Category Archives: growing older

Do we care more about dogs than we care about our senior citizens?

A man has been charged with causing suffering to a Metropolitan Police dog after a door was slammed on its head.

The short story is here for all to read.

Apparently, Lukasz Sklepkowski, 28, of no fixed address, has been charged with causing unnecessary suffering under the Animal Welfare Act.

You know what’s coming next …

We’ve had a week of CQC reports on hospital neglect of our mature citizens, followed hotly by another CQC report on the starvation of same mature citizens in our so-called care homes.

Can someone explain to me why one dog should be more precious than thousands of vulnerable people in need of care?

At least the dog had several police officers to protect it during its activities.

There is allegedly the Animal Welfare Act.

Where is the Human Welfare Act?  I’ve searched but haven’t found it so far.

 

 

 

 

 

 

 

 

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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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And then along came dementia

At the age of 80 she was 5’2” with eyes of blue, slim, elegant and full of energy still.  Well-dressed, well-spoken, perfectly kempt – all indicative of the wellness that had been a factor throughout her 80 years of life.  Like her brother before her, she had developed non-insulin dependent diabetes when she was about 70, but it was well-managed by her and by her doctor.  She ate a healthy diet, she loved walking, she didn’t have any vices – so the diabetes happened, rather than being caused by lifestyle choices.  She kept taking the tablets – the diabetes behaved itself.

If you ever wanted to phone her, you had to do it either before 9 in the morning or after 5 in the evening, because the intervening hours were all filled with ‘doing things’.  “Been out with the girls for a wander” – “It’s club day today, so we’re there all day for a lunch, a laugh and a natter” – “It’s market day today so we always go to stock up on a few bargains” – “We went Up West for a potter about”.  On it went, week in, week out.  Apart from Sundays.  “Oh no, we never go out on Sunday – that’s our day of rest!  We all do our housework on a Sunday.”

To celebrate her 80th  birthday, we went on holiday together.  She was up, showered and dressed by 8 o’clock every day, raring to go.  Breakfast over and off we went!  She walked the socks off us, she did!

We introduced her to digital photography which she found absolutely fascinating.  She may have said there were no flies on her Dad, but he’d be thrilled to know that there were no flies on his youngest daughter either, still at the age of 80 plus.  Once we gave her a few basic instructions on the camera, she was shooting like a professional.  Back at base, she soon took to adjusting her photographs on-screen, using a mouse like she’d had a mouse in her hand for years.

But, a few months later, in the Autumn of her 80th year, the alarm bells began to alert us to the fact that something was just not quite right.

“What are you having for dinner today?”

“Chicken”

“What a whole one?”

“Don’t be daft!  I bought two pieces of chicken.  I’ll cook both today, have one hot today and the other one cold tomorrow with salad.”

At first I just thought “clever move, what a good idea”, but when I got the same reply next time I phoned, and the next, I began to be a little suspicious.  Up to then, we’d never even had the slightest inkling that things might not be all they should be, so I suppose, in a way, I began to stick my nose in more often that I’d ever done before.   We started to make more frequent visits, and I’d have what she called a ‘snoop around’.  Just checking that things were still normal-looking, that the fridge had food in it, that the kitchen/bathroom/bedroom were all they had always been and that ….. ….

Yes, it was met with her usual wicked sense of humour and a wry smile, as she looked me in the eye and asked “are you checking up on me for some reason?”  But soon it became obvious that things were far from normal, and for the first time in her life she needed to call for help.  Or rather we, her family, needed to call for help on her behalf.

The two ‘rogues’ that I mentioned previously – in A life lived well before dementia – were her Great Great Grandfather, and his son, her Great Great Uncle.  Both pleaded guilty at the Old Bailey when accused of a warehouse break-in and larceny – back in the mid-1800s.  They had stolen property from ‘their master’, property that formed part of the tools of their trade, valued at a couple of £s only.  Perhaps they were planning to set up their own little enterprise!

