08th February 2017

Welsh Lessons Through a Lens: the 2015 Flynn Report

A strong Welsh legislative and regulatory framework is currently forming, to govern the commissioning, and delivery of social care. However, one important report which develops our understanding of good practice in the sector deserves more attention. The Flynn report was a 2015 Welsh Government report following a police operation called Operation Jasmine. This was a £15 million Gwent Police investigation, commencing in 2005, following 63 ‘cause for concern’ deaths of frail older people with compromised mental capacity.

In its Executive Summary it presented;

“…an insight into the people and organisations involved, an overview of the findings and analysis plus the recommendations. It concludes with six ‘lessons for the future’ of older people’s residential care as requested by the First Minister.”

For me, it delivers hugely powerful insights which feel more cogent and realistic, less mechanistic if you like, than many government reports. From these, it appears possible to see a pathway to good practice and humane care standards. I present below the six ‘lessons,’ the subsequent discussion and my own thoughts in italics.

Flynn Report Lessons

  • Scandals fix nothing permanently.

The answer cannot reside in an exhortation to read 106 lessons, in rare and piecemeal interventions or a plan to avoid mistakes. It lies in understanding the complexities of the care home infrastructure and the associated business models - as well as in employing talented and competent managers to recruit, supervise and train staff to support frail older people in homes that are their workplaces.

For me this exhortation to understanding the whole sector, its ethos, values and dynamics is critical to making real and sustainable progress in raising standards of care.

  • Citizens cannot rely on the conscience of care home owners to deliver valued care and support to frail older people.

Good governance is critical to quality and safety in homes for frail older people as well as residents being and feeling embedded in relationships - with their relatives, friends and advocates and with health and social care practitioners and the wider agencies - of which they are a part. All should insist on participating to ensure that there is a window so that residents can look out, the community can look in and there is scope for residents to be and to feel part of their neighbourhood.

I feel that this involvement of care homes within the broader communities, to which they belong, is one bulwark against them becoming mini-institutions with all the associated risks that this presents.   

  • It is assumed, without evidence, as acceptable practice, to group older people with dementia together in particular homes, without sufficient staff who are inadequately managed, trained and supervised, on the grounds that they all have similar needs.

Since the growth of the sector has preceded reflective research to guide its structure, function and direction, the investigatory attention of the media has been instrumental in highlighting the consequences of the deficient practices (including planning processes which advantage developers), it is up to;

  • commissioners to engage with the reality of the impoverished lives of too many residents with diminishing capacity and
  • the sector to demonstrate the effectiveness of their interventions and support arrangements, including how a culture of valued relationships may be nurtured, for example.

I feel that good training, not just what has historically provided, is key in realising this goal. So much training fails to engage in the reality of both clinical diagnosis and personal experience that it misses the point.

  • Older people’s injuries, pain and life-threatening deep pressure wounds were unobserved, unreported, reported inaccurately and/or reported belatedly – and yet, in this case, no crimes were identified by the Crown Prosecution Service.

The rhetoric of concern has to be matched with credible action. It is essential that all necessary clinical care is provided alongside timely processes to identify ways of preventing further harm – which must include prosecution.

This suggests widespread cultural and leadership failing to me. Care staff who are overwhelmed by workload and those who have simply never seen good care are much more likely to perpetuate such negligent practice.  

  • The public sector should not underwrite companies which have produced considerable rewards for the few at the expense of the many.

This means that local authorities and the NHS have to demonstrate long-term prudence, pool their learning from older people, families and research, build on their knowledge of the strengths and weaknesses of the whole sector and combine their purchasing power. Being explicit about what they will commission and why - should herald a new relationship with older people, their families and providers.

An end to hands-off commissioning, where provision is assumed to be good enough unless the inspectors say otherwise. If a stake-holding approach is to work all stakeholders must be truly invested in their involvement.

  • Private interest pursued at the expense of others has a long history, however the public interest cannot be subordinate to the short term personal gains or even the criminality of a minority of directors of care homes.

The external scrutiny of the care and support of older people by commissioners, care managers and regulators should be matched by ensuring that companies in this sector open their boards to independent scrutiny. A lasting achievement of Operation Jasmine has to be a readiness to adopt a long-term view. Companies which have demonstrably failed older people should be allowed to fail and their directors should be disqualified. They have depleted public trust. The needs of frail older people cannot be subordinate to those financially sophisticated businesses and/or powerful directors; if that situation should prevail we will remain in search of accountability indefinitely.

This final lesson feels so critical that those of goodwill must ensure that we are all accountable and strive to do our best for some of the most vulnerable within our communities.

The report is available in Welsh at;

http://gov.wales/topics/health/publications/socialcare/reports/accountability/?skip=1&lang=cy

Or in English at;

http://gov.wales/topics/health/publications/socialcare/reports/accountability/?lang=en

*All information is correct at the time of publishing

Nic Bowler

Welsh Care and Social Services Inspectorate Specialist

Dr Nicholas Bowler is a researcher and consultant to government-level [Welsh Government Review of Secure Services, 2009] – specialising in QA/compliance focused projects. He has interests in clinically relevant training, service development and research. He enjoys working with clients to support them in identifying problems and initiating projects to improve practice.

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