Tag Archives: care

NMC to review ‘serious cases’ before the employer does so

There’s an old saying, with many variations on the same theme:  ‘everything comes to him who waits’, and my favourite variation is  ‘all things come to him who waits – provided he knows what he’s waiting for’.  I’m not absolutely sure that this next revelation is something I knew I was waiting for – but after years of waiting for the NMC to get its act together, there’s a small chink of light appearing.

The NMC (Nursing and Midwifery Council) is to review serious cases before internal investigations are conducted by the employer of the nurse(s) in question.  According to Nursing Times

Nurses and midwives involved in “very serious cases” that pose a risk to patients should be referred to the Nursing and Midwifery Council prior to an internal investigation, the regulator has stated.

In updated guidance on referrals, the NMC has called on employers to make referrals as quickly as possible in order for it to consider issuing an interim suspension until the case has been fully investigated.

The regulator said it had “clarified its advice as a result of cases in which employers have misunderstood their responsibility to refer quickly if patient safety is at risk”.

It states: “The revised advice specifically encourages employers to refer a nurse or midwife at an early stage in very serious cases, even before they conduct their own internal investigation.”

NMC director of fitness to practise Jackie Smith said: “We would like to remind employers that if they believe the public’s health and wellbeing is at immediate and serious risk, they should contact us straight away.

“This will give us the opportunity to issue an interim suspension or restrict the person’s practice while the case is investigated,” she added.

The revised advice and information also notes that in less serious instances cases may be referred back from the NMC to the employer to be dealt with locally.

The guidance also includes more detailed information about the existing responsibilities of employers to check references, identity and competence.”

This news is of such importance, that I’ve just given you the full content of the Nursing Times article, and I trust that will be acceptable.   It’s not so easy to find the updated guidance on the NMC website, but this is the nearest I’ve found – Urgent referrals and interim orders.

As an employer you have the power to suspend or dismiss a member of staff, but this will not prevent them from working elsewhere. Even suspensions by a local supervising authority midwifery officer (LSAMO), which would prevent a midwife from practising in that region, will not prevent a midwife from practising in other regions, or practising as a nurse if registered accordingly.

We are the only organisation with the powers to prevent nurses and midwives from practising if they present a risk to patient safety. In very serious cases it will therefore be appropriate to refer a nurse or midwife to us at an early stage, even before you conduct your own internal investigation. This allows for the possibility of issuing an interim suspension or restricting the practice of the nurse or midwife concerned until the case has been thoroughly investigated.

I am shocked to discover that this has only just been ‘clarified’ by the NMC, but it goes a long way to explain to me why I’ve had such a fight on my hands for the last 4 years now. 

Perhaps I was naive and took it for granted that the onus was already there on the employer, in my case one of the big care home providers, and that the NMC would be contacted by any employer who has serious concerns about the standards of care being provided by a registered nurse or midwife.  I didn’t know then how easy it was for the employer to allow several registered nurses to resign from their employment. 

Perhaps I was equally naive to expect that the Local Authority would have a duty to follow through with all the sensible procedures, in order to protect other people who could be at risk if those same registered nurses who were allowed to resign were then ‘employed’ elsewhere.  But when a care provider has several 25-year contracts with the same local authority, you begin to learn how to whistle in the wind! 

Perhaps I was even more naive to expect that the local authority’s Safeguarding/Protection of Vulnerable Adults unit would be equally responsible for ….. safeguarding others.

The NMC is a Regulator.  The GMC is a Regulator.  The CQC is a Regulator.

What is being a regulator all about if it fails to regulate in the way that most of us, mere mortals that we be,  would want and expect a regulator to regulate?

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Who guards the guardians? Oh yes! Good question.

So, Lord Justice Leveson has one simple question at the heart of the public inquiry he is to oversee.

Who guards the guardians?

If only that same question could be asked about those who are charged with guarding our mature relatives in need of care at the most vulnerable stage of their lives.

It would require Lord Justice Leveson to ensure that his inquiry would encompass not only the toothless Care Quality Commission, but also the care providers, the local authority commissioning departments,  local authority facilitators (for want of a better word), the whole network of careless care that so often destroys the lives of those who deserve better care.

The ethics and culture of the care system need a thorough examination also.

“The terms of reference raise complex and wide-ranging legal and ethical issues  of enormous public concern,” said Justice Leveson in a statement released this afternoon.”

The same should be said about the way in which we have allowed a care system to develop that raises equally complex and wide-ranging legal and ethical issues of enormous public concern.

