Category Archives: NHS

Care in the UK over two weeks in December 2012

1 December 2012: TENS of thousands of vulnerable people are being physically and mentally abused by the very people meant to be caring for them. Disturbing figures reveal that 130,000 adults were ill treated – usually at the hands of carers or family. Abuse most often took place in their own home or care home.  Read more here.

1 December 2012: Abuse of elderly patients by NHS staff rises by a third in one year with a  shocking 36,000 offences reported last year alone.  Read more here.

1 December 2012: Care home regulation criticised by Norman Lamb.  Regulation of the care sector is not fit for purpose, care minister Norman Lamb has said as he unveiled proposals on English care homes for consultation. He also said there was a “significant lack of corporate accountability for the quality of care”. One suggested measure involves companies having to open up their books to inspectors to ensure they are financially sound. Read more here.

1 December 2012: Care home companies could be forced to open books to prevent another ‘Southern Cross’ collapse.  Read more here.

4 December 2012: Care home job advertisements ‘encouraging’ criminals to apply.  Convicted criminals have been encouraged to apply for jobs in care homes looking after frail, elderly people.  Read more here.

4 December 2012: Ann Clwyd, Labour MP tells of inhumane treatment and says she fears normalisation of cruelty now rife among NHS nurses.  Ann Clwyd has said her biggest regret is that she didn’t “stand in the hospital corridor and scream” in protest at the “almost callous lack of care” with which nurses treated her husband as he lay dying in the University Hospital of Wales in Cardiff.  Read more here.

4 December 2012: Melton Court care home to be closed by Friday. The manager of a South Yorkshire care home, which has been ordered to close by Friday, says she is in talks with two potential new providers. The 21 residents at Melton Court in Maltby have to find new homes, after it emerged the owner is in prison. The Care Quality Commission (CQC) revoked Ishtiaq Zahir’s licence and said the home is operating illegally.  Read more here.

5 December 2012: A PENSIONER with Alzheimer’s died after she plunged down a lift shaft when the door was left unsecured, a court heard yesterday. Annfield Plain company faces health and safety charges after tragedy.   Read more here.

5 December 2012: Wrexham – Concerns over care at mental health hospital.  Read more here.

6 December 2012: Leicester – Dementia sufferer ‘left in agony’ at George Hythe House care home in Beaumont Leys, court hears.  An 89-year-old dementia sufferer was left in agony for four hours with a broken thigh  because a care home supervisor could not be bothered to assess her, a   jury heard. Sarah Bewley was “too busy” doing paperwork to see the woman after she suffered a fall, despite several requests from a care assistant, it was claimed.  Read more here.  See below.

7 December 2012: Regulator moves closer to setting up ‘negative register’ of adult care staff.   If the proposals are approved by government, a national code of conduct would be applied to workforce and the HCPC would consider serious complaints made about individual professionals; any decisions to uphold a complaint would be made public, as would the resulting sanction.

A “negative register” would be maintained of those found unfit to practise.  Read more here.

7 December 2012:  Leicester – Jury clears Leicester care home boss of neglect charge.  After the not guilty verdict was announced, Judge Lynn Tayton QC said: “This case raises very worrying issues, particularly concerning systems that seemed to be in place which created a situation in which no-one took responsibility for the care of this lady.  “She was left in severe and unnecessary pain for a number of hours.”I hope those in charge of the home have looked at the systems and the staff training.” Read more here.

7 December 2012:   Chorley, Lancs – A care-home worker and her husband who subjected  their children to years of horrific abuse were facing jail yesterday after being  convicted of cruelty.  Read more here.
8 December 2012: Wolverhampton – An investigation has been launched into safeguarding at a care home, which helps people with mental health, drugs and alcohol problems.  Read more here.
8 December 2012: Derby – A national health watchdog has issued a damning report on a privately-run Derby care home.  The Care Quality Commission has told the company  that owns Cleeve Villas Nursing Home, in Wilson Street, to do more to protect the safety and welfare of residents – or face legal action.  Among the problems identified were:
  • No organised stock control system of medicines
  • Failure of staff to update crucial medical documents
  • Care plans reviews not completed on time
  • Failure to ensure prescribed medicines were always available
  • Medicine doses not being documented, meaning it was unclear whether medications had been administered
  • No appropriate systems in place for the safe disposal of medicines when they were no longer required.