The Old Bailey records show that the prosecutor had stated that the prisoners were father and son, and that “the elder prisoner”, who had been 23 years employed by him, had induced the younger one to assist in the robbery.  The elder prisoner – her Great Great Grandfather – was sentenced to 4 years’ penal servitude; the younger prisoner was sentenced to one month’s confinement followed by three years in a Reformatory.  A heavy price to pay for stealing a few £s’ worth of goods.  As far as I am aware, they are the only instances of wrong-doing in the whole of the family – right through to the present day.  They paid the price of the crime they committed, which is more than can be said for those who – by  their sins of omission – some 160 years later, committed their own crimes against a meek and mild 83 year old person in their care.

Charlie Chaplin, meek and mild,

Stole a sixpence from a child

When the child began to cry

Charlie Chaplin said goodbye

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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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CQC’s dynamic system of regulation

When I saw Mark Easton’s report on BBC News at Six yesterday about the changes in the way care homes in England are to be inspected, it made me wonder – yes, yet again! – whether the world has gone completely off course, heading for a major collision.

Then I read Mark Easton’s blog ‘Care and the Community’ and the words used by CQC have thrown me completely.

We rely on people who use services and those who care for and treat them to tell us about the quality and safety of services. This feedback is a vital part of our dynamic system of regulation which places the views, experiences, health and wellbeing of people who use services at its centre.

Dynamic system of regulation?  Dynamic?

Dynamism presupposes energy and effective action –   not exactly characteristics for which the CQC has ever been renowned.  Lethargic might be a more appropriate adjective to describe the CQC.

The CQC and its predecessor CSCI have been short of a dynamo – or even more than one – for  years, and there’s not much chance of new-found energy coming via a system of informal regulation which will rely on the already depleted energies of older vulnerable care home residents and their relatives.  It’s unfair to place such a burden on their shoulders.  But it will make it easier for care providers to cough out the old chestnut “well, nobody else has complained”.

Care Services Minister Paul Burstow said in Mark Easton’s report “…. we’re determined to actually make sure responsibility sits where it should be, with the commissioners, with local authorities and with the providers”.   Burstow almost implies that those commissioners, local authorities and care providers never had any responsibility in the past to ensure quality care in care homes.  So what were they commissioning, authorising and providing?  Crap Quality Care in the UK?

Anyone who has ever tried to shake awake either CSCI or CQC and to try to get some kind of dynamic action from them will be in a state of severe shock now.  It has never been possible in the past to get anything that resembles ‘concern’ from CSCI/CQC, so I have little optimism for the future.

Especially as the cuts currently being forced through in local authorities up and down the land will make dynamic localism an empty promise.

But if the plans to abolish councils’ legal duties to provide social care come to fruition, there will be no care homes.  There will be no care.  Social care will be gone into the hands of the private providers, available only to those who can afford to pay the charges of those private providers.  I wonder what it will be called if it becomes a discretionary rather than obligatory provision of care.    Local care?  Discretionary local care?  Survival of the fittest via neglect of the needy?

Is that a civilised way to support vulnerable adults in need of care?  It wouldn’t be allowed if it were cats and dogs we were talking about, so it should not be considered good enough for older people.

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Two more Ps added to the Con Dem Dictionary

They’ve been and gone and done it again!!  First they came up with Seven Ps for  the Vision for Adult Social Care.  Now, they’ve added two more Ps to the Con Dem Coalition Dictionary.

They are to give us the PIP!

Oxford English Dictionary (OED):

to have (also get) the pip: to be (or become) depressed, despondent, or unwell.

to give a person the pip: to annoy or irritate; to make angry, bad-tempered, or dispirited.

The proposed PIP has already achieved its purpose with me!

The proposed PIP is the Personal Independence Payment, a 21st century replacement for the DLA (Disability Living Allowance).  The Consultation Document arrived yesterday. 

“We are committed to a sustainable and fair system that allows people to work when they can and provides unconditional support to those who are unable to work.”  Allowing people to work when they ‘can’ will require the creation of jobs; denying or even giving people the PIP will not create those work opportunities.  Unconditional support?  That may be a first from the Coalition.  It’s hard to see where that unconditional support will come from, when you read some of the inflammatory language used to describe people in receipt of benefits, words that should never have entered the Coalition Dictionary.

