Improving care for older people: Regulation and Inspection'

Driving Improvement in care services for older people explored at national conference.
Findings from Inspection and Regulation highlighted to help improve practice.

Shona Robison MSP, Minister for Public Health, addressed delegates at a national conference in Edinburgh today (29 January 2008). The National conference, ‘Improving care for older people: messages from regulation and inspection' explored how the findings of Inspection and regulation activity can help to improve practice in the care and support for older people in Scotland.

The event at the Edinburgh International Conference Centre (EICC) was jointly organised by the Scottish Social Services Council (SSSC), the Care Commission and the Social Work Inspection Agency (SWIA).

Over 150 delegates, including care service managers, heads of community care planning, people who use services and carers, shared experiences and discussed how the quality of life for people living in care homes can be improved.

Leaders from the SSSC, the Care Commission and SWIA spoke about how they work together to drive improvement through regulation and inspection. Delegates also participated in seminars and workshops on achieving quality through partnership, promoting nutrition in care homes and grading for improvement.

Shona Robison MSP, Minister for Public Health, said: "I am delighted to speak at this joint event organised by the three inspection and regulatory bodies with key responsibilities for the quality of care and the care workforce. Older people in Scotland with care needs deserve the best possible standards of care and support. The Scottish Government has demonstrated its commitment to older people, for example by making dementia a national priority and increasing Free Personal and Nursing Care payments. The work of the inspection and regulatory bodies plays a vital role in identifying and promoting good practice and in improving standards of care. This joint event is an important opportunity for care professionals to share knowledge and expertise."

Speakers at the conference included Professor Mary Marshall, who lectures and writes about dementia and is a member of the Independent Funding Review of Free Personal Care, Alexis Jay, Chief Social Work Inspector, Carole Wilkinson, Chief Executive, SSSC and Jacquie Roberts, Chief Executive, Care Commission.

MRSA in Care Homes and Nursing Homes

Methicillin-resistant Staphylococcus aureus (MRSA) is not only a dangerous, sometimes fatal and difficult to treat disease for hospital patients but also a significant concern in care home settings where residents often have nursing needs. Despite this surprisingly few studies have examined how to prevent MRSA spread among elderly residents in Care Homes according to Carmel Hughes, lead author of a recent review of the subject.

( Check here for other MRSA related publications)

MRSA Risk Factors
The usual antibiotics, like penicillin do not work with the organism MRSA and the problems it causes are compounded by the fact that it spreads very easily, often on the hands of health care workers. Elderly Care Home (Nursing Home) residents can be particularly vulnerable not only because the risk of infection increases with advancing age but also because a proportion of residents will have periods in an out of hospital where they may either pick up or pass on the bug.

In addition to these factors residents in nursing homes also live in close proximity to each other, are often on multiple medications, are susceptible to pressure sores and often have catheters. All of these are factors which facilitate MRSA infection.

The reviewers searched for randomized and controlled clinical trials that focused on infection control interventions in nursing homes. "We found no studies that looked at ways of preventing the spread of MRSA in nursing homes for older people," they report.

Hospitals have isolation facilities and greater access to infection control expertise compared to Care Homes and infection control training is not routinely available in nursing homes.

MRSA control measures in Care Homes
Care Homes (nursing homes) can and must still learn lessons from the existing research; which has been mostly hospital focussed.

MRSA intervention in Care Homes / Nursing Homes should include screening of recently admitted residents to the nursing homes possibly with the assistance of attending GP's. A thorough approach might also need to take account of residents who have periods of hospital admission and the possibility that they may aquire MRSA during these periods.

Staff training in the importance of hand washing and high standards of cleaning and decontamination is very important as are mechanisms to ensure the staff follow such routines. Identifying specific members of staff to take responsibility for promoting and monitoring infection control measures may also help.

Carmel Hughes is a professor of primary care pharmacy at Queen's University Belfast in Northern Ireland. The Cochrane Library is an international organization that evaluates medical research.
Reference: Hughes CM, Smith MBH, Tunney MM. Infection control strategies for preventing the transmission of methicillin-resistant Staphylococcus aureus (MRSA) in nursing homes for older people (Review). The Cochrane Database of Systematic Reviews 2008, Issue 1.

Scotland National Rape Crisis Helpline launched

Scotland will pioneer the first national rape helpine to offer support and information to anyone affected by sexual violence. The Scottish national rape helpline which is being launched today will provide support to victims and help for friends and relatives. The Rape Crisis Scotland helpline will be open seven days a week from 6pm until midnight. The freephone number is 08088 01 03 02.

Neither Scotland or the rest of the UK currently have a national helpline. Current funding levels only allow volunteers to handle phone lines for a few hours two or three days a week. This poor provision was despite the fact that reported rapes north of the Border had risen 8-per cent.

Women who were desperately in need of advice and support often had to leave messages on the answerphones because the helplines were not open. It was feared that this could be deterring women from reporting crimes such as domestic abuse cases.

Scotland's conviction rate for rape is among of the worst in Europe at approx 4-per cent. Reported rapes rose from 596 in 1997-98 to 900 in 2004-05 an 8-per cent increase.

Crerar Review: Public Scrutiny in Scotland

The Report by Professor Lorne Crerar of the “Independent review of regulation, audit, inspection and complaints handling of public services in Scotland” was published on Tuesday 25th September 2007 on http://www.scrutinyreview.org/

The Crerar review concludes there is widespread agreement that Scotland’s scrutiny system is too complex, costly and burdensome on public bodies. From the evidence gathered, Crerar finds that the scrutiny system doesn’t necessarily scrutinise the right things, has grown in a piecemeal fashion and requires strategic co-ordination.