Read more here.

Read the CQC report on Cleeve Villas here.

That list of failures is just the kind of thing most people don’t know about, so  awareness raised to the top is what we need in the world of care.

When it comes to the comment made by the spokeswoman for Cleeve Villas Care Services : “As a dedicated provider of care services, we at Cleeve Villas have taken on board the suggestions from CQC as to how to enhance our overall performance and have already taken steps working with a specialist healthcare consultancy to address these.”Our aim as always is to ensure the individual and complex needs of our residents are met.”

I don’t believe you.  Yet.  This is not the first CQC detailing same/similar problems.   What has taken you so long to show that you care enough to provide good quality care?

9 December 2012: Vulnerable care home residents are treated like “brutes or malfunctioning machines”, said Hilary Mantel, the author, as she spoke of the “utterly depressing” search to find accommodation for a disabled friend.  Read more here.

10 December 2012:  We haven’t a clue how much a care home will cost us.  The vexed question of how we pay for the care needs of Britain’s ageing population rears its ugly head so often that it is no wonder everyone thinks it is a pain in the neck.  Read more here.

10 December 2012: Star ratings: Families need reliable information on care home performance.  Read more here.

10 December 2012: Preventative care for elderly under threat.  Services have been cut or frozen by two-thirds of local councils since coalition came to power, according to ComRes study.  Read more here.

10 December 2012: A Birmingham care home is being investigated by council and health bosses amid  allegations of neglect.  Bramley Court Care Home, in School Road, Yardley Wood, is facing the probe  after a complaint was made about the standard of care given to elderly  residents. New admissions have been suspended while a joint investigation is carried out  by the city council and NHS Birmingham and Solihull.  It is not the first time the home has been in the spotlight over its  treatment of residents. In August a report by watchdog, the Care Quality Commission, found residents  were being put at risk of not receiving adequate food and drink.  Read more here.

10 December 2012: Winterbourne View scandal prompts new care guidelinesReport warns that care sector risks slipping back into institutional culture typified by Victorian asylum system.

The report warns that, elsewhere, staffing cuts caused by reduced fees paid to care providers are causing residents to be left alone for hours at a time and are fostering excessive reliance on use of drugs and on physical restraint, “often for minor perceived misdemeanours”.

Brendan Sarsfield, Family Mosaic’s chief executive, said: “We would argue that if providers don’t believe this has ever happened in their services, it just may be that they haven’t looked hard enough.  Read more here.

10 December 2012: Care home provider Family Mosaic has warned that the care sector is in danger of slipping back into the institutional ways of the past and is urging care providers “not to be complacent” and be vigilant for danger signs of abuse.  Read more here.

10 December 2012: Winterbourne View scandal: Government rethinks use of hospitals.  Norman Lamb said “”We need to have a situation where people who run care organisations – public or private sector or voluntary – know that they are accountable for the services they provide and there are consequences if they don’t.”  You can’t argue with that so let’s home he brings about accountability.  Read more here.

12 December 2012: Copthorne, Sussex – Care home boss suspended over death of patient.  A care home manager has been suspended by the Nursing and Midwifery Council over allegations she shredded a document to cover up a mistake which led to the death of a resident. The resident of  Orchid View care home in Copthorne was given three times the prescribed dosage of Warfarin, a drug used to prevent blood clots, over 17 days in 2010. Read more here.

12 December 2012: Stockton care home boss denies a catalogue of failures.  Meal times at the home were “appallingly organised” and 15 out of 17 patients  lost weight over a one-month period, the Nursing and Midwifery Council heard.  Read more here.

12 December 2012: York care home warned to make urgent improvements.  The Care Quality Commission has issued a formal warning to Mimosa Healthcare (No 4) Limited, which is the registered provider of Birchlands Care Home, that they are failing to protect the safety and welfare of the people using the service.  Read more here.

