At inquest the GP also defended as unimportant a 6cm gallstone which could easily have impeded the delivery of bile which I allege would have been needed since the patient would have needed to draw on stored bile because she was continuously on a high fat diet. She had a persistent cough. She was fed then put to bed very shortly after even after I had reported her hiatus hernia. It seems her records were not checked because it was not in her recent records and checks into past records were not made. One cause of death was given as pneumonia. It could not be ascertained if it was aspiration pneumonia.

    The Fact of Death Certificate did not show dementia. I requested that dementia be added to the death certificate and was informed by the coroner's court that once made out it could not be modified. The coroner did, however, have the cause of death modified to include dementia. I deduce that statistics in Salford may fail to show dementia on death certificates.

    I declined to travel to the inquest for health reasons and because I was afraid for my safety. I acquired CDs of the proceedings. My understanding is that the coroners court is an open court and can be attended by anyone. I received from the coroners court a letter obscurely stating -

    "This recording is provided by the Coroner with the following warnings:

    1. This recording is not to be used for any purpose other than for transcribing for possible legal proceedings or listening to.

    2. Any other use of the recording or any part of it by copying, publishing, transmitting or broadcasting in any way (including on the internet) without prior consent of the Coroner, may be in contempt of court punishable with imprisonment.

    3. If the recording is to be used to produce a transcript, the transcript must be shown to the Coroner before being used for the purpose of any further proceedings."

    I was looking for a finding of Prevent Future Deaths (PDF). For reasons that entirely escape me, no one from the supervisory body, that is Salford NHS, was called by the Coroner's Court to stand witness at the inquest even though Salford PCT and CCG had had complaints from me over a long period of time, right up to the level of the the PCT's Chief Executive, Dr Mike Burrows, who I believe is now the NHS Director for devolved Greater Manchester with a budget I believe of around £6 billion.

    Astonishingly the GPs did not have concerns about the use of those anti depressants in those specific circumstances or the occasional necessity to prescribe antibiotics and so had not reported concerns about care. It was implied that the antibiotics were for chest infections rather than infected pressure sores or skin flaps. Both I and the other involved relative had presented at various stages to the home and the GP's Advanced Nurse Practitioner our mother's Advance Decision which clearly stated that she wanted no life prolonging treatments if she had any of the diseases listed, including dementia. We were not happy when that nurse insisted that antibiotics be given for a couple of weeks if needed to treat a cold for example but she was adamant. It is awful to think that people may be forced to survive against their wishes only to be subjected to neglect and abuse. Clear Advance Decisions should be adhered to fully without personal interpretations by professionals who do not even know the patient.

    My mother was denied nurse funding when there were strong indications that it had become necessary and when eventually I managed to get NHS funding for her, her primary needs after several emergency hospital admissions, were so great that Continuing Health Care funding was required. The suffering and extra costs I believe could and should have been avoided.

    I have gone on at length to get it off my chest because more than 2 years later I am still very distressed by it all.

    It was not reported accurately at the inquest but, yes, she was self funding whilst in residential care....

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  • I wish to make a correction to my above comment.

    It was the post mortem report, not as stated the Fact of Death Certificate, that originally did not show one of the causes of death as dementia.

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