“…. work is the best form of welfare for those who are able to do so” provides a new Coalition Dictionary definition of welfare.  Or is Maria Miller meaning the kind of happiness that David Cameron was talking about measuring, with £2m to be spent on a ‘happiness index’.   In my own family, the ‘welfare’ of working at a certain Remploy establishment never provided much happiness for our person with a disability, nor did it provide a decent salary; it provided an exceedingly boring, unbelievably repetitive and demeaning job that nobody would have chosen to do, had it not been forced onto a disabled person as the only ‘option’, and with very little in the way of financial reward.

“The rising caseload and expenditure is unsustainable” – but disability does not discriminate; disability arrives without warning and without counting the financial cost that a caring society should be able to manage.  Soon our discriminatory Con Dem Coalition – that arrived without warning and without giving us all the chance to count the cost – will make disability vanish altogether.  Now that really would be progressive, and if they can manage to achieve that one, I’m sure many disabled people will be enormously grateful.  But a caring government cannot turn a blind eye to disability.  Unless, of course, we don’t have a caring government.  Or unless we have at present a government with a disability.

“Instead, each case will be looked at individually, considering the impact of the impairment or health condition, rather than basing the decision on the health condition or impairment itself.” – I wonder if they’ve counted the cost of that plan, because that surely will be unsustainable.

“The new assessment will focus on an individual’s ability to carry out a range of key activities necessary to everyday life.” These sound so much like the Activities of Daily Living (ADLs) that are preventing so many vulnerable elderly people with dementia from receiving the healthcare and support they need.  According to the fuzzy thinking of some local authority bean counters (a.k.a. the finance department) ADLs only require ‘social care’, but not healthcare.   Is that where we are now heading?  Towards a world where disability is no longer to be considered anything to do with health, but only a function of being a person  in the (small) society?  Requiring the need to carry out only the basic ADLs of life?  Apart from the special equipment that a disabled person may need to perform the ADLs “necessary to everyday life”, are we now about to prescribe life?  Or should that be proscribe?  Who is to judge and dictate?

“this will involve a face-to-face meeting with an independent healthcare professional, allowing an in-depth analysis of an individual’s circumstances.” – Another unsustainable cost.  Transforming itself from cost to gain – to a sustainable gain for the independent healthcare professional fraternity that will no doubt emerge via a for-profit Provider of Independent Professionals (see below!).

“We know that some people’s needs may change over time, and sometimes so gradually that the customer themselves won’t notice.” The customer?  The customer????  What an unwelcome and insensitive word to use to describe someone with a disability.  But it may be a revealing word – revealing the way in which people with a disability are seen by our Con Dem Coalition.  You’re just a customer – so if you don’t like what we have ‘on offer’ go elsewhere.  But there is no ‘elsewhere’.  Sad!

“in line with the Government’s new strategy on fraud and error, there will be penalties if an individual knowingly fails to report a change that would have resulted in a reduction in benefit” How sad to see mention of ‘fraud’ so early in a request for consultation.  What is the total cost of DLA fraud?  Where is the evidence for that claim?  Please publish proof – 3 more Ps to add to the Coalition Dictionary!

“We must ensure that our resources are focused on those with the greatest need.” There is an unspoken message here, the implication being that there will be a severe scaling of disability and the exclusion of those disabled people who are not deemed to be in greatest need.  Critical needs only?  Severe needs maybe but not guaranteed?  Moderate needs possibly but unlikely?  All the normal needs associated with a disability – probably not a cat’s chance in hell of the focus being on those needs.

“The definitions currently used are subjective and reflect views of disability from the 1990s, not the modern day. For example, ‘mobility’ as currently defined concentrates on an individual’s ability to walk, not their ability to get around more generally.” Are we to receive a definition of mobility according to the Coalition Dictionary?

“One will be awarded on the basis of the individual’s ability to get around (the mobility component), the other on their ability to carry out other key activities necessary to be able to participate in daily life (the daily living component).” “Eligibility – The individual must have a long-term disability” – HELP!!!  That’s a Coalition Dictionary definition of disability.

“Personal Independence Payment will only be available to those with a long-term health condition or impairment.” as above!

“Our initial proposal is that the assessment should consider activities related to an individual’s ability to get around, interact with others, manage personal care and treatment needs, and access food and drink.”