12 December 2012: Wall Heath care home told to shape up or face enforcement action.  The Care Quality Commision (CQC) is demanding an improvement in the standards of care at Holbeche House after inspectors found failings during an unannounced visit in October.  The Wolverhampton Road home, which is run by Four Seasons (Bamford) Limited, was found to be below standards for the care and welfare of service users and assessing and monitoring the quality of services.  Andrea Gordon, deputy director of operations (central region) for CQC, said: “The law says these are the standards that everyone should be able to expect. Providers have a duty to ensure they are compliant.  Read more here.

12 December 2012: Nurse at Rodborough care home slept with vulnerable female patient and invited another to swingers’ parties. Trevor Rice, a senior triage mental health nurse at Park House Mental Health Resource Centre, was formally removed from his post by a Nursing and Midwifery Council disciplinary committee on November 23.   Read more here.

12 December 2012: A bungling nurse who was cleared to work in Sussex despite making a number of shocking errors is being investigated for a second time.   Nicanor Sindanum made national headlines after he was allowed to continue to work as a nurse despite being found guilty of 17 serious errors by a nursing panel while working in Scotland.   In June this year a nine-month banning order imposed by the Nursing and Midwifery Council (NMC) in September 2011 was revoked and replaced with conditions of practice order.  This meant that, despite his failings, Sindanum was allowed to start work for an Eastbourne care home so long as he told bosses that he had restrictions placed on him. But now it has emerged that Sindanum faces a second investigation for alleged failings dating from 2009.  Read more here.

13 December 2012: Slyne-with-Hest, Lancashire – Four people have been charged with offences under the Mental Capacity Act 2005 following a police investigation into the mistreatment of residents at a care home in Slyne.  Read more here.

13 December 2012: Wales – More should be done to reduce Wales’ reliance on using care homes as a way to look after older people, says a group of Assembly Members.  The assembly’s health committee has backed moves to help people keep their independence for as long as possible. Families need simple and accessible information about the options available for elderly relatives, it said. It pointed out that many elderly people who pay for their own care were unaware of the help available to them.  Read more here.

13 December 202: Panshanger, Welwyn, Herts -Massive arrogance’ jibe as ‘out of scale’ care home plans thrown out.  Read more here.

13 December 2012: Morpeth, Northumberland – Coroner hits out at care of woman in Morpeth home.  Mr Brown, recording a narrative verdict, yesterday concluded the fall “did  play a part” in Mrs McEwan’s death as the fractured femur caused immobility  which made her more susceptible to the fatal complaint. The coroner also found three serious failures in the care of Mrs McEwan.

He ruled senior carer Stephanie Wilson had left Mrs McEwan’s bed in an  elevated position, moments before she fell while trying to get into it.

Furthermore, Mr Brown said staff had failed by phoning a doctor’s surgery  instead of an ambulance after the fall, even though Mrs McEwan was in obvious  pain and in need of such care immediately.

Finally, the coroner said workers had been wrong to lift Mrs McEwan back on  the bed, saying they should have left her where she was comfortable until the  ambulance arrived.

Mr Brown nevertheless accepted that staff had been misguided and in need of  better training rather than motivated by malice.  Read more here.

13 December 2012: Croydon  – Are Croydon care homes up to the job of looking after borough’s most vulnerable?  Nearly a third of care homes in the south of the borough are failing patients and residents in one or more key standard, an Advertiser investigation has found.

Campaigners for better care say the findings paint a “dire” picture for sick and elderly people at a time when savings in care provision are set to be enforced.

Among those that are failing in one or more key standard are homes which charge elderly people up to £800 a week.

Stuart Routledge, chief executive of Age UK Croydon, said: “It is appalling that any nursing home should fail to protect the dignity and respect of their patients and residents.

“This survey underpins the urgency for social care funding reform so that those older people who struggle daily with chronic ill health, frailty and disability have the peace of mind that they will be well cared for at their time of need.

“In particular, this shows the dire consequences of a social care system that has been under increasing financial pressure over the last eight years and in many areas is now financially stripped to the bone.

“Staff across health and care services have a professional and moral duty to make sure the dignity of their patients and residents is enshrined in every action. This means involving people in decisions about their care, providing care that treats people with respect and helping people to be as independent possible.”

Read more here.

