Sarah Baker case and the funding of care regulation

The case of Sarah Baker, the former drug addicted manager of Parkfield Care Home in Somerset, who has been convicted of the manslaughter of an elderly resident and theft of residents drugs should sound a serious warning bell for all political parties as they contemplate levels of funding for care services regulation after the election.

There has been a trend in the last few years, and a highly naive one in the view of this blog and in the light of the failure of regulation of the financial sector, to take the view that regulation of all forms can be drastically scaled back and the risk "transferred" back to the providers of care services by relying increasingly on a self assessment and self regulation model - with the regulator scaling back direct inspection drastically and "verifying" these activities.

While some movement in this direction is a healthy thing, there is, as is often the case in social care, a terrible tendancy to throw the baby out with the bathwater. The Sarah Barker case illustrates in the starkest terms the perils that lie ahead if a future government, under the excuse of "better regulation" , seeks to drastically reduce the funding for care regulators and leaves a mere rump which will "validate self assessment" and deal with complaints investigation after things have gone wrong.

The case illustrates why effective and in depth regulation directly at the service unit level is so vital and why models which relies too much on how the "organisation" is performing are deficient.  The only real way of testing if good quality care is being delivered is by actually going out and looking at it in detail.

Even in the best regulation system there will be severe cases like the Sarah Barker case. Nothing is more certain though than that we will see more and more of these cases if governments look to make "easy" savings by cutting back on regulation in this area.  Regulation can and must be made efficient and good risk predictor models developed so that intervention can be targeted. Self assessment can and should be encouraged and providers and services with a good consistent record can and should get a lighter touch.

But we should be acutely aware that as we tread this path the risks of more serious incidents in the care sector will rise significantly. The process of modernising regulation needs to be handled incrementally and with caution. Government needs to think very carefully before it abandons effective regulation and makes swinging budget cuts that will limit the ability of the Care Quality Commission (and the Care Commission in Scotland) to carry out effective regulation.

Doncaster Chidrens services enquiry ordered

Children's Minister Beverley Hughes is reported to have written to Doncaster Council to express concern linked to serious case reviews were ordered into the deaths of seven children in the area. Ofsted recently rated Children's Services in Doncaster as among the worst in the country and criticising their arrangements for protecting children as inadequate.
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Seven deaths are subject to serious case reviews with two children murdered by their fathers. Four of the children were less than one year old when they died.

16 month old Amy Howson died had her spine was snapped in two by her father, James Howson, 25. He was found guilty of murdering his daughter and told he must spend a minimum of 22 years in prison. The mother, Tina Hunt admitted cruelty and was given a 12-month suspended sentence.

The findings of three reviews on the deaths of children who were abused or neglected have already found that social workers missed chances to intervene. one review described the Children's Services department as chaotic.

Child & Youth Care Network Learning Zone Launch

The International Child and Youth Care Network provides a free online portal for Child and Youth Care practitioners ( including foster parents) to share discussions and issues and learn from colleagues. They recently launched a new free learning resource – The Learning Zone Network which offers free online learning modules.

Chairman of the Board of Governors of the Network Leon Fulcher, MSW, Phd, recently launched the new “The Learning Zone Network”.

The Learning Zone Network provides “an in-service education initiative for Child and Youth Care workers and Foster Parents seeking quality professional e-learning opportunities. Offered over the internet these courses provide the opportunity for self-paced learning in a flexible format using the latest technologies (video, audio podcasts, etc.).”

Access to the material on the Learning Zone Network is free.

Those working in Child and Youth Care may wish to sign up for the International Child and Youth care Network and Learning Zone. The Learning Zone offers a unique modular online environment for learning and development in Youth and Child care work.

The short learning modules on the Learning Zone are very interesting. They are video based ( you will need to use a computer which is Flash enabled) and allow you to test your observational skills – but be warned they are not easy!

Access at www.cyc-net.org/

The death of light touch regulation?

The current global financial crisis unavoidably raises questions about the general rush towards "Light touch" regulation that has been a feature not only in financial regulation in the UK but also in the general UK approach to regulation.

The move towards light touch regulation may not have started in the Blair years but Tony Blair made clear during his premiership that his concern was to ensure that regulation did not get in the way of business. Indeed regulation was seen almost as an obstacle to the efficient functioning of business.

This agenda was, of course, driven in part by the self interests of the business lobby, many of whom saw regulation not as the legitimate exercise of control by society on their conduct but as an impediment in their pursuit of "efficiency".

