The Community Gateway CIC responds to CQC's report on the 'State of Care' and how care and support can be personal and safe

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The Community Gateway has launched a 'solution roadmap' promoting choice and control so it services can be both personal and safe. The Care Quality Commission published its report in to the 'State of Care' in England. The report highlighted 23 per cent of the homes and hospitals visited lacking adequate staffing levels. Tens of thousands of Britain's most vulnerable people are at risk from "poor or unsafe care", with one in five care homes failing to ensure residents eat properly, the government's watchdog said on Friday 23 November 2012.

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I believe it's of paramount importance for the betterment of Service Users, a less well known secret is told. It is a right that Service Users have the right care and that agencies who provide good quality care have a level playing field to operate on.

The insight provided by the Serious Case Review in to Winterbourne View for South Gloucestershire, authored by Vic Citarella and Margaret Flynn of CPEA, provides great insight in to many of the issues Community Gateway see as pertinent to community based care also. Health Secretary Jeremy Hunt said: "There can be no hiding place for those providing poor care or sub-standard practice." Community Gateway say that this is only half the story and that actually yes there is a hiding place, if care moves to the community sector which can be very positive, if like any service it is not managed correctly. Community Gateway has developed a number of solutions to ensure Hunts statement becomes a reality not an empty promise - so that there will be no hiding place - and Community based carer is safe and personal.

The Community Gateway CIC has put together a video which Executives in Commissioning organisations should pass to their Managers and Heads of Service to watch, who are concerned about the report findings and wish to increase the safety of personalised care in the community. Part one is embedded in this release with part 2 and 3 of the video on The Community Gateway's own website. A number of solutions as can be seen on the solution roadmap, and have been developed to help commissioning organisations and providers to better embed information advice and guidance services leading to improved signposting, improved outcome focussed reablement and intermediate care services, supported by the mainstreaming and embedding of Telecare. Community Gateway has also, as show in the webinar video, developed a unique approach to commissioning Learning Disability services for outcomes, and providing the ideal platform for payment by results.

The jailing of 11 care workers last month covered in both BBC News and Community Care (Community Care article, Kirsty McGregor article, 29 October 2012, 10.38) for neglect and abuse at the Winterbourne View Hospital for adults with severe learning disabilities, comes as no comfort for people right now with loved ones in residential care. The truth is that as the Panorama report highlighted, some people are 'bullied' using legislation and powers for people to be 'sectioned' and are as a result placed in care which is wholly inappropriate and inadequate - sometimes called 'warehousing'.

Chris Haynes, Interim Commissioner says "Warehousing is sometimes perceived incorrectly as easier and more efficient and cost effective and usually commissioned in response to failure demand management. This can understandably lead to challenging behaviours, created by the environment and not the individual."

Vic Citarella of CPEA, the organisation who conducted the Serious Case Review in to Winterbourne View supports Haynes' comments "Contrasted with supported living, which can be a great deal more rewarding for those in care, within the community as opposed to hospital based and in residential or nursing care can, and often is a great deal more positive. Community based care can be a far more appropriate form of care for the right people, where the support is provided well, and for many is certainly the best place to be."

David Behan, CQC Chief Executive, said: "Where we find standards are not being met we require improvements and we will use our enforcement powers where necessary to tackle issues such as staff shortages or the failure of service providers to involve people in decisions about their own care." Community Gateway suggest however that this where one of the issues lie with community based care, if not commissioned and managed correctly.

Nathan Downing, Director of Community Gateway says "A well kept secret and why Behans and Lambs promises may be empty unless this advice is heeded, is that a great deal of care provided in the community in supported living can be just, if not even more challenging to monitor. Sometimes driven by pricing which is unrealistically low and in some cases, staff shortages in both community and residential based care leading to the practise of agencies moving care workers arround between supported living environments, meaning that less than the commissioned care is actually being delivered."

Community Gateway reports that this could mean that inadequate medication, nourishment, or recreational and community opportunities are provided, which is still being paid for by both the authority and family or service user through charging. In other words, some Care Agencies are billing and invoicing for time they are commissioned to deliver but never actually provide. Community Gateway has through several projects found that some agencies will then pay staff less based on a lower amount of time that care workers submit on their actual time sheets, even though the agency bills the full amount of commissioned care. This clearly does not provide a level playing field for the majority of providers playing by the rules and where the unit prices are paid at a sustainable level.

The Community Gateway CIC is a 'not for profit' social enterprise which works in the areas of implementing solutions that provide improved safeguarding, improved visibility of service quality, and commissioning for outcomes and payment by results.

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Richard Haynes
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