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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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“Dignified Care?”

“The treatment of some older people in Welsh hospitals is “shamefully inadequate”. That is the message today (14 March 2011) from  Ruth Marks, Older People’s Commissioner for Wales, as she publishes a major report into her review of the experiences of older people in hospital in Wales.

The Commissioner calls for ‘fundamental change’ to ensure that older people are always treated with dignity and respect when they are in hospital. She also reminds health organisations of the legal powers invested in the Older People’s Commissioner to effect necessary change.”

Ruth Marks’ short video should be compulsory viewing for all hospital staff, wherever they work.

The full report should be compulsory reading for all hospital staff, wherever they work.

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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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Filed under care, care fees, care homes, Care UK, dementia care, domiciliary homecare, growing older, Local Authority, NHS, suffering

The meaning of CSR?

CSR = Comprehensive Spending Review

CSR = Cheer Smirk Rejoice

LibDemCon MPs cheered –they smirked – they rejoiced.

LibDemCon MPs applauded, smiling, seeming satisfied that they had destroyed enough.

Coalition Ministers smiled even as their own departmental budgets were cut.

The poorest will lose a higher proportion of their income than the average, according to the government’s own graphs.  Brendan Barber TUC General Secretary said that the poorest tenth of the population would lose a fifth of their income because of Coalition cuts; the richest would lose just 1.5 per cent of their income.  He may now revise that estimate.

Some councils will go bust.

750,000  public sector job cuts are forecast.  Or more?

Twice as many women as men work in the public sector and 40% of all female workers are employed by the state.   Women have been encouraged to become gainfully employed, largely in the public sector, with young children being placed into childcare, another largely female industry.  The majority of care workers are women.  Not many male librarians where I live.  It’s rare to meet a male in local admin jobs either.  Is this a plan to send women back to the past?  Could that really be seen as progress?

An additional £7bn welfare cuts, on top of the £11bn already announced.

The convenient accounting that has gone on with the £2bn to social care (via the NHS in part) is a con!  That money is not ring-fenced, so it will just be swallowed up by the big local authority pot that has just been cut savagely via the CSR.  Goodbye social care; an unwelcome return of the poorhouse/workhouse. And don’t be fooled by this attempt to persuade people to use Personal Budgets.   They are enormously complex to operate, requiring most people who’ve tried them to turn themselves into employers, or to employ someone to manage the Personal Budget for them.  Or is that another part of the con trick?  The responsibilities of unpaid carers will increase; the burden of care will fall on their shoulders.  Their narrow shoulders, not the broad shoulders mentioned by Creepy Osborne.

Any government that can remove the mobility component of DLA from people in residential care cannot sink much lower.  At the moment, many people in residential care are allowed the grand total of £21 per week for ‘spending money’, after their care costs have been paid for.  That’s all they are allowed to retain.  Remove the mobility allowance and they will be trapped forever, within the walls of the care home.  Is that really the best we can offer and still call it ‘care’?

The IFS says spending review cuts are regressive and will hit the poorest in society, not the richest.

This is not what I call ‘fair’.  Nor are we all in this together.  The Big Society?  Not sure that one will wash any more!

By strange coincidence of the calendar, Nick Clegg has just been named Communicator of the Year at the PRWeek awards.  “The judges (sixty-two senior PR professionals) praised Clegg for his smart general election communications campaign that positioned him as a fresh alternative to the other political parties.

In fewer than 12 months, Clegg has gone from leading a party frustrated by a lack of media attention to the full glare of the world’s media, as he walked side by side with Prime Minister David Cameron into 10 Downing Street on 11 May.

Style over substance; if Clegg was that good a communicator, the Liberal Democrats would have won the general election, as opposed to having to swallow everything they ‘communicated’ beforehand in order to shack up with the Tories.

Joanna Lumley won that same award last year.  “She was chosen by judges for her work spearheading the Gurkha campaign for settlement rights. As a figurehead she was able to move seamlessly from the media scrum to heavyweight political programmes such as the Andrew Marr Show, and had the clout to secure meetings at the highest political level.

Joanna Lumley might make a better fist of government than this bunch of clowns.