We have now seen the consequences when regulation becomes so light touch that it fails to adequately grapple with the risks arising in a regulated sector. The consequences for us all following the clear failure of financial regulation will be serious and long lasting.

This pressure for light touch regulation has been all too apparent in the care sector with care provider representatives often pressing for a significant reduction in regulation and painting it solely as a burden.

In the care sector a significant failure of regulation might not have national economic consequences but it may have profound consequences for the lives of people who are being supported by care services. In the worst case scenario people may die because of inadeqaute checks of safety critical systems. They may suffer abuse through inadequate management control, training or recruitment of staff. They may suffer long term blight on their lives through the drip drip corrosive effect of care which is sub-standard.

While we should no more accept inadequate regulation of care services than we should of financial markets this is not a call for highly bearaucratic regulation. That is the opposite extreme and would be as equally destructive of good quality care as a lack of regulation.

What is need is risk based and proportionate regualtion. This is not the same as light touch regulation. Light touch regulation implies that the regulation system aims to touch lightly on all providers alike. This may not always be what is desired but this is too often where talk of light touch regulation takes us.

In contrast to this, a risk based and proportionate regulation system will be focussed on assessing the risks in the regulated sector and distinguishing and intervening in those areas where the risk is highest. It means reducing the regulatory "footprint" on services which are demonstrably of good quality - but increasing it in where risk oor poor performance is apparent.

A move away from "cyclical" inspection has been apparent recently, for example as recommended by the crerar review in Scotland. There is little doubt that standard cyclical inspection can often safely be reduced but great care must be taken in moving in this direction.

If regulation is to be calculated on the basis of risk and be proportionate this can only be on the basis of intelligence. It is vital that some of this intelligence is collected first hand so that the regulator does not have to rely excusively for extended periods on information provided by those who are regulated. This has serious implications for the extent to which frequency of inspection can be reduced in the care sector and regulators must ensure that frequency does not reduce to the extent that they may no longer have reliable information on which to make risk assessments.

Rose Park Care Home Fire tests Scots Law

The Crown Office has announced that it is to launch a third attempt at a prosecution of the owners of Rosepark Nursing Home (Care Home) were 14 residents died in a fire in 2004.

Two previous attempts at a prosecution have floundered because of technicalities with Scots law which have so far resulted in the failure to hold anyone properly to account for the Rosepark care Home fire tragedy.

A first attempt at a prosecution foundered when the trial judge Lord Hardie ruled that it was only possible for the alleged offences to be carried out by employers, and he ruled that the three owners of the home who had been named in the indictment were not in fact employers in law.

Later in July 2008 a second attempted prosecution failed, this time because the indictment named the partnership as the legal entity in the indictment. The partnership had however at that time been dissolved and the prosecution could not proceed because having been dissolved the partnership no longer had any legal identity.

A third prosecution is now being attempted against Thomas Balmer, Anne Balmer and Alan Balmer in their capacity as the surviving partners of the dissolved firm of Rosepark Care Home.

The Crown Office said that "The whole surviving partners are indicted in their representative capacity only and not as individuals."

Also named on the indictment are Croftbank House Limited, formerly Balmer Care Homes Limited.

The Crown Office stated that "In Scots Law, a firm is a separate legal person distinct from the partners of whom it is composed. The Appeal Court held that on dissolution of the firm there was a complete cessation of the persona of the partnership (that is the separate legal person) and that a dissolved firm did not retain a limited persona for the purposes of criminal prosecution which could be prosecuted in its own name."

A Preliminary Hearing on the new indictment is to be held at the High Court of Justiciary in Glasgow on the 30th October 2008.

The relatives of those who died will be impatient to see a proper court examination of the occurrences around this fire. It is vital that the court proceeds with examining whether those charged with the duty of looking after their relatives safely fulfilled their responsibilities. It would be a sad day for justice in Scotland if this third prosecution also fell on a technicality and prevented the bereaved seeing those involved in the ownership and provision of this care home called to account.

This case must also proceed because otherwise it will become clear that other owners of care homes can by means of dissolving their partnerships or companies avoid being held to account for their actions.

23 Social Workers had inappropriate relationships

The General Social Care Council has recognised that "inappropriate relationships" are one of the main areas of concern in the regulation of Social Work and Social care professionals in England. A report published today by the General Social care Council the body that regulates Social Workers and Social care professionals in England reveals that around 800 people have been refused professional registration and 23 people have been barred from practice by the social work regulator in the last five years.

