Allegations against home carers - is more inspection really the answer?

In response to the report that 23,000 allegations of neglect and abuse have been made against home carers there have been many calls for an enhanced inspection regime.
I question this - what is it meant to achieve?

Home carers visit vulnerable people in their own homes. Unless an inspector can accompany them on all occasions it is highly unlikely that any form of abuse will be witnessed by an inspector. So how can we prevent abuse (only a few of the allegations resulted in prosecution)? The answer of course is recruitment and training carried out by the business owner. 

Even this will not totally eliminate the tiny percentage of people who present well and manipulate the system to appear good but are in fact evil. 

Sadly these people exist. We can only undertake rigorous screening, including observing and monitoring responses to training. But in the desperate need for care staff, employers must realise that cutting of corners will mean that they will be held accountable. This would jeopardise their business and their clients, which is too high a risk to take. 

This brings me to the failings in the current inspection regimes. What is inspection for? Some Inspection bodies will tell you that 'inspection brings improvement'.

So with this being the best outcome achievable, inspectors are in fact business consultants paid for by the tax payer? 

The public thinks inspections make sure nothing untoward is happening, to protect people - but as mentioned above, what are the chances of an inspector walking in on an abuse situation, especially if visits only take place twice a year?

The government uses inspection data to get an overall picture of the state of the services available. It bases its view on the often subjective judgments or ratings of inspectors which are at best inconsistent. 

The only purpose I can see of an inspection regime is the production of a report, which prods service providers into action on the basis of 'naming and shaming' because the reports are publicly available. More recently, commissioners of these services have been using the judgements in these reports to decide whether public money can be spent in them. 

However, that leaves self-funders to fend for themselves, and a lot of care seekers do not know these reports even exist, however inconsistent and subjective they are!

It seems to me that what we want are services run by competent people who stay in touch with how their front line services are being delivered - and are willing and able to take action when they discover poor care. 

The gatekeeping to such services should be rigorous and highly selective. Some inspection bodies have this process - it is called 'registration' and is a form of licensing. Over the years it has become a rubber stamping exercise and this can be demonstrated by the very low number of refusals to register by the inspection body and appeals against their decision.

Obtaining a licence to run a care business should be a matter of pride, similar to obtaining a qualification, not a (low) hurdle to get over.

Having obtained such a treasure, the awarding body should be vigorous in reacting to concerns raised, and if the owner of the business is found lacking, prompt in removing this license. These powers already exist, but are rarely used! 

So for me, no - inspection is not the answer! There is an old saying 'a pig does not get fatter if you keep weighing it!'

More rigorous regulation, which inspection bodies already have the power to use, is the answer! 

The inspection body referred to in this article is the CQC – but the principles apply equally to Ofsted, especially their children's social care and early years responsibilities.


Joan Mansfield
Owner –The Care-Co-operative Ltd