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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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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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Filed under care homes, growing older, neglect, NHS, professional responsibility

Intermittent connections in the world of dementia and care

There is what is known as a ‘major Service Outage’ in my part of the UK, and many of us are struggling with creepingly slow broadband connections – all are up the creek without a paddle for the foreseeable future, and no amount of troubleshooting has so far been able to sort us all out.  I’m told I have an intermittent connection, but no boffin has so far been able to create the constant connection that I need.  And as those strangely disconnected moments turned into hours, then days and now weeks, we have all been driven to distraction.  So, many micro filters have been changed, routers powered down and powered up, settings have all been checked, lines tested … and so on.  The systems have all had a thorough MOT.

But the brain behind the broadband can’t send the right signals to the right place at the right time for a meaningful, reliable and constant connection to be established.

Just like dementia.

When the brain’s working properly all those little electrical impulses work their way along the nerves to and from parts of your body and parts of your brain.  The neurotransmitters help those signals to jump across the gaps between the nerve cells.  And language, movement, problem solving and memory all work according to plan, according to the blueprint.  The connections remain constant.

But, with Alzheimer’s disease, the brain shrinks as the number of nerve cells in the brain reduces.  You can’t grow new nerve cells, so as more and more cells die away, the problems of dementia increase.  The neurotransmitters are reduced too so they can’t send the same signals.  The intermittent connections begin to surface.

The brain needs a good supply of blood – via blood vessels – for it to function, but if the vascular system in the brain becomes damaged, because of diabetes, high blood pressure or heart problems perhaps, or a stroke, the blood can’t reach the brain cells, so they eventually die.  And then along comes Vascular Dementia to wreak havoc.  More intermittent connections surface.

It’s 100 years since Alois Alzheimer first described Alzheimer’s.  Very little of Alzheimer’s teachings had to be revised and, though 100 years older today, they have not been corrected or amended but only confirmed.  Alois Alzheimer was apparently an optimist.

Dementia is the word we use to describe the symptoms that occur when the brain is damaged by disease, the most common being Alzheimer’s Disease.  Vascular Dementia is the second most common form of dementia.

Dementia is degenerative, and the speed of decline varies. A person will become repetitive both in speech and movement, will look in a mirror and fail to recognise their own image, will also fail to recognise their own family and friends, will lose the ability to carry out everyday tasks (the so-called activities of daily living or ADLs), will often become verbally and/or physically aggressive, will become agitated, may suffer hallucinations and delusions, will gradually suffer severe memory loss, will often lose their speech entirely and in the latter stages they will lose the ability to swallow, the ability to move, the ability to breathe.

Dementia leads to death.  There is no cure.

For some unexplained reason, Dementia is  seen at present as a problem requiring social care rather than health care.  And that is where the intermittent connections in the world of dementia and care really begin to show themselves.

Paul Burstow, Care Services Minister and Liberal Democrat MP, had a crack at local authorities for jumping the gun and making cuts in care support ahead of next month’s public spending review.  He also told Community Care that “Every local authority has a responsibility to do its best to make efficiencies and protect the frontline – there are better ways they can do this than salami-slicing and slash and burn.”    I can only agree with him when it comes to salami-slicing – if only because I can think of a few salamis that I’d like to slice, all currently involved in the care industry and in the dementia care industry.

Mr Burstow is also upset by the low uptake of personal budgets.

The Princess Royal Trust for Carers published the results of its survey of 800 carers, who care unpaid for a sick and disabled family member, and found that over half (53%) of all carers who work earn less than £10,000 a year, with three-fifths (60%) having to spend all of their savings to support the person they care for. 89% say that they are financially worse off as a result of caring and, consequently, almost two-fifths (39%) fear they will lose their home.  Broke and broken: Carers battle poverty and depression.

Read these Quotes from Carers – the intermittent connections in the world of care are clear to see.

Today, Stephen Dorrell – the new Chairman of the House of Commons health committee – has urged politicians to face up to the way in which vulnerable elderly people are being forced to pay for medical care, health care, all because of the redrawing of the boundaries between health care and social care, without proper debate or scrutiny.