I’m not talking about phone-hacking.  I’m talking about the preservation of life.

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Absolute privilege in the world of politics v. absolutely no privilege in the world of care

The concept of absolute privilege is not something that I’ve ever contemplated seriously before this afternoon. It’s been known for more than a few years that MPs have a comfortably convenient place for them all to ‘protect themselves, in their own best interests’.  It’s called the House of Commons.

Today’s non-world-shattering news is  all about the privacy of an individual to keep their own ‘affairs of life’ private and personal and away from the public gaze, and the public magnifying glass.  I can’t claim to be interested in this particular individual’s personal circumstances, personal life, personal affairs; I can declare that I’m not interested at all in whatever  may have caused the need for an injunction, super though that injunction may have been in legal terms.

But I do care about the double standards that are operating here.

An elected MP  that I’ve never heard of before – sorry,  MP, but you haven’t made your mark in my world – can  overturn something that has been observed and not flouted by our reliably (un?) reliable media.  All it took was for this particular MP – a representative of the people – to open his mouth and speak two words.  Then the rest of the reliably (un?) reliable media can duplicate those two words.  Not that we didn’t know those two words anyway!

At the same time as this ‘Who Done What With Whom?’  trivial pursuit has been going on, the world of care continues to puzzle me by its own absolute privilege.  But with a difference.

A local authority and a care provider can call upon the equivalent of a ‘super injunction’ to prevent me from being able to know the precise circumstances of the neglect and subsequent death of a relative who was at risk.  She was most certainly at risk in their care.  Not that we knew that then, when we agreed to her coming under their ‘caring’ wing.  But their need to protect themselves and their own best interests appears to be paramount.

The person they failed had no rights; her best interests were demolished within days.  As her close  relative, as her named personal representative after her death, her executor, I have no rights either to achieve justice on her behalf.

Justice?  Hush my mouth, for using a word that may before long vanish from our dictionary.

I have tried so very hard to restrain myself, so that I don’t name and shame each and every one of those involved, from the care home staff (names all known to me), the care provider, the care home, the care home manager(s) and their regional supervisors, the GPs involved, the local authority and its many responsible departments, the CQC inspectors who failed to notice ‘absent systems of protection’, the adult protection coordinator who failed, the social worker who failed, the whole team of mental health care of older people who all failed, ….. …. …. and so on.

All because I have wanted to achieve a decent outcome.  According to the laws of our land.  But the latest blow that has been landed on my shoulders – via one of the regulatory bodies involved – is beyond explanation or even understanding.  And yet, I am still – stupidly, perhaps – hesitating to name and shame the whole bunch of them.  Almost 4 years after her death in so-called care,  almost 3 years after I placed onto the ‘responsible regulatory body’ what they call ‘a complaint’, I am being treated still with contempt.  The Case Officer involved could not even bother to inform me about the latest hurdle that I now have to jump.

So,  I’ve played by the rules.  But they still can’t

I’ve been throttled, strangled, constrained by  concepts that come close to ‘super injunction’ and ‘absolute privilege’ but perhaps in a converse way.

Is a bonking footballer worthy of more care than a supremely decent 83-year old person in need of care?

Am I the fool?

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A life lived well before dementia

“Kites rise highest against the wind, not with it

She was born into a decent, honest and hard-working family.  A family that was neither rich nor poor; not blessed with an excess of good fortune but not unduly hard done-by either.  Just an average working family.

As far back as the mid 1700s her ancestors were a delightful mix of butchers and fishmongers, dressmakers and tailors, coal merchants and carpenters, tallow chandlers and umbrella makers.  With a few rogues along the way of course, two of whom served their sentences at Newgate Prison for minor misdemeanours.

So, you see, the most essential skills for survival ran through her bloodstream.  What more could she have asked for?  A coalfire to warm the living quarters, tailored clothes to wear, fresh food to eat while sat at a carefully crafted table, a light to read by and umbrellas galore to protect against the elements.  Umbrellas of protection; umbrellas with as many spokes as were needed to maintain that canopy of care.

More or less the Essential standards of quality and safety which made clear the outcomes her own family expected over centuries.  I’ve borrowed that phrase, of course, from our most esteemed (by some, but sadly not by me) regulator of care.  There’s one essential standard of quality and safety that she had, in abundance, that doesn’t seem to feature in today’s essential standards of care: basic common sense.  She inherited more than her full measure of that, and it kept her in good stead throughout her life, before dementia arrived and the need for caring care came into her life.  Honesty and decency coursed through her veins, alongside that basic common sense.  That’s three essential standards that seem to be missing from the caring care in the UK.

