Dr. Tracey Cooper:

It is a difficult challenge. This is not, and cannot be, about black and white decision making, regulations, standards and compliance, because we simply are not in that world. I spoke at the end of the presentation about the focus on safety. I use a phrase, "Get it safe, keep it safe and then we will build quality." Certainly, in the first number of visits and inspections we conduct we accept that it is extremely challenging every day to keep the number of staff and keep the right skills of those staff in services. Of course, we must take into account the challenges that are being faced. In addition, however, these services are being provided 24/7 to very vulnerable people. We have never prescribed in any of our standards that X number of staff must be provided for Y facility to do Z.

What we would expect on a continual basis is that every provider will assess the climate, challenges and the workforce they have available to them against the needs of the people for whom they are providing the service. The first thing we would expect every provider in these services to do is say, "These are the type of people we have living with us and these are their needs. That means we must provide X number of staff to cover them appropriately and these are the skills the staff will need." People who have more needs will need staff who are, perhaps, trained to a slightly different level from others. The first interest for us is that we would want sufficient numbers of suitably qualified staff. In challenging times we find that if providers lose permanent staff, it is difficult to replace them. The question then is how that is being contingency managed, how they manage the risks for residents and provide as safe a service as they can and then, obviously, there are the quality aspects. That is done in a number of ways. Some people have agency arrangements and some are more able to recruit than others. However, given those challenges, our focus must be on finding out how those providers are managing the services and the risk of those services. Some people might say that they must be careful about the type of people they accept for a time because they do not have sufficient staff any more to deal with people with particularly special needs.

First, we must be pragmatic, realistic and relevant to the environment, but we must also be the custodian of vulnerable people. We closed a nursing home a number of months ago for a variety of reasons. This place had high risk, high acuity and very dependent people. It had challenges in its staffing and was providing these services 24/7, but it had no qualified nurse on duty for a chunk of the day and then the providers lied to us and said they did. It is really difficult. Ours is not a puritanical agency, we just want to know what people are doing to manage. There are different ways to do it and I am not saying it will be easy. We will have to get our approaches right - Phelim Quinn mentioned consistency which is really important for us - so the judgment of our inspectors takes those issues into account. However, we must balance that with ensuring the services are safe.