The debate surrounding NHS Continuing Healthcare – which is healthcare fully funded by the NHS, in any ‘setting’ so in hospital, in a care home, in one’s own home, in a caravan or even on a double-decker bus (privately owned, of course!) – is something that most people never need to come into close contact with, unless and until they or their relatives are old, and/or with health needs.  And especially, unless and until they develop dementia.  Then, for some strange reason, the connections of the professionals suddenly resemble our broadband problems: fully funded, but fully intermittent.

Many people are denied the human right to return from hospital to their home, by healthcare professionals and by social services.  They’re told they need ‘nursing care’ 24/7 in a care home.  They are then offered by the NHS £100 towards the cost of that nursing care, the Nursing Care Contribution.  But they are then also forced to pay £3500 per month or more for residential care, often shabby and sordid residential care.

All because they have health needs that are such that they can no longer live an independent life.  Residential care is the choice of last resort for so many people, because they can no longer be cared for at home.  And that applies especially to those with dementia.

They are often forced to sell their own homes – or rather their family is forced to sell the home, because by this time, the person needing 24/7 care is in no position to do so themselves – to pay the extraordinary costs of residential care.  Extraordinary costs, because nobody is ever given a breakdown of that cost, but it’s not normally a fair charge.  The quality of care provided is rubbish in many care homes, with enormously inflated charges, enormously inflated pre-admission promises of care, enormously low-paid workers, mostly immigrant workers, enormously low standards of training, especially dementia training.  But enormous profits for the care home industry.  (see the CQC announcement today today about some of the sordid care homes and agencies it has forced to close.  Many  other sordid care homes and agencies have survived the CQC axe – but only just, and only thanks to some very closely woven and constant connections.  There’s little chance of their connections becoming intermittent.)

The hoops and hurdles that have to be faced by those who challenge the decision-making process (also known as the National Framework for NHS Continuing Healthcare) are so complex and complicated that the so-called professionals can’t even work their way through them all.  And then the family members who find the inner strength to challenge it all are forced to spend years, and years and years being humiliated by the Primary Care Trust (PCT) and Social Services (SS).  It comes to resemble a game without rules, like Snakes & Ladders with venom-filled snakes hissing and spitting at the poor souls who try to climb the rungless ladders.

Except that there are rules.  There are legally binding rules that should not be broken.  But they are being wilfully broken, by the NHS, the PCTs, and the SS.  Aided and abetted by governments, one after the other.  They are all in it together, to paraphrase David Cameron.

“We are clear about what we must do … in a way that protects the poorest and the most vulnerable in our society, in a way that unites our country rather than divides it, and in a way that demonstrates that we are all in this together. Prime Minister David Cameron’s speech on the economy, Milton Keynes, 7 June 2010,

Dementia is an extraordinary disorder of the brain, a disease of the brain, a most devastating illness, for which there is no cure.  People die of and with dementia.  But dementia is not being acknowledged as a disease, an illness, a destructive force, removing from a previously capable and competent human being each and every single quality that defines a human being.

We as a civilised country ought by now to have found a way to create the constant, reliable connection between needs and service provision.  Dementia care still suffers from a ‘major service outage’ of a kind that paralyses those with dementia and their family members caring for and about them.

I am sick and tired of reading, hearing and watching our government, our ministers, our politicians, our healthcare professionals, our social care professionals and so on, all cry out in shock horror about the problems of caring for the elderly that we are facing, but they continue to do nothing to correct the ills of their ill-defined system.  Actions speak louder than words.  If we really are all in this together, then we should not be so lily-livered about sharing the responsibility for it together, via taxation.   All that is required is for the connection to be made, between health needs and care.  Between dementia and care.

After all, tomorrow it could be any one of us – even you – with dementia and needing care.

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Filed under abuse, Alzheimer's, care, care fees, care homes, dementia, dementia care, law, liability, Local Authority, NHS, NHS Continuing Healthcare, politics, professional responsibility, social work

Seven steps to end the scandal of malnutrition in hospital

A poll of 1,000 nurses for Age UK found just under a third did not feel confident that malnutrition would be noticed by staff.

Fewer than half said their hospital screened patients on arrival, as guidelines recommend.

