Belfast Telegraph

Sunday 20 April 2014

Are frontline carers carrying can for care home cutbacks?

Power vacuum: the management of Ralph’s Close was flawed but Edwin Poots has focused his investigation on frontline staff

It emerged last week that the Western Health and Social Care Trust (WHSCT) has suspended a number of employees following allegations of maltreatment of residents at a Derry care home.

All of those suspended are frontline staff. No one at management level, or any official of the WHSCT, is included.

Investigations now underway by the trust and the PSNI focus on specific allegations brought anonymously to the trust. It is possible that disciplinary proceedings will follow, or even, potentially, criminal charges.

However, no investigation appears to have been undertaken into the possibility that the collapse in standards of care at Ralph’s Close had as much, or more, to do with management failure as with staff behaviour.

Ralph’s Close, in the Gransha complex, is designed to provide residential care for 16 adults with a range of learning disabilities.

The lack of focus on management seems surprising, given publication in the Belfast Telegraph last week of details of five ‘failure to comply’ notices issued by the Regulation and Quality Improvement Authority (RQIA) following unannounced visits to Ralph’s Close.

Taken together, they identify 26 ‘specific failings’. All of the failings appear to be wholly, or partly, failures of management.

An intervention by the health minister, Edwin Poots, on Monday seemed to imply that it was only staff on the ground who must be called to account.

Mr Poots urged workers with any knowledge of abuse to come forward and announced that Ralph’s Close was now being independently monitored “on a 24/7 basis” to ensure that any further abuse couldn’t go undetected.

This seemed to some workers to miss the main point: “Most of the issues highlighted by the RQIA are to do with structures, staffing, staff appraisal, training, supervision, reliance on the use of agency nurses and so on,” said one yesterday.

“If those issues aren’t at the heart of any investigation, we won’t find out what went wrong. But that means looking at policy decisions at the highest level and targeting management as well as people on the ground.”

One of the most telling items recorded by the RQIA referred to an unannounced visit to Ralph’s Close in July: “At the time of the commencement of the inspection (10am), the manager of the unit had been on duty from 12 midnight. The manager remained on duty throughout the inspection until 3.15pm and appeared physically unfit to effectively manage the home.”

The person identified here as the manager was not, in fact, registered as a manager. He was a ‘Band 5’ worker slotted into a ‘Band 7’ position.

Or, to put it another way, the trust was getting managerial work done at non-managerial rates, resulting in arguably inappropriate staffing of a challenging, sensitive and highly responsible position.

The staff member concerned was entirely blameless. Whether the same can be said of those who put him in the position is a different matter.

The RQIA noted: “The manager reported that the required staffing complements had not been achieved despite his repeated representations to the trust regarding the inadequacy of staffing levels ... There was no evidence that staff capability or competence assessments had been carried out.”

Some of the problems can be traced back to a major reorganisation over the past few years of health service staffing and pay structures under the heading ‘Agenda for Change’.

As part of this exercise, in 2008 a number of WHSCT residential care staff with Band 7 qualifications were told that their roles were being re-designated Band 6. This meant a cut in pay from £29,789-£39,273 to £24,831-£33,436.

Six of the workers opted for redundancy, instead, leaving some of the gaps in the mix of experience, skills and qualifications seen in the problems which were to accumulate at Ralph’s Close.

The most relevant change came when the Band 7 worker who had been running Ralph’s Close was replaced by the Band 5 worker observed by the RQIA to be “physically unfit to effectively manage the home”.

His next-in-line on the day of the RQIA visit was a senior manager at Band 8 (£37,996-£ 54,714) level. There was a gap above him; little support around him.

In effect, say the workers, in practice, on a day-to-day basis, whatever remaining staff were available were left to run Ralph’s Close as well as they could. If this wasn’t good enough, it can hardly have been entirely their fault.

There is no reason to suppose that the circumstances at Ralph’s Close are unique. There is a crying need for a wider-ranging and higher-reaching inquiry than has so far been contemplated.

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