“This might mean, for example, considering an individual’s ability to get about in a wheelchair, rather than ignoring the wheelchair, as we do currently.” What will be the consequences for a person with cerebral palsy, say, who is not able to stand and walk without the support of two walking sticks, and who cannot take one single unassisted step before falling to the ground, but who has made the personal choice not to use a wheelchair whilst preferring to use two walking sticks to aid mobility from chair to table, from table to bathroom, from bathroom to bed, from front door to car (with hand-controls, and all paid for by the person), from car to place of work, from  …. etc etc etc?  Is that person to be categorised as ‘fully mobile’ or ‘could be fully mobile if we force her/him to use a wheelchair or else we remove his/her PIP?’  This plan is beginning to scare me.

Or will a person with exactly the same disability as another be entitled to PIP because she/he makes the personal choice of walking with sticks rather than using a wheelchair as an aid to mobility?  Whereas a person with exactly the same disability and the same manifestations of that disability is to be denied PIP because she/he makes the personal choice of using a wheelchair?  Yes, I am confused by this one.

“What aids and adaptations should be included? Should the assessment only take into account aids and adaptations where the person already has them or should we consider those that the person might be eligible for and can easily obtain?” And would those aids and adaptations be chosen by the person?  Or merely the ones the PIP decision-makers decide can be afforded by this onslaught on people with a disability?

“What would be the implications for disabled people and service providers if it was not possible for Personal Independence Payment to be used as a passport to other benefits and services?” Surely that question does not need to be asked – it’s obvious.

“The social model of disability says that disability is created by barriers in society.  We remain committed to the social model of disability. The new assessment will not be based solely on the medical model of disability and focused entirely on an individual’s impairment, but will instead focus on the ability of an individual to carry out a range of key activities necessary for everyday life.” This obsession with the ‘activities necessary for everyday life’ must surely go against everything the Disability Discrimination Act has ever stood for.

“Many people think that disability is caused by an individual’s health condition or impairment. This approach is called the medical model of disability.” The fact remains that some disability is indeed caused by an individual’s health condition or impairment, and that cannot be ignored.  You cannot change the focus of disability from medical to social needs.  Disability is not created by barriers in society – however, the barriers in society often increase the disability.  Chicken and egg!  The Con Dem Coalition has no mandate to scramble eggs, for the convenience of – and in the best interests of – the Con Dem Coalition’s sustainability.

“measuring each individual’s expenditure would be administratively complex and expensive” – and yet the plan is to assess and review each and every single application and applicant?  How will we be able to afford the one, but not the other?  The costs will be enormously expensive but will come via the creation of a new pot of gold for a new breed of independent Providers of Independent Professionals (a different kind of PIP!!) – a new bandwagon for the ‘for-profit health and care providers’ to pounce on.

In the recent past, Tory MP Rory Stuart described some of his constituents as “primitive people, holding up their trousers with bits of twine”.

The Government decided to get tough – on benefit scroungers by bringing in Experian to assist with bounty-hunting of the poor

The magnificent IDS (Iain Duncan Smith) decided to talk of sin, when referring to people who were without work.

Then along came Howard Flight, Tory peer, with his preposterous claim that changes to the child benefit system would encourage the poor to “breed”.

Where next?  Perhaps those who are unfortunate enough to be in receipt of a disability will all be required to PIP off to a Dickensian workhouse.  Or why not swap places with the House of Commons’ scroungers?

The Con Dem Coalition members are unlikely to be on the receiving end of many of the decisions they are now making.  I just hope there will be a system in place to pick up the pieces of their decision-making.

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Councils’ body says cuts threaten home care for elderly

“Virtually all” councils in England and Wales could be forced to end home help for elderly and disabled people, the Local Government Association has said, according to this report from  BBC News.

Care Services Minister Paul Burstow said it was “wrong to scare people”.

But shadow health minister John Healey said: “This shows you cannot make big budget cuts without big consequences.

But you can scare people, of course, if you are a Big Budget Cutter who can’t see the Big Consequences for the Big Society that hasn’t yet been created.

Perhpas we would be better off with ‘virtual councils’.

Otherwise  “virtually all” elderly and disabled people who depend on home care from their councils will be “virtually  neglected”.

Sad world we now inhabit.

I’m not feeling positively optimistic  about the future of care for  elderly and disabled people.

