CQC Cancels Dorset Residential Care Home’s Registration

The Care Quality Commission (CQC) has taken enforcement action to cancel the registration of the service providers of Thistlegate House in Dorset to protect the safety and welfare of people in its care.

The providers appealed this decision to cancel but the tribunal found in the CQC’s favour, concluding that CQC’s evidence was overwhelming and the decision to cancel was proportionate and necessary.

The CQC’s decision to cancel the registration of the provider means they can no longer legally operate a residential home service from its premises at Thistlegate House in Charmouth, Dorset or any other premises that CQC would regulate in England.

Inspectors visited the home five times since January 2013 with the latest inspection taking place in April 2016. Major concerns in relation to the quality, safety and monitoring of the service were found at each inspection. The management stated that they fully complied with the regulations but inspectors found no evidence of this.

There was a continued failure to ensure that people were protected from risks and inspectors found that there were breaches in regulations on every inspection. Despite a number of enforcement measures being put in place to bring about fundamental change to the service. This action had not resulted in people receiving the care appropriate to their needs.

There was a continued lack of action to mitigate risks. These included people not receiving their medicines safely and safeguards not being in place to protect people from abuse. Safeguarding issues raised by Dorset County Council had not been investigated by the providers.

In addition, there was a consistent lack of training and supervision support provided for staff this was putting people at risk of unsafe care or care that was not appropriate to their needs and people in the home were sometimes treated in ways that were not respectful. End of life wishes had not been discussed or recorded.

Deborah Ivanova, Deputy Chief Inspector for Adult Social Care in CQC’s south region, said:

“People are entitled to services which provide safe, effective, compassionate and high quality care and the owners of Thistlegate House have failed their residents.

“The provider was placing people at significant risk of receiving inappropriate or unsafe care and made little attempt to address the issues we identified despite having several opportunities. For this reason we had no option but to cancel the registration.

“Our priority is always the safety of people using health and social care services and we would not consider this kind of action if we did not feel there was a serious risk to people, their health and wellbeing or that the environment they were in was unsafe.”

“I hope the action we have taken together with the tribunal decision should send a strong public message that we will not hesitate to use our powers to take tough action if we have concerns about the care and welfare of people who use services. We will work with providers to encourage improvement but if this is not in place then our role is to take action to protect those who are at risk of harm”.

Kings Fund Analysis into the Causes of GP Crisis Published

New research from The Kings Fund has revealed the extent of the crisis in general practice.

Their report, Understanding Pressures in General Practice, analyses 30 million patient contacts from 177 practices and includes extensive research with GP practices and trainees.

As well as a growth in the number of consultations, it shows that general practice’s workload has become more complex and intense. For example:

• There has been a 13 per cent growth in face-to-face consultations and a 63 per cent growth in telephone consultations, contributing to stressful and highly pressurised working days for GPs, despite other members of the team providing triage and managing minor illness.
• The overall number of consultations (face-to-face and telephone) has increased over the past five years at a rate three times that of the rate of increase in the number of GPs.
• The biggest increase in consultations were among the over-85 age group (up 28 per cent), who are more likely to have more than one chronic condition.
• The complexity of the cases being seen by GPs has increased, with many requiring more than a 10 minute appointment.
• The drive to move care out of the acute sector and back into the community hasn’t been adequately funded, putting additional pressure on existing resources in the community and therefore on GPs.

The report also underlines the scale of the recruitment and retention crisis facing the profession, finding that fewer GPs are choosing full-time clinical work. New research for the report found that five years after qualifying:

• only 1 in 10 new GP trainees plan to be working full time seeing patients in general practice.
• GPs are retiring earlier and in greater numbers: between 2009 and 2014, 46 per cent of GPs leaving the profession were under 50; between 2005 and 2014 the proportion of GPs aged between 55 and 64 leaving doubled.

The report argues that the Department of Health and NHS England have consistently failed to collect national-level data that could have anticipated the crisis that has now emerged. It says that general practice is at risk of falling apart unless significant additional investment is accompanied by new ways of working that build on current good practice.

As well as improvements to data collection and intelligence the report’s recommendations include:

• Placing general practice at the heart of new sustainability and transformation plans to ensure that the voice of general practice is heard and acted on.
• Developing new and innovative models of general practice (for example, multispecialty community providers) with a balance struck between the benefits of working at scale through federations and networks and making sure services are responsive to local people.
• Designing a workforce strategy through Health Education England that supports sustainable careers for GPs and their fellow team members, promoting sustainable and fulfilling options for development and recognising changing career preferences.

Beccy Baird, Fellow at The King’s Fund and lead author of the report, said:

‘While we have data almost in real time to tell us what’s going on in A&E, the only national-level data we have on activity in general practice is, at best, a year out of date. It wouldn’t be acceptable to try to run a hospital on out-of-date information and it shouldn’t be for general practice either.’

She added:

‘Investment alone won’t help the crisis in general practice. To avoid the service falling apart, practical support to do things differently is crucial and must be underpinned by an ongoing understanding of what is driving demand and activity. Only then will working in general practice be an attractive proposition and ensure the service remains at the heart of the NHS.’