Her Dad was the first member of the family to benefit from an education.  He was the first on his side of the family to leave behind the umbrella making trade.  He became what today would be called an Insurance Executive – well, everyone’s an executive nowadays, but he was special.  “He was ever so clever, was my Dad” she used to say.  “He was ever so good with words.”  “There were no flies on my Dad!”  It was from her Mum and Dad that she took on such qualities that strengthened her backbone: she stood upright against all odds.

A happy childhood was enjoyed by all, with the usual gentle progress into adulthood being marred only by  World War II doing what WWII did to so many inner London families.  Then a working life in one of the trades of her ancestors, right through to her retirement.  Soon afterwards, she suddenly found herself living on her own.  But she coped.  She crumbled at first, as you do, but then picked herself up and put herself together again.  She’d played with the components of umbrellas as a child, so she knew how to reconstruct her own canopy.

Like so many of her generation, she worked hard, worked long, worked for every single thing she wanted in life.  She was never out of work and was never in receipt of benefits from the state; she had no debts and owed nothing.  She didn’t earn a fortune, but again, like so many of her generation, whatever she acquired, she gained through hard work and pride.  The pride she enjoyed was that she never needed to look over her shoulder.  She harmed nobody; she was gentle, decent, honest and solid.

Then dementia arrived just as she moved beyond her 80th birthday.

(To be continued)

“Kites rise highest against the wind, not with it

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Legal nooks of care, whistleblowing, cotton in ears & velvet soles on boots

“Behind the most ancient part of Holborn, London, where certain gabled houses some centuries of age still stand looking on the public way, as if disconsolately looking for the Old Bourne that has long run dry, is a little nook composed of two irregular quadrangles, called Staple Inn. It is one of those nooks, the turning into which out of the clashing street, imparts to the relieved pedestrian the sensation of having put cotton in his ears and velvet soles on his boots.”The Mystery of Edwin Drood by Charles Dickens

That was “one of those nooks which are legal nooks”.

I was born and grew up not far away from that ‘legal nook’, long enough ago to have experienced the peace and quiet of the City of London on a Sunday morning (then!).  Little did I realise that I’d be reminded of Dickens’ description when I read the report on whistleblowers from Public Concern at WorkSpeaking up for Vulnerable Adults : What the Whistleblowers Say.

There are far too many disturbing quotes from the report – which is very user-friendly so you’ll have to read it yourself – but here’s a few that grabbed me, from the 100 cases looked at:

  • Year on year we receive the highest percentage of calls to our helpline from the care sector (15%).
  • In care, 55% of all calls were about abuse.
  • In 40% of all our care cases, concerns were initially ignored or denied by the organisation.
  • Additionally this is a sector with many workers who may be considered vulnerable due to low pay, low awareness of rights and lack of access to or knowledge of support.
  • Within the care sector itself, over half of the calls we receive are about abuse. The most common concerns being: physical abuse, lack of dignity, neglect, conduct of staff, verbal abuse and medication administered incorrectly or not at all.
  • the vast majority of workers in the care sector (80%) have already raised their concern when they call us and over a third of these concerns are initially ignored, mishandled or denied by organisations
  • care workers often do not realise that they are actually “blowing the whistle” until they encounter difficulties when having their concern addressed or are mistreated personally
  • whistleblowers struggle with the lack of feedback from organisations regarding how their concern is being handled
  • we also receive calls from workers across the adult social care spectrum including: social workers, safeguarding teams, volunteers, students, cleaners, doctors, nurses and other professionals.

And that’s all from the first couple of pages of the report!

The report looks at physical abuse, medication concerns, neglect, financial abuse and so on, and works its way through various case stories, all demonstrating the need for safeguarding vulnerable people in care and also the workforce providing that care.

It has allowed me to understand more of the reasons why I have needed to bang my head against a brick wall in recent years.  It also confirms to me what I sadly had to learn the hard way: that – in my own experience of dementia care – the local authority (all departments from the care commissioning team through to the Safeguarding/Adult Protection unit), the mental health care of older people multi-disciplinary team , the CSCI/CQC regulators and the care providers all colluded to care far more for themselves, to protect their own best interests above all others, than they ever cared for my relative’s best interests, and the best interests of other vulnerable older people in this particular part of the world.

They closed ranks in their own ‘legal nook’ to such an extent that I’m almost in need of care myself, because they have almost managed to transform me into a vulnerable adult, by their own sins of commission and sins of omission.  Almost, but not quite.