In fact, I’m virtually pessimistic about it all.

Forward to a real future we could all care about.  Not back to a past we thought we’d virtually and really left behind.

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The Patient Resident deserves better care

If, as I suspect, the Comprehensive Spending Review allows the growth of independent care providers, my plea to everyone involved, in a professional or personal capacity, is to keep on demanding quality care.  Shout loudly and clearly, with the emphasis on the words quality care.  Until, that is, we achieve a standard of domiciliary care and residential care that we can be proud to call care.  Then keep a watchful eye.

The case of Jamie Merrett 37-year-old tetraplegic patient, who suffered brain damage when his ventilator was switched off by mistake at his home in Devizes, Wiltshire last year, is disturbing on many levels.  Sadly, there are numerous others who suffer the consequences of equally appalling care.

The Nursing & Midwifery Council code Standards of conduct, performance and ethics for nurses and midwives requires a registered nurse to ‘recognise and work within the limits’ of his/her competence. As far as I’m aware, that includes agency nurses as well.

Both Violetta Aylward and Ambition 24hours (the agency that provided her services to Jamie Merrett) share the responsibility for their actions.   I just hope that Ambition 24hours does not escape suitable punishment.   ‘One of the leading UK nursing agencies, Ambition 24hours, part of the A24Group, specialises in the provision of specialist nursing jobs for registered nurses and healthcare assistants for both temporary and permanent placement within NHS Trusts, private hospitals, nursing and residential homes, HMP Prison services, mental health and learning disability environments’.

Ambition 24hours needs to revise its ambition and to make care and control of itself its Number 1 ambition.  Only then should Ambition 24hours be given the right to provide care to vulnerable people.

It is not unknown for care home nurses/agency nurses/care workers to be well aware of the fact that their manager is making demands of them to carry out duties for which they are unqualified, untrained and unsupervised. The culture of care is such that they carry on regardless. The Patient Resident suffers the consequences – and perhaps dies as a result.

Then, everyone sticks together with the kind of superglue that takes years to dissolve. That’s what creates the foul smell of the ‘for profit’ culture – if you will forgive my language.

The nurse is protected by the manager or agency; the manager’s protected by the care provider’s regional manager; the regional manager’s protected by the care provider; the local authority’s ‘bed manager’ is protected by the commissioning department; the local authority’s protected by the LGO; they’re all protected by CQC – and so it goes on. Every single one of them has another layer of protection.

All except The Patient Resident, that is, and The Patient Resident has no layer of protection at all.  By the time the superglue comes out to cement all the guilty layers, The Patient Resident is beyond protection.  Too late did they all care.  Too late for The Patient Resident.

It’s only if you have the inner strength to spend 3 years or more, peeling away each of the layers that you discover the root cause. Nobody cared enough to ensure that each and every single layer was fit for purpose.

A for-profit multinational care provider or agency can import care workers from abroad who have only a minimal command of the language of those they are to provide care to, little knowledge of our health and social care systems, little incentive to go that extra mile. They have no job security, are paid a minimum wage, dare not speak the word abuse or neglect – they too are abused.

Unless, like John Adeleye, former dementia care worker/care home activity co-ordinator – recently departed from X Factor – the good publicity for his for-profit care provider former employer suddenly causes the care provider to care about him.  I hope he received a fat bonus from his former employer, Care UK, or at least a golden handshake for the good publicity he gave.

Care home charges are sky high for The Patient Resident. The Patient Resident is in need of care, so places their trust in the word ‘care’.  Neither The Patient Resident, nor his/her family, can possibly know the ins and outs of the care industry, at the very moment when they are looking for quality care.  It is only after a tragedy that the real truth emerges.  There was no such thing as care able to be provided.  But nobody noticed.  Nobody cared enough to notice.

Today, I’ve been reading about this new initiative called the Dementia Action Alliance made up of over 40 organisations committed to transforming the quality of life of people living with dementia in the UK and the millions of people who care for them.  Signatories to the Declaration have published their own Action Plans setting out what they each will do to secure these outcomes and improve the quality of life of people with dementia by 2014.

Why should it take you all that long?  Dementia’s been around for a century now, or rather it’s over a century since one form of dementia was given the name Alzheimer’s by Alois Alzheimer.  This troublesome elderly population has been growing older by the day for best part of a century too.   Get a move on!!

