A care home or a disaster waiting to happen?

This is not something I’d planned to write just yet, but the shocking abuse of people with learning disabilities at Winterbourne View shown in the recent BBC Panorama programme, and the reasons behind the demise of private care provider Southern Cross have troubled me enormously,  so I’ve revised my plan.  I will do all I can personally to raise awareness of the crisis in care that is slowly being revealed.  With help from everyone involved and interested enough to care, we will bring about a change for the better.

I had intended to work my way slowly through the failings of the so-called care system that have affected my own family and my own life before reaching this chapter, but the world has changed, so I will start at the end.

The horrors of the torture of adults with learning difficulties at Winterbourne View long-stay/residential hospital have caused many people to ask questions.  The regulator CQC has so far not come up with answers but has promised an internal investigation.  Paul Burstow, care minister, promises action to safeguard vulnerable people in care.  Andrew Lansley, health secretary, managed to use the scandal to plug his questionable Health and Social Care reforms in his statement on Winterbourne View, and he talks of a ‘serious care review’ (sic).

John Healey, shadow health secretary, can manage only this empty comment on Southern Cross: “Thousands of very vulnerable people and their families will be worried sick by what’s being reported about Southern Cross.”  Ed Miliband is turning into the invisible man, so I can’t find anything of interest that he’s said over the last week – but he did get married recently so the honeymoon may be reason for the sound of silence.

It’s almost as if this bunch of ‘representatives of the people’ have only just arrived on the scene from another planet – but, no, they’ve all been on one side or other of the political washing line for years now.  Wearing blinkers, and all turning a blind eye to what so many real people have had to put up with.  Yes, I’ve written long and clearly worded letters to all of them over recent years, but – just like the CQC did to Terry Bryan, the senior nurse with the big whistle that nobody bothered to listen to when he blew it loudly in their ears – they all stick their heads in the sand, delegate matters downwards to someone who has a high qualification in the ‘copy & paste department’, who then creates a meaningless letter of reply quoting platitudes.  Pointless exercise – and a waste of an opportunity to ‘represent the people’ which is what they’re all paid to do.

I listened to BBC Radio 4’s Any Questions at the weekend.  Some of the panel don’t even know the difference between NHS care and social care, but they are the ones with the power to influence the audience, to make decisions about our lives.  Power is dangerous; power corrupts …. but that’s something I’ll leave for another day, and I will try to return to the abuse of power.

For far too long, the sound of silence has done its best to try to deafen and silence those of us who have not turned a blind eye.

Those responsible for the neglect and abuse of vulnerable adults in need of decent care have managed to create a system that arrogantly dismisses each and every major concern that is brought their way.  People ask how a care home could possibly exist that doesn’t provide decent care.  People ask who is responsible.  People wonder who is to blame when things go so badly wrong.   I’m not alone in knowing how these things come about – read on!!

They’re all in it together.  The care providers, the local authority care commissioning departments, the so-called regulator CQC, the formal complaints procedures that take away the will to live from those who dare to complain, the social services departments, the safeguarding of vulnerable adults units, the MPs who can’t be bothered to care, the Ombudspersons, the police who can’t find a way to help, the GMC, the NMC, the PCTs, the ICO – to name but a few.

After the scandal of Winterbourne View, someone asked “Is this the tip of an iceberg?”.  It is one hell of an iceberg.

Is what follows the description of a care home fit for purpose?  Or was it a disaster waiting to happen?

Please share any answers you may have, because I’ve almost lost the will to live too, but only almost.

A residential care home for 90 frail and vulnerable older people, many with dementia, described as a flagship, state-of-the-art care home, showing ‘the way forward for the future care of older people’, but where:

• there were no systems in place for appropriate staff selection, staff induction, training, and on-going supervision
• communication with GPs and other health services was seriously, dangerously and sadly lacking
• new staff received no induction programme
• pre-admission assessments, risk assessments did not reflect residents’ needs, follow-up assessments were not undertaken
• care plans were not written up in a meaningful way, let alone looked at by the staff
• the staff did not understand their roles
• there were no systems in place to monitor hydration and nutrition
• the nursing records did not reflect patients’ needs
• the care plans did not identify needs
• the record-keeping was seriously challenged and challenging
• no charts available for the monitoring of decline in a resident
• there was no system in place for clinical supervision and performance appraisal
• nursing staff without chronic disease management training
• no records kept of any training that was provided, if any was provided
• no knowledge of or training for diabetes management in place
• no system in place for routine monitoring of diabetes, swallowing or breathing difficulties,
• unsigned and undated and often illegible records kept, with entries that were meaningless
• a total lack of understanding of the need for and reasons for accurate medical/clinical records to be kept
• MAR (medication administration records) with entries unsigned or countersigned, and changes made without signature or date
• no records available to give details of the suitability of the staff to be employed in their positions
• no records available to give details of the employment status of the staff.

