Of misplaced trust. Of bureaucracy & cover-up. Of a social care system paying lip service to the needs of Scotland’s most vulnerable.
Extract V: Scotland’s hippie dippie Care Inspectorate
From the sitting room window, I watched the RSPCA van pull into the care home car park. On impulse, I smiled and waved in its general direction then saw that I might be regarded as one of those poor people I’d seen staring bleakly at passers-by through care home windows. Not waving but drowning, I’d thought, waving cheerily back but wishing I could do more. It turns out I was right.
“If only they could take me too!” I said, turning to address the room’s only other occupant and pointing towards the window. “The RSPCA!”
The room’s only other occupant didn’t look up but seemed to smile. Or was that a grimace, even a grrrrrrrrrrimace through gritted teeth! I couldn’t tell. She carried on, head down, flicking through pages in the file balanced on her knees, ticking boxes, it seemed. She was from the Care Inspectorate. And, I’d been told to be on my best behaviour.
I’d been told, also, to tell the woman from the Care Inspectorate, “It’s great that places like this exist!”
Three days this week, in the lead-up to the Care Inspectorate’s visit, we’d done role play with Liz, the part-time activities coordinator. Liz took the role of the Care Inspectorate inspector which seemed to require her to pull on a black wig and smile at each of us in turn, saying, “Hello, how are you?”, to which, we were to reply, “I’m fine thank you. It’s great that places like this exist!”
Fran said, “Nobody puts words in my mouth! I’m saying nothing!” and the rest of us murmured in agreement.
“Shouldn’t we be saying, it’s great that this place exists?”, George wondered. “It doesn’t sound right if we’re glad that places like this exist. It’s as if we’re not fully behind this particular place.”
All but Liz, the part-time activities coordinator, agreed with George’s every sentiment. She thought it wrong to change horses mid-stream. She said so!
I tried out the line on my son when he came to take me for tea.
“It’s great that places like this exist!”, I said, apropos of nothing and, perhaps, without sufficient sincerity and we creased up at the thought of anyone trying to brainwash me … and, presumably, the Care Inspectorate … and came up with our own variant. I daren’t disclose what we thought I should say and, in the event, the woman from the Care Inspectorate showed no interest whatsoever I me so I had no opportunity to let her know.
I sat down in an armchair close enough to watch the woman from the Care Inspectorate in action, as it were. Authority figures fascinate me. Poor deluded fools who think they know better than the rest of us! Someone ought to tell them!
“I’m Elle!”, I said. The woman from the Care Inspectorate was too busy to reply. She wore a laminated card on a ribbon round her neck. I couldn’t read her name from where I sat.
Since moving into the care home, I’ve taken to sitting with my fingers crossed, hoping that the overgrown elm in the garden would land on the building and put us all out of our misery. Or, short of that, that the porridge pot would explode and rip apart the kitchen, preferably before they start serving breakfast, so that the whole dump can be officially declared unfit for human habitation, that sort of thing. For, it is a dump, this care home. And, I don’t know why the council keep sending people here, to be frank, or why the Care Inspectorate doesn’t seem to notice. As for the owner, we won’t go there!
“Why don’t you come and stay a while?”, I suggested. “I wouldn’t recommend the food! And, you’d need to take care in those heels not to trip on the worn carpets. But, don’t let me put you off.”
Head down, Mrs Inspector continued smiling/grimacing.
“By the way, I wouldn’t sit in that chair, if I were you.”, I said, leaning froward and lowering my voice. “Some poor soul had what’s called an accident in it a few days ago. The smell has lifted but they haven’t cleaned it yet! I don’t expect them to!” All his was factually correct but Mrs Inspector wasn’t listening. She’d zoned out, as they say.
When I said, “You could do with losing some weight!”, scrutinising her with one eye closed, she looked directly at me for the first time, quite expressionless, as she got up! I uncrossed my fingers just for the moment and smiled.
“I’m Ellie!”, I said to her back as she left the room.
My son says that Care Inspectorate inspectors have no incentive to engage with care home residents on inspection visits for fear of being made aware of something they’d actually have to investigate and that they prefer to be blissfully ignorant or, as he calls it, “wilfully blind”.
The most fun I had in that care home … or hell-hole as my son calls it … was reading aloud with Annie and George and Margaret the ‘residents’ feedback’ in Care Inspectorate reports my son printed out and trying to guess which area of Scotland the care home must be in.
It doesn’t take a genius to know that Scotland is a melting pot of accents and that, for a multitude of reasons, people end up in care homes nowhere near the place of their birth and they take their accents with them.
We decided that the Care Inspectorate employs someone to sit in their fancy offices in Dundee … or at their kitchen table, now that they don’t even bother going in to work … to come up with likely-sounding phrases that they run through a dialect app to transform them into likely-sounding pieces of Doric, Lallans, Morningside, or Dundonian vernacular to fool us into believing that they take an actual interest in care home residents. It keeps people in a job, I suppose!