It’s interesting to note how many care providers are promising to provide the kind of care we all thought they were supposed to have been providing for years now!    Care UK even has the nerve to write into its own action plan: Whilst training has been recognised nationally as a key driver in achieving improved standards of care and delivery of care that is outcome focused, there is limited funding available to deliver this training – well, I could suggest a source of funding to you.  Have a look into your own company’s profits.    Have a look at all the profit you must have made from ‘cutting corners’ here and there and … round the corner.  Or even take a few of the £millions of compensation you have pulled in from the numerous contracts you failed to deliver, but for which you had negotiated 25-year contracts.  You’ll probably get more compensation from this latest one in Newcastle.

The Department of Health (DoH) and several care home groups have promised to reduce the use of anti-psychotic drugs to subdue dementia sufferers.  The use of ‘chemical cosh’ drugs for dementia patients will be cut and sufferers kept out of hospital beds, an unprecedented coalition of 45 organisations has pledged.  Please don’t leave that until 2014 too.

GET A MOVE ON!!!!

The Patient Resident and The Patient Resident’s family may not have the time to wait for you all to get a move on!!!!

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Care and progress? – Or ideology gone too far?

Plymouth – July 2010

THREE council-run residential homes could be closed as the city changes the way it looks after elderly and vulnerable people.

And a respite unit for people with learning disabilities also faces closure if the city council Cabinet agrees at its meeting next Tuesday.

The changes will come as part of a wider strategy to modernise care services.

The council has already moved older people out of a number of out-dated residential centres and into new extra care schemes where they can be helped to live with more independence.

Fife – October 2010-10

As public spending cuts begin to bite, councillors will be asked to consider three cost-saving options when the social work and health committee meet on Tuesday (19th October).

One of these includes closing all local authority residential care homes with residents moving to another care home of their choice in the private or not for profit sector.

Fife – October 2010 update

While councillors agreed on Tuesday to reject a plan which would have seen all 10 of its care homes closed and residents transferred to places in the private and voluntary sector, question marks remain over seven of the homes after the council agreed to consult with a view to “replacing existing provision as and when suitable alternative provision becomes available.”

Llanelli – October 2010

A new row is brewing over controversial plans to close two Llanelli care homes.

Union chiefs have complained to the Assembly Government  over the public consultation exercise being carried out on Caemaen and St Paul’s care homes

Carmarthenshire Council denies Unison’s claims the exercise is “unfair and inadequate”.

The union says the consultation document includes options to close both homes and privatise residential care home services.

Suffolk – October 2010

The council is to look at all 16 homes that it operates across the county – and has come up with three options for the future:

Option 1 – Closing the homes and buying in services from the private sector.

Option 2 – Selling off all the homes as going concerns.

Option 3 – Closing six homes and trying to sell off the remaining 10.

Isle of Wight – October 2010

Also proposed in the far-reaching consultation are plans to scrap free home care for the over 80s and increase charges for services, including meals on wheels, home care and day centre sessions — plans which have sparked concern among carers.
Frances Wright, chairman of the Isle of Wight branch of Carers UK, said: “All these charges will add up. It’s not just money — people are worried about paying for services but they are also worried services will disappear.”
A report commissioned by healthcare watchdog, the IW LINk, suggested further plans to cut support services for all but the most vulnerable people could prove to be a false economy. It found money spent on preventative social care services resulted in long-term savings for the council and other agencies, such as the NHS.

This week’s Comprehensive Spending Review has caused Nigel Edwards, Acting Chief Executive of the NHS Confederation, to warn in a letter to The Daily Telegraph that hospital beds in England may fill up with the elderly and vulnerable because of cuts to local authority social care funding.  “Hospital beds will be blocked for those who badly need care because the support services the elderly require after discharge will not be available.”

= = = = = = = = = = = = = = = = = = = =

Once upon a time – not a bedtime story, this one! – elderly and vulnerable people were spending longer than necessary in nasty, horrible, depressing, run-down Victorian long-stay hospitals.  Many were fairly averagely normal (whatever that means) when they arrived; some were just seen as a danger to the public, so were lifted and incarcerated.  Before long they became institutionalised to such an extent that a return to normal life in the community wasn’t on the cards.   Even young unmarried women who had become pregnant were forcibly held in some of these appalling institutions – and they never recovered from the experience.

