A paperwork ‘industry’ driven by regulatory, commissioning and safeguarding requirements is undermining the quality of care in residential and nursing homes, research for the Joseph Rowntree Foundation has found.
Fear of blame and litigation and insecurity are driving managers and staff to prioritise the completion of paperwork over direct care with residents, while they often have to provide the same information to commissioners, regulators and safeguarding agencies.
One manager interviewed by researchers said they spent 20% of their working time completing paperwork, while the research identified more than 100 pieces of paperwork that were regularly completed by care homes.
Researchers identified a number of sources of duplication in the paperwork required of care homes. For example, the Care Quality Commission and adult safeguarding boards used different incident reporting forms that served largely the same purpose, while NHS commissioners were found to be asking for very similar information from care homes as the CQC.
“There seems to be very little co-operation between different regulators and commissioners, and some duplication arises when they ask for much
the same information but with a twist to suit their own individual needs,” said the study.
The mountain of paperwork undermined care in several ways, found the study:
- it removed managers from providing a leadership role for the home and interacting with staff;
- it reduced staff’s sense of vocation as they were judged more on their ability to complete paperwork than to deliver good care;
- it undermined co-operation and joint working between providers and commissioners and regulators;
- it reduced professional autonomy among care staff.
The report made a series of recommendations to ensure that paperwork was limited and helped drive good-quality care. In the short-term, it said that the Care Quality Commission and NHS and local authority commissioners should improve information sharing to remove the duplication of requirements on care homes. It also said that the CQC and adult safeguarding boards should develop a common incident reporting form.
Over the longer-term, it said that residents and providers should develop measures of quality so that the right things were measured by paperwork, while inspectors should focus less on compliance in judging homes and more on observing the way care is delivered and the relationships between staff and residents.
About the research
The findings were based on a desk-based review of paperwork used by care homes and an in-depth look at three care homes and how they used paperwork based on observations, and interviews and focus groups with staff, managers, residents and relatives. The research team from equalities consultancy Brap also interviewed two providers, two provider associations – the English Community Care Association (now Care England) and the National Care Forum – and local authority commissioners and quality assurance leads, and Care Quality Commission and adult safeguarding board representatives.