Is this a good time to dilute care home rules?

http://www.theguardian.com/society/2014/oct/21/dilute-care-home-rules-law-abuse

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When inspectors arrived at the 82-bed specialist dementia care home in Peterborough, and ventured beyond the immaculate reception area, they first smelled the urine and then found residents still in bed at 10.30am, some lying in wet sheets, with staff ignoring their pleas for help. It was judged “appalling”.

That was in May. Within a month, the Barchester Healthcare home had been turned round, thanks to the manager being replaced and a series of other urgent actions ordered by the Care Quality Commission (CQC) inspectorate. The verdict of inspectors in June was almost glowing. But the case is set out in the commission’s new State of Care report as a reminder of the exceptions that do exist to the “many examples of excellent care” it comes across.

The report was published last week on the day a dozen MPs met for 25 minutes in a Commons committee room to nod through new statutory regulations for care homes. These regulations, to be part of “fundamental standards” across health and social care, include a “duty of candour” on the part of care providers when things go wrong and a “fit and proper persons” test for directors of care organisations. Both measures are to apply immediately in the NHS, but from next year to all care providers.

In the wake of Mid Staffordshire, Winterbourne View and other recent scandals, attention has understandably focused on these headline measures. But curious – to some observers, alarming – changes are being made deep in the detail of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

In the name of “light-touch” regulation, existing rules governing care homes are being pruned and rationalised. Out goes a requirement that homes must inform residents of complaints procedures; out goes a stipulation that homes must offer a choice of food; and out, most extraordinarily, goes a requirement to plan for and have in place emergency procedures. As Judy Downey, chair of the Relatives and Residents Association, puts it: “This seems to us to be pretty disastrous.”

The association, which fights on behalf of people in care and their families, has been struggling to shine a light on the changes. It doesn’t buy the argument that the less prescriptive fundamental standards – which include general provisions for handling complaints, nutrition and “safe care”– will have at least the same effect as the current rules. But it is almost too late to stop the switch.

In the Commons committee that met last week, Labour merely raised a couple of perfunctory queries about the duty of candour and the directors’ test. The shadow health minister, Jamie Reed, said nothing about the dilution of care home rules. The care and support minister, Norman Lamb, said fewer rules would “strike a balance” between effective safeguarding and flexibility in the running of care organisations. So keen were the MPs to get away that Lamb had to stop the chair closing the session before he had responded to Reed’s points.

Care home operators complain loudly, and sometimes with good cause, about being over-regulated. But you have to wonder if this is a good time to go for a lighter touch: only 24 hours before the committee met, the Health and Social Care Information Centre reported that English councils had investigated no fewer than 35,810 allegations of abuse in care homes in 2013-14 – that’s almost 100 every day.

Those responsible for such investigations seem understandably nervous about the rule changes. “We would expect, in all circumstances, that homes will have in place all the elements concerning emergency and complaints procedures, as well as making sure that residents have a choice over what they eat,” says David Pearson, president of the Association of Directors of Adult Social Services. “I am advised that, irrespective of the regulatory regime, these will be key factors in any CQC inspection.”

The Department of Health stresses that this will be the case. The new regulations, to be read in conjunction with proposed CQC guidance, will in many respects be stronger, says a spokeswoman. In stating that a care home resident must have their needs and preferences taken into account, for instance, they will go beyond simple provision of two alternative meals, neither of which the resident may like.

For those who remain unconvinced by such reassurances, there is a last, slim chance to think again. On Thursday, the grand committee of the House of Lords is due to consider the new regulations. It has no power to vote them down, but it could send them back to the floor of the house with a call for further reflection.

From dangerous dogs to child support and housing information packs, there have been many ill-considered statutes that would have benefited from a pause and further thought.