Not for the first time, I ask why everything can be hidden behind the word ‘confidentiality’.  We now have the vulnerable being cared for by a vulnerable workforce, according to this report, so it’s hardly surprising that nothing changes for the better.

It’s as if the whole care sector has become anaesthetised, numbed and indifferent to all that is going on under the umbrella of care.  I have been planning to write more about my own experience of dementia care, and this report has sharpened my resolve, so I will go back to the beginning and work my way through it all, chapter by chapter, stage by stage.

“…. the sensation of having put cotton in his ears  and velvet soles on his boots ….”

The cotton may still be in their ears – the velvet soles of my boots will have to be removed.

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Whistleblowing in the sphere of Vulnerable Adults

My thanks to Fighting Monsters AMHP for bringing to my attention a Report from Public Concern at Work about whistleblowing in the care sector.

The title of the report – Speaking up for vulnerable adults: What the whistleblowers say – speaks for itself, almost, and is available here for anyone interested.

I’ve read it twice now; it’s only 21-pages long and it’s very well written indeed.  I’m going to read it a third time before I comment any further, but I just wanted to say a quick thank you to Fighting Monsters and to Public Concern at Work for allowing me to see, in part, the reasons why I was beginning to think that the pea had been stolen from my whistle, over the recent years of my own attempts to blow it in the ears of those charged with providing decent standards of care in the UK.

“Public Concern at Work is the leading independent authority on whistleblowing in the UK. We run a free advice line for those who have witnessed crime, danger or wrongdoing at work.”  I wish I’d heard of Public Concern at Work  before now – because I could have pointed a few people in the right direction.

It’s not just my pea that’s been stolen.

If I forget to return to this report, I’ll be surprised – or it may mean that I’ve been abducted.

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Who’s keeping a finger on the pulse of care in care homes for the elderly?

The results of a ‘care homes survey’ carried out by PULSE make for interesting reading.  Interesting, but also shocking for anyone who has ever questioned the standards of care in a care home with nursing.

A significant minority of the 100 PCOs responding to Freedom of Information Act requests do not provide even basic care-home services, with 14% providing no access to tissue viability nursing, and 10% have no access to continence advisers.

The investigation, which involved submitting three separate FOI requests to each PCO, reveals the patchy nature of services across the NHS, as well as the headline findings of soaring numbers of serious incidents and sharp funding cuts.

Of the GP practices that responded to the survey:

67% say that the funding they receive for the care of patients in care homes is not adequate for them to provide a safe and effective service.  14% say it is adequate; 19% don’t know.

61% say that the arrangements for the medical and nursing care of patients in care homes is not organised satisfactorily in their area.  26% say it is satisfactory; 13% don’t know.

41% say that on unscheduled call-outs, they ‘sometimes’ receive the information and nursing back-up they need.  9% say they always receive it; 28% often; 19% occasionally; 3% never.

40% provide once a year medication reviews for patients in care homes.  33% once every six months; 17% once every three months.

60% said they were ‘sometimes’ left with no option but to prescribe antipsychotics to patients with dementiathat is unacceptable, a totally unacceptable way to treat patients with dementia, if ‘treat’ is the right word.

42% rated the nursing care of patients in their local care homes for the elderly as acceptable.  5% ‘very good’; 23% ‘good’; 23% rated the care ‘poor’;  6% rated the care ‘very poor’.

44% rated the nursing care of patients in their local nursing homes as acceptable

48% had observed Staff sloppy or unprofessional in their local care homes.

40% found Staff lacking in compassion

72% found Poor quality of staff training

47% found Patients denied their dignity or sufficient stimulus

6% found Evidence or suggestion of abuse by staff

And yet:

65 & of those GP practices had not complained in the last year about the quality of care for residents in care homes;

23% had complained;

12% don’t know.

Astonishingly:

58% of those GP practices who had complained did not know whether the complaint was satisfactorily investigated by their primary care organisation

24% felt it was not satisfactorily investigated

17% felt it was.

Many more staggering statistics in the full survey report, but it is distressing to read that 53% of those who responded found that Mental Health Care services and 34% that Continence Support were being savagely cut for care home residents.

Dr Krishna Chaturvedi, a GP in Westcliff-on-Sea in Essex, said: ‘Our practice has served more than 10 residential homes for 20 years but due to the increasing stress, we decided to take all homes off the list after making several pleas to the SHA and PCT for extra support, none of which was forthcoming.’

