One of the things I love about the development of the CQC legislation on “registered manager” is that the individual is held to account for what happens in their home – by omission or commission, they will answer for what occurred. I love this because it encourages ownership and fosters leadership. I love that the buck stops with this person. They are empowered. It is a good thing – responsible and forward thinking yes BUT what about the rest of those above the home manager? I know there is a responsible nominated individual assigned who will also be held to account but..here it comes, what about those in the middle?
Before some unscrupulous readers assume a negative intent here – there is none. I have worked for and served many care home groups with some remarkable senior managers in place. I am simply making the point that regardless of their ability there is a slight disconnect between the home managers with legal accountability and those more senior managers who make decisions about direction / resource allocation without this responsibility. The CQC is aware of this and reviewing this matter. In the mean-time here are a few thoughts about the limitations and vulnerabilities of the current system;
The registered home manager is fully responsible for taking action to ensure the home is compliant but what if those above do not offer support – how does the registered home manager exercise their responsibilities then? What do you do if the support structure doesn’t agree to what’s needed? This is where the legal vs organisational accountability conflict occurs. I wonder if the care home management structures have evolved sufficiently to enable the registered managers’ to do their job?
The least effective support structures I’ve come across have had the following characteristics – senior managers holding the RM accountable to extreme levels of rigour, without any accountability themselves and occasionally with passive aggressive behaviours. I’ve encountered senior managers being subjective without reviewing any objective data at all – e.g. well designed and executed audits or detailed resident and staff feedback. In my view, the inherent problem with this type of support is the lack of focus and objectivity.
The most effective support structures I’ve come across are just that – plainly support structures both by intent and by design. They have a spirit of support woven in. They are in response to the complex job of running a service compliant with the CQC KLOE’ (key lines of enquiry – is the service well led, effective, responsive, safe, caring?)s and make it easier for the RM to do so – usefully highlighting areas for adjustment / improvement. I know some groups do full mock CQC inspections with very good actual CQC results after. There is a lot of great practice out there.
To conclude I think the sense of ownership intended by this CQC legislation focus is helpful but it needs to be married to a sense of support and an effective and responsive management structure above the registered home manager for optimal results. That way organisational accountability and legal accountability are aligned. In the end, decisions about the service should reflect the needs of the residents it serves. As an industry we mustn’t allow politics to get in the way of great care.
In my view, we are all accountable aren’t we?
Liam Palmer is an Elder Care Management Specialist and author of “Management Development for Care and Nursing Home Managers”. His passion is in championing sustainable quality in care homes by equipping new and aspiring home managers with practical leadership skills.