SMEs in British Costal Resorts Get a Boost

Image reproduced under license from Ronald Saunders, Flickr

Projects dotted across the country, from Durham to Dorset, have been awarded up to £50,000 each to help restore local landmarks to their former glory, supporting local businesses, in and out of season.

Communities Minister Mr Francois said he hopes that the work will encourage a wave of enthusiasm for trips to our much-loved seaside areas – and help boost the £4 billion that tourism generates for coastal communities every year. Mr Francois said “Across our Great British Coast we’ve got heritage hooks to be proud of, but some of these places need some tender, loving, care.

That’s why over the past year we’ve invested £3.7 million to get them back into ship-shape and now 15 more brilliant British attractions will be buoyed up by work to restore them to their former glory.

This country has sight-seeing gems that are a match for anywhere in the world and I’d urge people to take a trip down to the seaside to discover them.”

Projects Receiving Funding

• The Churches Conservation Trust in Kent, to provide access to the tower of St Peter’s Church Sandwich offering a birds-eye view over one of the most complete medieval townscapes in England.
• Illfracombe Museum in Devon, to protect and preserve its unique collection of Victorian curiosities right on the seafront.
• Maryport Coastal Community Team in Cumbria, to brighten up the local lighthouse, getting it back into working order and putting the spotlight on Maryport as a tourist destination.
• Ryde town council on the Isle of Wight, to revitalise the western gardens, creating an arts and performance area, around Ryde pier.
• South Shields council, to develop options to help link tourist trails on the South Shields peninsula from historic sites like the Arbeia Roman Fort to the forthcoming North East Centre for the Written Word - The Word.
• Lancaster city council to give a new lease of life to a disused lido in Morecambe and turn into a welcome venue for festivals, arts and leisure.

Analysis has shown that that money already invested from this fund is doing its job, with every £1 invested creating a boost of upto £8 – great news for coastal SMEs and the communities they support.

Booktrope to Close at the End of May

Booktrope, set up in 2015, promising to transform the book publishing world with a new ‘team publishing’ model, has announced it will be closing on the 31st May due to a lack of revenue.

Their business model brought together freelance editors, designers and marketers to collaborate through their online tools to help authors develop their manuscripts, and sell books. Freelance contributors were not paid a set fee for their contribution, but were awarded a share of the royalties for each book they worked on. Booktrope brought together the various specialist in a virtual world and handled legal issues in return for 30% of net profits.

Booktrope distributed books both digitally and through a print-on-demand model and worked with a wide range of bricks-and-mortar stores as well as Amazon and subscription e-book services like Scribd. All published books will be removed from sale as of 31st May and rights will return to authors on the 1st June.

The company started in 2015 with over $1 millon in seed money and directly employed 11 people. All employees and contributors have been contacted with details of how final royalties will be paid.

“Much has been accomplished by Booktrope and our community over the past six years,” read the email from CEO and co-founder Ken Shear; co-founder and CTO Andy Roberts; and COO Jennifer Gilbert. “But even with a collection of excellent books and with very strong contributions by creative teams who’ve provided editing, design and marketing services, Booktrope books have not generated sufficient revenues to make the business viable.”

“Booktrope has helped hundreds of authors get over 4 million copies of their books into the hands of readers. We are proud our creative teams have produced almost 1000 books using our platform. Thank you to all readers, authors, investors, partners, and creative team members who were a part of this journey with us.”

Reaction on social media to Booktrope’s closure has been mixed, with many authors thanking Booktrope for helping them get published. But understandably, there has also been a degree of anger and frustration. Ally Bishop wrote on Medium: “Neither of us have said a word publicly against Booktrope largely because we felt foolish for getting involved with them in the first place. But now, watching the flames rise from what was, at best, a foolish venture, and at worst, designed to fail, some truths should be noted, if for no other reason than to warn fellow authors and creative types.”

“Booktrope never placed a priority on qualifications when hiring. The people at the top had little-to-no book publishing or editing experience, yet those same people were their acquisitions team…They didn’t ask, didn’t check backgrounds, didn’t require their book marketing managers to have any previous marketing experience.”

CQC Board Approves 2016/17 Business Plan

The Care Quality Commission has published its business plan for 2016/17. The business plan sets out the first phase of the CQC’s five-year strategy for health and adult social care regulation in England.

4 main priorities have been identified for the year:

1. To complete the first comprehensive inspection programme of all acute NHS trusts, adult social care service providers, GP practices and out-of-hours services, trusts and independent hospitals. Ensuring that registration processes support service providers to deliver high-quality care while encouraging innovation. Developing a baseline of understanding of quality across health and social care that is unique not just in England, but in any country.
2. Ensuring that their approach remains relevant to a changing environment. Making better use of intelligence, developing a shared view of quality with providers, and developing a framework with NHS Improvement on how well NHS acute hospitals use their resources.
3. Developing the CQC’s own skills to embed cultural values and to respond to the changing needs of the organisation and wider system.
4. Demonstrating the difference the CQC makes. Evaluating, measuring and reporting on their own performance, quality, management assurance, impact and value for money, using this evidence to learn and improve.