Is this really what we mean by “CARE”?

The vast majority of people in need of residential care, with or without nursing, come from  a generation of stalwarts that grew accustomed to the understanding that if you want a job done properly, you should “do it yourself”.  And they did just that, for as long as they possibly could.   There are some things they no longer can do for themselves.  If Cameron and Clegg and Co. continue with their vicious cuts campaign, they will force that generation to suffer the consequences.

Is it time for the words care home to be erased from our vocabulary?

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How fair is Britain?

I’m half-way through reading “The Greatest Show on Earth” by Richard Dawkins.

I’m hooked!

Alongside, I’ve also been dipping into the first “Triennial Review “published today by the Equality and Human Rights Commission.  No, I haven’t read the full 750 pages yet, but I’ve read the transcript of the video overview, and a good few more pages too. 

Read more ….

I’m twice hooked!!

OK, I admit it was the word ‘triennial’ that grabbed me … for purely personal reasons.  I am approaching a first “Triennial Review” that is all my own.  Namely the Triennial Review that I promised myself I would conduct at the end of my 3rd year (yes, third year) into the circumstances of neglect that surrounded my own relative in need of caring care.  But neglect was all that came her way.  And she died a painful death, and an earlier than anticipated death, as a result of that neglect.

“It’s the job of the Equality and Human Rights Commission to help society make further progress.”  Would that be the Big Society that David Cameron keeps banging on about?  Or the other (only?)  Society that we all know of old?  And yes, I am quietly hoping it’s the second of those two options that the Equality and Human Rights Commission strives to help.

Can you help me also, EHRC?  Can you help me to achieve progress, as I work my way through the muck that is being delivered (almost daily now!!) from those who are supposed to care about ‘fairness’ and to care about ‘care’?  If you are able to do that, please get in touch and I will graciously accept your assistance.

Or are there two societies now?  One Big; one Small.  One where ‘fairness’ is defined by the Big Society backed by the ConDemNation, to the detriment of the Small Society comprising the little people?

“This October we are publishing our first ever such review, entitled ‘How Fair Is Britain’.

It describes the chances, choices and outcomes in life of people from all different groups.”  I’m still looking for a few words in the transcript: older, people, dementia, in care, but then I found some of them in the online summary.

Care and support:  (follow the link below if you care to read it all ….)

http://www.equalityhumanrights.com/key-projects/triennial-review/online-summary/care-and-support/

“As might be expected, we are more likely to need care as we grow older. We are also more likely to provide it later in life, as we have children and as our families and friends age with us.”

Don’t get me wrong, EHRC.  I applaud our past history of fairness, our well-known and well-recognised tradition of fairness and respect for other points of view, culture,  gender, race, sexuality,  religion and so on … that meaningful equality (as you call it) that we have achieved.  Historic prowess shouldn’t allow for complacency.

History is neither our present, nor our future. We must find the way to demonstrate today that we value and care enough about our history of fairness, our reliable traditions connected to our history of fairness, and our past celebrations of our ‘fairness’ to carry us forward to our today and to our tomorrow?

It is not enough though to express good intentions, what matters is making a practical tangible difference.  And you can’t hope to make change happen in the real world without looking hard at the facts.

I do appreciate that you’re also in a fragile state, EHRC, being – for want of a better phrase – currently under review.  But then again, I do wonder whether this fairness that we purport to attribute to this (as we would like to see it) fair nation of ours really does care, or even  whether the word ‘care’ may disappear from our vocabulary fairly soon, to be replaced by … neglect.

The spending review currently being imposed by our Married-by-Convenience Coalition Government may well demolish all of our hopes for ‘fairness’, especially fairness in old age.  If we allow everything that has become known as caring care to be scrapped without decent consultation and without decent consent, then the Older Person will be thrown out with the mucky bathwater.

Do we really care?  If so, why don’t I believe you?  Why is our ‘caring care’ not visible?  Why have I spent 3 years of my life trying to establish whether or not we/you/they really do care?

Have we evolved enough to care?  Or are we in need of another “Blind Watchmaker”?

Will I be thrice hooked?  Ever?  Never?

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Alan Simper ‘died for want of care by those charged with it’

I’ve mentioned Southern Cross Healthcare several times recently.  Today, a Coroner had fairly meaningful words to say about a Southern Cross care home, Swiss Cottage nursing home, Leighton Buzzard, Bedfordshire, after a man died as a result of ‘inexcusable failures’ by care home staff. Britain’s largest care home provider was criticised after a pensioner died as a direct result of ‘inexcusable failures’ at the hands of Southern Cross Healthcare’s staff.