But, there is a serious side to this which the Care Inspectorate don’t recognise: the risk of the most vulnerable residents feeling the need to pick up local slang used by staff in order to ‘fit in’. With hindsight I can see that, when I was abused in the care home of which I was expected to say, “It’s great that places like this exist!”, I developed coping mechanisms to get by including mimicking the staff’s coarse vernacular for it made them laugh. I reasoned that, if I were popular, I’d be a less-likely target for abuse. The thought that my abuser would turn their attention from me and focus on one of my fellow-residents is something that haunts me to this day!
BetterCareScotland’s data, from the lived experience of our subscribers – care home residents, their family members and friends together with care home staff, former and in-post social workers, and Care Inspectorate staff who dare not blow the whistle for fear of the consequences – show that Scotland’s Care Inspectorate lacks the professional expertise expected of a serious regulator.
By actively seeking to recruit people with “soft skills” when risk management, governance, regulatory and compliance expertise and technical and analytical skills and experience are needed, we find a Care Inspectorate with historical leadership issues and an organisation that has lost its way so completely that it is now fully out of its depth.
Our analyses find that Scotland’s social care regulator has a consistently-high fail-rate in targeting care homes which pose the greatest risk to the wellbeing of residents and staff. This is unacceptable in a care sector that can, literally, bury its mistakes.
It leads us to question whether Scotland’s Care Inspectorate plays a meaningful role in uncovering issues in the delivery of care. And, if this is by design or outcome – for Scotland’s Care Inspectorate does not operate in a vacuum. And our subscribers’ experiences suggest that it fails to act independently of local authorities when things go wrong.
We test the hypotheses that the Care Inspectorate is fair and consistent and recognises the key-risk-indicators in residential care provision for older people for we find evidence of it failing to target commercially-unviable care homes for older people that are strategic-fits for local authorities despite the risks to residents and staff from under-resourcing when the care provider has no economies of scale on which to draw.
BetterCareScotland asks, also, if the Care Inspectorate fulfils its statutory obligation to act independently of local authorities in High Level Investigations or if it is incentivised to close ranks and follow the local authorities’ lead. And, therefore, if the Care Inspectorate in its current form adds any value whatsoever to social care delivery and provision processes for older people in Scotland.
SCOTLAND’S HIPPY DIPPY CARE INSPECTORATE
The recently-retired chief executive of Scotland’s Care Inspectorate claimed that the “soft skills” of the Care Inspectorate’s staff enable them, in some hippy dippy way it seems, to “sense” when things don’t feel right on inspection visits to care homes for older people in Scotland.
BetterCareScotland’s data show that the Care Inspectorate’s crystal ball doesn’t work!
Email BetterCareScotland for a copy of our February 2021 research paper for Scotland’s Parliament,
HOLDING SCOTLAND’S CARE INSPECTORATE TO ACCOUNT?
A critical evaluation of Parliament’s scrutiny of Scotland’s social care regulator!
SO LAST CENTURY
In general, our data indicate that the Care Inspectorate’s philosophy, operations and methods are ‘so last century’. By way of example, during the pandemic, the Care Inspectorate produced fortnightly reports for Scotland’s Parliament from which nothing can be ascertained or comparisons made or conclusions drawn from one report to the next. At a time when Scotland’s decision-makers needed key facts and reliable hard data that could be eyeballed by busy people, the Care Inspectorate supplied bed-time stories.
What these fortnightly reports do provide, however, is an insight into the Care Inspectorate’s inconsistency of approach on inspection visits, a common complaint of care home managers. We see this as evidence of ill-discipline which no well-regulated sector should observe of its oversight bodies when confidence is needed and springs from the Care Inspectorate’s reliance on “soft skills” which, by their nature, create bias and subjectivity where certainty is key.
By extracting the information content from these fortnightly reports, BetterCareScotland has produced the sort of meaningful data Scotland’s Parliament should have expected to receive. It is an irony that, despite BetterCareScotland’s resource constraints, our data are superior to those of the regulator of Scotland’s social care system.
LET BETTERCARESCOTLAND KNOW
If you have concerns about the response you received from Scotland’s Care Inspectorate when you reached out, let BetterCareScotland know!
We will protect your information and will not share it with others.
If you prefer to remain anonymous, you can tell us of your experiences by completing only the ‘Message’ box of the feedback form on our website’s Home page.
Love and Peace!
“There is no greater agony than bearing an untold story inside you.” … Maya Angelou
Help to ensure that the vested interests and perverse incentive structures in Scotland’s social care system can be be designed out of the National Care Service so that the Scottish Government can deliver on its promise of good care outcomes, as standard, for all people in need of care in Scotland.
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If you prefer to remain anonymous, you can tell us of your experiences by completing only the ‘Message’ box of the feedback form on our website’s Home page.
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Love and Peace!