Dementia currently affects 1 in 14 people in the UK. Many people will either know someone with dementia, have had to support and care for someone with dementia or have been diagnosed themselves.
At its simplest, governance can be explained as the processes by which the owners or trustees of an organisation lead and manage the activities of the organisation. However more recently, it has come to have particular significance as a means of giving assurance on a range of issues, such as safeguarding and financial stability in the care sector.
Most organisations have policies, procedures and a management structure through which they hold directors, managers and staff to account. However, the best policies and procedures in the world will not ensure the delivery of high quality care services unless the other key elements of a good governance system are in place. Good governance matters because without it, it is impossible for those with any kind of management responsibility – including owners, directors and trustees – to know whether the things they aspire to for their organisation are actually being delivered.
There are many elements to a comprehensive governance system and all are relevant in the current climate. As with any aspect of governance, it is the execution of robust policies and procedures that is most important and it is in the execution rather than the theory where care providers tend to struggle.
The starting point for any organisation is getting the right staff on board. Providers need to recruit people whose values and behaviour reflects the organisation’s aspirations and fundamental approach to the provision of care. Only carefully selected individuals whose skills, experience and ethics match the needs of the organisation should be recruited - and a policy of hiring only such people will go a long way to delivering high quality care.
Once the right employees have been selected, it is important to train and develop them. At induction, and in regular updates, it is critical that staff have a clear understanding of the attitudes and behaviours the provider expects. They need to know exactly what they should do if they see anything in the course of their work that raises questions about whether the provider’s expectations are being met by others – whether such behaviour is abusive or just poor practice. Engaging the entire workforce to examine, develop and test the behaviours required can be a very useful quality control mechanism.
Whenever incidents or accidents occur there must be a robust process of recording, reviewing and learning in order to establish how any recurrence might be prevented. Having records reviewed by people unconnected with the service, to identify patterns of incidents involving particular service users and/or particular staff is a powerful means to achieve improvements and spot emerging problems.
Should a problem present itself, staff must be encouraged to report issues and concerns through the management process (e.g. through supervision or raising issues directly with managers) but it is also important that the provider gives access to an independent agency where staff can raise matters outside the management structure. The provider’s commitment to such whistle blowing procedures must be made absolutely clear in order for it to be effective.
The best judge of whether the care and support provision in place is giving someone the best life possible is the service user, often followed closely by family or friends. It is all too easy for staff to see their clients, and particularly their families, as demanding and unreasonable. Positive encouragement should be given to family and friends to participate in the life of the home or the care and support arrangements for a home care package, as a key element of an open and transparent service.
Where service users have difficulties in comprehension or communication, it is important that they have access to effective advocacy services, through which they can find a way to express how they feel about the support they receive and how it is provided. Advocates can also support people who may otherwise fear they have to tolerate the unacceptable attitudes and behaviours of others which can give providers an invaluable, independent view of their services.
In order to maintain a safe environment, providers should ensure systematic checks are made through structured management supervision, sampling and spot checks, and more formal audits conducted by people from outside the service on key aspects of the service’s operation. Fail-safes can be introduced to ensure that for key issues (such as medication) there is a system in place that cannot allow any basic failures to occur.
These are just some highlights of where good governance matters. Providers who want to build and sustain a reputation for quality assured care and support will ensure that these key ideas form part of well structured, comprehensive and transparent governance arrangements. This will not only be of value internally, but also in building and retaining the confidence of service users, families, commissioners, funders and regulators. It will also give a strong message to employees, which will assist in the recruitment and retention of staff with the values and behaviours the provider wants, creating a virtuous and self-perpetuating cycle of improvement.
John Wearing is a partner at Anthony Collins Solicitors.
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