Care homes face paperwork ‘industry’ that damages quality of care

Commissioners, regulators and safeguarding agencies duplicate requirements while fear of blame drives managers to prioritise paperwork over care

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.

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2 Responses to Care homes face paperwork ‘industry’ that damages quality of care

  1. Andy cole March 3, 2014 at 10:53 am #

    I had an inspection by CQC followed a couple of weeks later by a team representing the local commissioner. Both visits amounted to the same thing, an in depth look at paperwork.
    On top of that we also have a local risk and independence team and a local authority accreditation team.

    In fairness to CQC inspector, one of the outcomes he was checking was records but he was clearly more interested in quality of care.

    While paperwork is important, I can trully relate to the cartoon above.

  2. Alex Knapp March 5, 2014 at 10:20 pm #

    It is really good to hear that the CQC inspector was more interested in the quality of care and I think the consultation around the “Fundamental Standards” is an opportunity to get the message out there that it should not be about paperwork, but PRACTICE.

    It is what our staff put into practice that effects the outcomes of the people we support, not the bits of paper!

    Take the opportunity to tell CQC via the consultation that it is time to change, we must focus outcomes, results, practice, competence and safety, rather than attendance or completion.