Bedfordshire and Luton Coroner David Morris’ words:  ‘There was a failure of professional responsibility at all levels.  Mr Simper, whilst incapacitated by rapidly deteriorating physical and mental health, died on this date for want of care by those charged with it.’

Another report of the same story, this time via BBC News.   I’m not a natural reader of the Daily Mail, so I always try to match the content elsewhere, and the BBC is normally reliable.

There’s one mutually shared aspect of every single sad story of neglect that I come across – along the lines of ‘lessons will be learned’ :

Sarah O’Mara, Area Manager for Southern Cross Healthcare, said that a full investigation had been carried out following the death of Mr Simper.

She said: ‘Following Mr Simper’s death, Southern Cross co-operated with the Police and other authorities in their investigations.

‘We also undertook a comprehensive internal review in consultation with social services and the Care Quality Commission.

‘As a result, significant steps have been taken to improve the quality of care provided at Swiss Cottage.

‘The health and well being of residents is our priority. Under the new leadership, staff are focused on providing the very best and most professional care.’

These words become meaningless after a while, and the story of Mr Simper echoes the experience of my own relative, and also the same questions I have been asking for more than a couple of years now:

  1. How can a care home, provided by one of the biggest, richest, fattest care home providers in the UK, be allowed to open and operate, if it then takes the death of a vulnerable resident for an “Action Plan” to be put in place to achieve the very standards of care we all expect to find in any care home?  And all that, in our case, within 6 months of the care home opening and receiving residents.
  2. Why does it take an investigation by the Local Authority, Social Services, CQC (CSCI as was), the local commissioning team, the police, the coroner for ‘significant steps’ to be taken to provide the quality of care that a big care provider should know all about?  And the home is then not allowed to accept new residents for a full year, in order for ‘acceptable standards of care’ to be seen to be present – in our case, again.
  3. Why is it necessary for someone to die, before quality care is provided’?
  4. Why are so many of these investigations conducted ‘behind closed doors’ unless a coroner is involved, so that the general public knows nothing about it all, knows nothing of the ‘clean up’ that is conducted, knows nothing of the pain it causes?  That is the burning question for me.  Although there are other questions simmering away at present.

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In the best interests of the parties

Over the last few days politicians of all colours of the rainbow have come out with the phrase ‘in the national interest’.  I am still not convinced that they are talking about anything other than their own interest, the longevity of their particular party and their personal role within that party.

Then I remembered a similar phrase from the world of care: ‘in the best interests’, enshrined now in the Mental Capacity Act.  Everyone involved in the care of a person without the mental capacity to make a particular decision on their own has a duty to demonstrate that each and every decision they make on behalf of that person is ‘in the best interests’ of the relative, friend, patient or resident in their care.  And yet, in my experience of those ‘best interests’ decisions, few decisions made by the professionals were in the best interests of my relative.

With apologies to all those good people working in the care industry (and I know there are many – just that we were not fortunate enough to meet any).   The GP failed to care enough.  The social worker’s favourite phrase, when asked to solve a problem or even just to answer a question from family, was “I’ll see what I can do” which usually resulted in the most amazing period of inactivity.   The local authority failed to do anything at all in the best interests of their tenant, leaving a vulnerable person to live for weeks without central heating, without hot water and even without access to the outside world when the lift broke down.  It’s a tall order to expect an 81-year-old to walk down from the 5th floor and then back up again, day after day.  The extra-care social housing operated in the best interests of the domiciliary care agency owning the premises and running the service.  The mental health team spent more time caring about their own best interests than the best interests of their patients, and made major decisions without even bothering to inform family or to call a best interests case conference.  The legal advice they took to enable them to wash away all traces of their dirty dealings is staggering.  Their assessment unit couldn’t assess the best interests of a pea, let alone a desperately sick person.

And then, the care home.  The dénouement.  The final disgrace in the name of care.  It’s hard for me to use the words care home now, but neglect home doesn’t sound right, so I’ll just call it a home run in the best interests of Care UK.

I may be suspicious  when I hear our almost-elected almost-representatives talk of decisions, deals and pacts all being considered and discussed ‘in the national interest’.  But I will be watching, with interest, to see how they manage to overcome their failure to understand the message sent by the electorate.  A loud and clear call was sent out for change, perhaps even for a coalition government based on cooperation.  In the best interests of the electorate.

Now is the time for all good men to come to the aid of the party.

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