David Dehan, Chief Executive said “The pressures on the health and social care system will not decrease – it’s how we respond to these pressures that is crucial. Working together, we can ensure that people who use services get the high-quality care they deserve.”

The CQC will be publishing its’ full five-year strategy in June 2016, which will include further details of future inspection activities, work being undertaken to evaluate and set quality standards and share resources with service providers.

RCS Publishes New Professional Standards for Cosmetic Surgery, Endorsed by the CQC

The Royal College of Surgeons (RCS) has published new Professional Standards for Cosmetic Surgery, which set out the standards of good practice expected of all surgeons who perform cosmetic surgery. The guidance addresses key areas of risk such as communication, consent and professional behaviour, and is intended to improve patient safety and standards of care.

The RCS has been working with the General Medical Council (GMC), which has published its own set of professional standards for doctors carrying out cosmetic procedures to make sure they too provide the best possible care for patients. The GMC standards will come into force in June 2016 and will make clear the ethical obligations that doctors have towards patients.

The CQC has agreed to take into account both the RCS and GMC standards during their inspections and when making a judgement about the quality and safety of services being provided.

This will include taking into account whether registered providers have implemented effective systems so that:

· Surgeons performing cosmetic surgery are skilled and experienced in the area in which they practise.

· The operating surgeon leads the consultation with the patient to ensure they are fully informed and to outline the risks of the procedure, the likely outcome and provide the information that will help them decide whether or not to undergo surgery.

· The operating surgeon is the person who will obtain written consent from the patient. It will not be delegated to a colleague or other person.

· Consent is obtained in a two-stage process with a cooling-off period of at least two weeks between the stages to allow the patient to reflect on the decision.

· Appropriate indemnity insurance is in place to cover the procedures being undertaken.

· Financial inducements such as time-limited offers and discounts are not used or promoted.

The CQC regulates all independent clinics and hospitals that provide cosmetic surgery. They regulate cosmetic treatments that involve any instrument or equipment (such as an implant) being inserted into the body.

Books by Earliest Women Writers Bought Together for First Time

The Wellcome Collection is exhibiting manuscripts from the first female writers in the English language (Julia of Norwich and Margery Kempe) together for the first time in a new exhibition. The ‘This is a Voice’ exhibition aims to cast a spotlight on the meaning and emotions conveyed through the patterns of rhythm, stress and intonation in non-verbal forms of communication.

The Book of Margery Kempe, which was digitised by the British Library in 2014, is dated between 1436 and 1438. It is the story of a middle-class Norfolk woman’s life, and is widely seen as the first autobiography in English. Her book chronicles her domestic tribulations as the mother of 14 children, her extensive pilgrimages to holy sites in Europe and the Holy Land, and her mystical conversations with God, all dictated to a scribe as she claimed to be illiterate.

Margery Kempe’s manuscript lay hidden from 1520 to the 1930s, when it was discovered during a game of ping-pong. Whilst searching for a replacement ball the book fell out of a cupboard.

The Revelations of Divine Love by the 14th century anchorite, Julian of Norwich, was written after she claimed she had experienced a series of mystical visions in 1373. Her writings indicate that she was probably born around 1342 and came from a privileged family.

She believed that God sees us as perfect and waits for the day when human souls mature so that evil and sin will no longer hinder us.

Julian first wrote a short version of her book, of which only one copy is believed to have survived, and then a longer version about 20 years later, of which only three copies survive. She is considered to be the first female writer to work in the English language.

Incredibly the two women met each other during their lives, with Margery Kempe visiting Julian of Norwich for advice on her visions.

Anthony Bale, Professor of Medieval Studies at Birkbeck University of London said “It’s wonderful that the British Library has loaned the unique manuscript of The Book of Margery Kempe to the This is a Voice exhibition – not only did Kempe describe hearing voices and sounds but she also crafted a distinctive voice for herself. It is very touching that the Julian of Norwich manuscript is displayed alongside that of Margery Kempe: the two women – who can also legitimately be called two of the earliest women writers in English – met in Norwich, probably in the year 1413,”

“Julian’s reputation as a holy woman was already established, and Kempe visited her to see if the ‘holy speeches and conversations’ that Kempe had with God were real or not,” said Bale. “Kempe describes how Julian advised and endorsed her, and the two women had ‘much holy conversation’, over the course ‘of many days’ together.”

Author and psychologist Charles Fernyhough was part of the team who put the exhibition together. “We went to the British Library and met with the curator, and put to her that having these two manuscripts would send an incredibly important message - it would say that this experience [of hearing voices] has been around for a long time. That hearing voices isn’t new, and that it has been interpreted in more positive ways in the past ... It was such a coup for us to get [The Book of Margery Kempe] as it’s one of their most precious, prized things.”

The one surviving copy of the short text of Julian of Norwich’s book was “too valuable” to be loaned, so Wellcome Collection chose a 1625 version of the long text, said Fernyhough, which exhibits the “beautiful writing style” of its scribe.

The manuscripts are on display until the end of July.