The report ‘Raising standards: social work conduct in England 2003-2008’ which is published today is the first to address conduct activity since the General Social Care Council began registering social workers in 2003.

The report reveals that up to 31 March 2008:

214 people were refused registration by an independent committee, following issues relating to criminal convictions, health conditions, disciplinary matters etc.

582 people were refused registration on the basis of qualifications.

40 complaints about registered social workers or students are received on average per month.

There have been 49 independent conduct committee hearings resulting in 23 removals from the register, five suspensions and 19 people receiving an admonishment. In only two cases was no misconduct found.

Of concern is that over a third of all cases heard have concerned inappropriate relationships between social workers and people who use services or their family members. The Code of Practice for Social Care Workers is clear that social workers must not form inappropriate personal relationships with service users.

Sir Rodney Brooke Chair of the GSCC, said:
“Misconduct is very rare, and the majority of the 97,000 social workers and students carry out their work with true professionalism. Our report shows that where misconduct does exist, we have been able to take appropriate action to preserve public trust and confidence in social care services.

“Our first hearing took place just two years ago yet in that space of time we have been able to embed the standards expected of social workers through the Code of Practice and identify key issues such as those relating to inappropriate relationships.

“Perhaps more than any other profession, social workers should be acutely aware of the boundaries that should be in place in terms of their relationships with people who use services, their families and carers. Social workers must recognise and use responsibly the power that comes from their work, and ensure that nothing impairs their objectivity and ability to make sound judgements. Inappropriate relationships can potentially put people who use services at risk and we intend to work on a project to develop additional guidance.”

New Autism research Challenges traditional views

The traditional view of high end Autism has been that it arises in large part because of problems that the Autistic person has with responding to others - that the Autistic have an impaired ability to comprehend "the other".

Recent research findings published in the journal Neuron by Baylor College of Medicine researchers now turn this traditional view upside down.

The research appears to show that individuals with high end of the autism spectrum disorder actually have an inability to model "self" which causes a disability in understanding the world as a whole.

Dr. P. Read Montague Jr., professor of neuroscience, and director of the Human Neuroimaging Lab and the Computational Psychiatry Unit at BCM used a functional magnetic resonance imaging (fMRI) scanner to scan the brains of "high functioning" autistic individuals. The research found a "signature" in the brain that identified those with autism. This level of activity correlated with the severity of the autistic symptoms. The less activity - the more serious the symptoms. This could result in a test which would speed diagnosis.

The team used a technique called hyperscanning, developed in Montague's laboratory, which allowed them to scan two brains simultaneously while the research subjects played a trust game.
One player received an amount of money and then had to send whatever amount he or she wanted to the other player via a computer message. This amount is then tripled the second player then decides how much of this tripled amount to send back. The game is played over several rounds.

Previous work had shown that an area called the cingulate cortex was where most of the activity occured during the trust game.

The researchers compared the brain responses of normal subjects with "high functioning" autistic subjects and found that the autistic subjects did not play the game differently from their partners, who were taken from a population of similar teens without autism. Both groups of subjects made similar amounts of money overall and round by round.

However, the scans revealed that the the autistic youngsters' "self" responses were dim compared to normal subjects and the more severe the autistic symptoms the dimmer the response.

It was clear that the Autistic subjects cognitively understood the game but had a very low level of 'self' response which correlated with the severity of their autism.

"To have a good self concept, you have to be able to decide if the shared outcome is due to the other person or due to you," said Montague. "If people can't see themselves as a distinct entities at deeper levels, there is a disconnect."

Chris and Uta Frith (University College London) writing in the journal Neuron said, "This is an exciting result because it suggests that some mechanisms of social interaction are intact in these high-functioning cases. What is the critical difference between the self phase and the other phase? We believe that the simple distinction of self versus other is not adequate. "It involves higher-order mentalizing: you care what another person thinks of you, and even further, you care that the other person trusts you. You would not do this when playing against a computer. In autism there is no difference".

Further research to test the "model of self" aspects of Autism are anticipated which may throw light on the contribution of this deficit with people who are less high functioning. This research may also suggest intriguing possibilities for other ways in which to help people with autistic spectrum disorder.

Research published February 7, 2008, journal Neuron, (Cell Press. )

Autism Publications