The Crerar report short to medium term recommendations

• a radical increase in the sharing of information and co-ordination
between bodies.
• a renewed focus on users of services
• involving service users in standards setting
• an increased role for parliament
• fewer scrutiny organisations
• accessible reports by scrutiny bodies
• proportionality - focusing on poorer performing service providers and higher risk situations

Crerar Report - One scrutiny body for all?

In the longer term the report proposes moving to one national scrutiny body, one audit body, and one complaints handling body for the whole public sector.

Crerar report - other recommendations

The Crerar report also recommends that –
• Core risk criteria should be agreed by Ministers and agreed by Parliament to assess the need for current and future scrutiny
• Ministers should redistribute resources and functions from within NHS QIS,
the Scottish Government’s Health Directorates and the Care Commission in relation to private hospitals and related treatment – to an independent external scrutiny organisation
• All external scrutiny organisations should have one “status” with clearly defined lines of accountability to Parliament and to Ministers.
• Where scrutiny is needed, if there is more than one existing organisation, only one should be asked to do the work and be fully responsible and accountable. Creating a new scrutiny organisation should not be an option.

Crerar Report: Principles of scrutiny

The focus should shift to self assessment, supported by risk based, proportionate
external scrutiny. As service provider performance management improves in quality
and ability to reassure users, public and elected members, scrutiny can become
more proportionate to the risks, which in turn frees up delivery organisations to focus
further on improving their front line services. The scrutiny framework should –
􀂃 focus on the needs of the people who use services being scrutinised,
􀂃 drive improvement,
􀂃 ensure that public money is used as efficiently and effectively as possible.
The principles behind the system are for a simplified scrutiny landscape, with a
proportionate and co-ordinated approach.

Crerar Report: The future for Scrutiny bodies

The report does not make specific recommendations in relation to the future of particular scrutiny bodies as this was not the remit of the review. However the report does recommend that in the longer term there should be the development of one scrutiny body and this will have implications for a number of existing bodies.

Crerar Report: A Risk based and Outcome focussed approach to Scrutiny?

The report argues strongly for scrutiny which is risk based and which moves away from scrutinising inputs and processes and towards measuring outcomes.

The full report can be downloaded at http://www.scotland.gov.uk/Resource/Doc/82980/0053065.pdf

Healthcare associated infections study

National Healthcare Associated Infections (HAI) Point Prevalence Survey

This survey, carried out by Health Protection Scotland, is the most
comprehensive study ever undertaken into the extent of infections in Scotland
and leads the way in HAI research in Europe.

The survey recorded the presence of all types of infections in one day for every patient in every acute hospital. The survey found that the prevalence of HAI was 9.5 per cent in acute hospitals
and 7.3 per cent in community hospitals and the cost of these infections was approx. £183m per
year.
The study found that the highest numbers of HAI in acute hospitals were present in care of the elderly, medical and surgical wards.
The HAI task force will take these findings forward and is focusing on the following areas:
• examining the case for introducing an MRSA screening programme - targeting skin and soft tissue infections
• reducing blood stream infections
• ensuring additional surveillance data are put to use in the areas of general medicine and care of the elderly.

Vulnerable Young People transitions research

Scottish Executive: Review of Research on Vulnerable Young People and Their Transitions to Independent Living

The Scottish Executive has published a Review of research on vulnerable young people which was conducted by the Centre For Research on Families and Relationships, The University of Edinburgh ( Authors; Susan Elsley, Kathryn Backett-Milburn, Lynn Jamieson) The Full report is available from www.scotland.gov.uk/research

The report examines available research and data on the issues around vulnerable young people and their transitions from care to indepenedent living.

Recovered memories of abuse:new research

New research suggest that memories of abuse recovered through therapy may be less reliable than memories which are recovered spontaneously.

Some years ago an intense debate began about the reliability of recovered memories of abuse when a number of very high profile cases hit the headlines in a number of coutnries. In some of these cases memories of abuse had been recovered through intensive therapy and there was much debate whether such memories could be relied upon as accurate recollections of past events.

The whole issue of the reliability of recovered memory became a very hot topic in the fields of psychology and psychiatry with fierce advocates on both sides.

Elke Geraerts, a psychology post doctoral researcher at Harvard University and Maastricht University, the Netherlands, aimed to try to throw light on this problem using a large-scale research study designed to test the validity of such memories.


Of course people who recover memories in this way will tend to be convinced they are real authentic memories and this makes validating the recovered memories difficult.

Geraerts and her colleagues avoided this problem by using outside sources to corroborate the memories.

The researchers recruited people who reported being sexually abused as children.

They divided them into three groups.
1) Those whose memories were categorized as either "spontaneously recovered" (the participant had forgotten and then spontaneously recalled the abuse outside of therapy, without any prompting),
2) those whose memories had been "recovered in therapy" prompted by suggestion

3) those whose memories ofthe abuse was "continuous" in that they had always been able to recall the abuse.

Interviewers, who had no knowledge of which group the subject fell into, then interviewed other people who could confirm or refute the abuse events. these included others who heard about the abuse soon after it occurred, others who reported also having been abused by the same perpetrator, and those who admitted having committed the abuse.


The results to be published in the July issue of Psychological Science, journal of the Association for Psychological Science, showed that,

1) overall, spontaneously recovered memories were corroborated almost as often (37% of the time) as continuous memories (45%) but were less reliable.

2) memories that were recovered in therapy could not be corroborated at all.

Of course not being able to of confirm that the abuse had happened does not prove that the memory is false. It does however suggest that memories recovered in therapy need to be treated with a great dela of caution, as the therapy context raises the opportunity for suggestion.
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Source: news release issued by Association for Psychological Science.