Then, as the Welfare State gained strength, and as society gradually improved its attitudes towards the needy, the vulnerable, and those with disabilities, there was a plan to close these places down, once and for all.   From the 1960s, Care in the Community became the buzzword.  Then slowly,  all people were to have the same human right to a life with dignity, regardless of  their age, gender, race, colour … and so on.  Goodbye to institutions, asylums, long-stay hospitals.  Hello to care.  Or so we thought.

Here we are now, with the biggest onslaught about to take place on our public services, our welfare state, with the sick, the vulnerable, the elderly and the poor all about to become victims of a brutal ideology gone too far. Without a mandate from the Great British people for such draconian measures.  I want nothing to do with that kind of Big Society.

We found a way to care in the community.  Is there no place for care in the big society?

At the memorial service for PC Toms, on Monday 18 October 2010, David Cameron quoted “evil thrives when good men do nothing” – and as I watched a clip on TV News of him saying that, I wondered to myself whether the (then undeclared) Comprehensive Spending Review would bring a similar thought to our minds.

They don’t care, do they?

So we will have to show them that we care.

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GPs should review care home medication every six months

Question: Who’s keeping a finger on the pulse of care in care homes for the elderly? was a question I asked recently.

Answer: Older People’s Specialists’ Forum (OPSF) and the British Geriatrics Society

The Older People’s Specialists’ Forum (OPSF) is a group of healthcare professionals specialising in the care of older people. Its members include representatives from: The British Geriatrics Society, the Royal College of Speech and Language Therapists (RCSLT), the Department of Health, the National Association of Primary Care, the Society and College of Radiographers, the College of Occupational Therapists, the British Association of Art Therapists, the Chartered Society of Physiotherapists, the Royal College of Nursing, the Royal College of General Practitioners, the Royal College of Psychiatrists (Faculty of Old Age Psychiatry).

Nearly seven out of ten (68%) care home residents do not get a regular planned medical review by their GP and 44% are not getting a regular planned review of their medication a survey said today.

The survey was launched by the Older People’s Specialists’ Forum (OPSF) and asked care homes across the UK about their experiences of accessing healthcare services for their residents.

The survey also found that 59% could access specialist dementia services such as memory clinics and community mental health teams. Most care homes could request input from specialist nurses when a problem had arisen but very few homes appeared to have access to input from specialists to prevent problems arising.

According to PULSE, the British Geriatric Society will publish GP guidance next April to improve care in nursing and residential homes by tightening up medicines-management arrangements, following disturbing findings uncovered by Pulse’s recent special investigation.

The guidance will highlight the importance of six-monthly medication reviews by GPs or pharmacists, and the need for a medical and nursing care plan within one month of admission to a care home.

About time too, would be the reaction of every single person who has experienced sloppy, slapdash, uncaring medication control in a residential care home with nursing, specialising in dementia.  About time too.

CHUMS  Care Homes Use of Medicines Study looked at Medication errors in nursing & residential care homes, studying 256 patients in 55 homes. Patients were on a mean of 7.2 medicines each and 69.5% of patients had at least one error.  The field work was carried out in 2006‐7 .

The prevalence of errors was: prescribing 8.3%, monitoring 14.7% (for relevant medicines), dispensing 9.8% and administration 8.4%; these figures represent the likelihood that each act (prescribing a medicine, for example) will be an error. In terms of patients receiving errors: 39.1% received a prescribing error, 18.4% (of those who needed it) a monitoring error, 36.7% a dispensing error and 22.3% observed to receive an administration error.

The great majority of monitoring errors (91%) resulted from a failure to request monitoring. There was considerable variation between areas, with three‐quarters of monitoring errors occurring in London.

Conclusions: There is an unacceptable prevalence of medication errors in care homes, affecting some of the most vulnerable members of society.   Action is required from all concerned.

Questions:

Why should it take so long for caring care to be provided?

Why should it take so long for ‘required action’ to take place?

Why should it take so long for sensible measures to be seen to be in place to protect vulnerable elderly people?

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