Age UK has published a report Still Hungry to Be Heard – The scandal of people in later life becoming malnourished in hospital four years after the last campaign ‘Hungry to be heard’.

Age UK’s seven steps to end the scandal of malnutrition in hospital
Step one
Hospital staff must listen to us, our relatives and our carers
Step two
All ward staff must become food-aware
Step three
Hospital staff must follow their own professional codes
Step four
We must be assessed for the signs or risk of malnourishment
Step five
Hospitals should introduce ‘protected mealtimes’
Step six
Hospitals should implement a ‘red tray’ system
Step seven
Hospitals should use trained volunteers where appropriate

It’s not rocket science; it’s basic care.  It would be a positive demonstration of caring care if our government introduced compulsory monitoring of nutrition/malnutrition in hospitals.  And compulsory monitoring of the care and attention needed by people with dementia when they are in hospital wouldn’t go amiss either.

From The Seven Ages of Man, via the Seven Stages of Dementia, to the Seven steps to end the scandal of malnutrition in hospital.

More on the power of seven another day.  And a promise to those of you who have demonstrated that you care, there will be more about the Nuns who fled from the prospect of being placed into residential care, far away from where they would have chosen to live.  I’m watching you, Sisters, past and present and future.  There is more to come, but meanwhile, I’m off!!  To distant climes, and for a spell of relaxation.  Miss me, perhaps!  Or not, as the case may be.  It may not make one iota of difference to you or to me, while I am in far off regions.  Close to the powerful Nuns, but not that close.

Back whenever.

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Filed under care, dementia care, NHS, nursing, professional responsibility

The Coalition Government’s plans to privatise the NHS

A miscellany of comments on the Coalition’s plans to privatise the NHS by stealth and deception:

Seumas Milne writes in the Guardian: We cannot allow the end of the NHS in all but name. “In reality, Lansley’s health white paper opens the door to the comprehensive privatisation of healthcare and the end of the NHS as a national service.”  “The bottom line of this is the abolition of the NHS,” Dr David Price of Edinburgh University argues. “It will remove the government’s duty to provide a universal healthcare service.” His colleague, Professor Allyson Pollock, believes it will lead to “full privatisation”.”

Unison, Unite, Allyson Pollock and David Price, Denis Campbell of the Guardian , Martin Rathfelder of the Socialist Health Association all fear the same bleak future for the NHS – they can’t all be wrong, can they?

Essex County Council is having talks with Chelmsford-based Care UK about the fears local people have as a result of the budget cuts.

The Taxpayers’ Alliance Town Hall Rich List puts Essex County Council chief executive Joanna Killian on £265,000 a year – the highest-paid council boss in the country – so they’re watching closely.

Crop of the North – who describes himself as a lad from the North West sticks – asks What are they doing to our country? : “So the polite formalities have been done away with and the Tory Democrats are instigating a new period of Class War. We’ve already had the ‘get on your bike’ rhetoric, so consider this an extension in awfulness – new government, new politics folks!”

And suddenly, you’re reminded that there are a few MPs who care – so thanks Barbara Keeley – MP for Worsley and Eccles South – for introducing a Bill to Parliament to improve support for carers. “In Salford, nearly one quarter of unpaid carers are caring for more than 50 hours per week. Caring at this level takes a toll on the health of the carers, who are twice as likely to suffer ill health as other carers. Those caring for someone suffering from dementia or stroke disease are even more at risk of increased ill-health.  It is vital that GPs identify all such carers and offer them health checks and refer them for advice and support.” Good luck, I really wish you the very best of luck with your initiative.  It is long overdue, especially in the world of dementia care.

I wonder whether the same care will be found in all those companies who are waiting, panting, with their tongues out, for the opportunity to gobble up the bounty of the contracts soon to be made available via local authorities and in the privatised NHS, courtesy of the Coalition government.

Said it before, and I’ll say it again: we are surprised by and disappointed in you, Nick Clegg.  We are not surprised by but disappointed in you, David Cameron.  I hope you don’t get away with this savage attack.  No wonder you got together and arranged a secret “you can’t throw us out for years to come” pact.  Watch this space!

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Filed under care, Care UK, dementia care, NHS