I can’t list any more now – but I trust you get the gist of this particular disaster waiting to happen.

Was that a care home fit for purpose?  Or was it a disaster waiting to happen?

But nobody noticed.  Until it was too late.

And yet, the care provider provided the care home with nursing and many others; the local authority commissioning department commissioned it and allowed it to open – so delighted was the local authority that it gave several 25-year contracts to the care provider to provide such services; the CQC/CSCI inspected and found all to be in order – before the ship sank, that is; the social services department found it suitable for vulnerable elderly people to be placed there – but placing them at even greater risk.

Unsurprisingly, the ship hit the rocks.

Then, and only then, did they all go behind closed doors, into a huddle, impose a massive action plan, close it for a full year to new residents – that’s the best that could have been done, although there were calls in the area for it to be closed in its entirety.  But, hey, the local authority had entered into a 25 year contract.  The care provider was in splendid ignorance – at first, but is no longer so innocent.  The care provider is not a novice to this business.  That is one of the most distressing and most depressing aspects of it all.  How many other care homes are there, being run in a similarly shoddy fashion, with careless care being provided to some who because of age, disability or illness are at their most vulnerable and who deserve good care.

My patience has been tried and tested, almost to the point of exhaustion, as I worked my way through each and every stage of the complaints procedure, before being allowed to progress to the next stage, and I haven’t yet reached the end of it all.  It is obscene, offensive, corrupt, squalid and unworthy of the word ‘care’ for this system to be allowed to exist, with absolutely no accountability, nobody prepared or willing to accept personal responsibility, and all behind closed doors, so that the wider world remains unaware of what is being perpetrated and perpetuated.

Over the weekend, I decided to look back over quite a few years.  From just a couple of years:

published 13 June 1998 : ‘In the short term, decentralisation shifts responsibility for funding care to individuals. In the long term, the combination of decentralisation and privatisation may make the costs of care higher than they need be to government and society. In the USA, the loss of control over the finance and delivery of long-term care seems to have increased the cost to government and decreased quality and access for individuals. The effects of these policies have not been adequately studied and understood in either country.’  (Allyson Pollock and Charlene Harrington.  I do wish we would learn to listen to Prof Allyson Pollock!)

published 4 April 1999 : ‘Local authorities have to get as many placements as possible with insufficient money,” he says. “If care is going to be determined by people undercutting each other, we’re going to be in an appalling situation.

published 8 September 1999 : ‘Care homes may be forced to close due to government quality measures.  Care home owners are demanding urgent talks with the government because of fears measures designed to improve quality will lead to home closures. ‘

published 11 November 1999 :  ‘Training has been the Achilles heel of social care with about 80 per cent of the workforce unqualified and an absence of clear employer responsibilities and targets. But a five-year training strategy by national training organisation TOPSS England aims to change this.’

‘It sets training standards and new qualifications for local authorities and the private sector covering a social care workforce of approximately one million. It draws together NVQs and post qualification training, spanning care workers in nursing homes and social services directors. As well as setting targets for training and qualifications, the five-year action plan aims to predict what future skills will be most in demand and how the government, employers, and employees should pay for the training.’

‘And the picture of training to emerge in other areas is little better. Only 19 per cent of staff in homes for people with learning difficulties were qualified and only 23 per cent of staff in homes for older people.’

‘Andrea Rowe, manager of TOPSS England, says the new regulatory regime will be judging care homes on the quality of their training as well as service standards being developed by the government. “They will lean on homes and close them down if they don’t meet the new service standards,” she says.’

‘Private residential and nursing homes claim they face a financial crisis, pointing to a mounting number of receiverships.’

It appears that we have made no progress.  We being the real Big Society ‘we’ – each and every person involved in the decision-making process.   The ones to suffer are the ones in care.  They suffer neglect and abuse because of society’s inability to show that it cares. .