Category Archives: nursing

HOT Care in the UK

The Francis Report calls for a ‘legal duty of candour’.  He mentioned honesty, transparency and openness too.

He may well have stolen my term for exactly the same kind of care that he’s calling for.

HOT Care.

I’ve been calling for HOT care for more than 7  years now.  As have those affected directly by the Stafford Hospital.  Cure the NHS.  Cure the Care too.

HONEST +  OPEN + TRANSPARENT = HOT

I first used the acronym HOT in my correspondence with Islington Local Authority’s Mental Health Care of Older People team, circa 2005 and many times thereafter.  I’ve called for that same HOT Care in each of my communications with Care UK since 2007 when my relative suffered at the hands of such cold care courtesy of Care UK.

Could we now find a way to move towards HOT Care in the UK?

Is it so impossible for us to expect/demand/require HOT Care?

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The liars who pretend to care in the UK

Will the liars who pretend to care be able to hold their heads high?  Meaning that if – or even when – they have fatcat liars to tell lies on their behalf, what chance does the decently honest person have against the might of their lies?  Especially if the ‘system’ in place is geared to work against the decently honest persons telling the truth, the whole truth and nothing but the truth.

The liars are not required to speak much.  They have a pre-written script to follow, worked out by their fatcat liars-on-behalf.  Half-liars both of them = one almighty fat liar.  Both full liars = 2 almighty fat liars.  Multiply that by 3 or 4 or 5 or 6, and you have a system that stinks.  But it’s the way that care in the UK has decided to go.  Down the drain.

Will they be able to sleep at night, or even by day?  Hopefully not.  Forever and a day and a night; forever and all days and all nights.  Hopefully not.

Will the person who tells the truth be able to sleep at night, or even by day?  Probably not, but only because they may be destroyed by the lies they are not allowed to challenge.  They are now voiceless against the lies, not sure of what they are dealing with, not sure of how on earth this could have come about.

But knowing still, that they have done all they could possibly  do to present the truth, the whole truth and nothing but the truth.  All single-handedly; all honestly; all openly; all transparently.

Does the truth no longer count?  Do lies count more in our sadly sickeningly careless world?

Who cares?  I do.

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Why I despise the so-called system of care for vulnerable people

I’ve been fairly controlled over recent weeks, months or even years.  I suppose I’ve been waiting and hoping for a chink of light to emerge, for a culture change to emerge, for a way forward to emerge in the so-called system of care that we have allowed to be in place.

However, I am reaching screaming point.  Hardly surprising.  When someone is destroyed because of absent systems of protection, and when it then takes almost 5 years to work your way through to a full understanding of why the so-callled system of care for vulnerable people fails to provide decent care so very often – that’s when you reach screaming point.

Time and time again, the CQC comes up with yet another report as it did today, with a report into the ‘care’ afforded to people with learning disabilities.  Or rather the lack of  care.  I’ve read it all, but there’s not much hope for real change.

Week and month after week and month, our government comes up with …… not one single plan to improve things.

Year after year, the same old same old same old gets published in the press, reported on radio, featured on TV.

Still nothing changes, so I need to scream now.  It won’t change anything – but it may just help me to scream.

[Next section of this particular blog post: Deleted temporarily pending the return of sense to the world of care.]

Therewith, I will leave this one for today.  But not for long.

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Registered nurses working as Healthcare Assistants (HCAs)

The NMC (Nursing and Midwifery Council) website contains valuable information for those with an interest in the established fact that many registered nurses (and/or midwives) are working as HCAs (Healthcare Assistants).  The nursing profession is regulated by the NMC.  Healthcare Assistants are not regulated at all.  Problems  emerge when a Registered Nurse is employed by a care provider as a Healthcare Assistant but works outside of that role and still fails to provide the care required of a registered nurse.

A couple of direct quotes from the NMC are essential.  The full text of the NMC information is available .

First quote (my use of red below, not that of the NMC) :

Accountability

If a nurse or midwife is employed to fulfil the role of an HCA, they should only undertake the roles and duties outlined within their job description. However, by virtue of their registration, they would remain accountable for their practice. This means that they would be bound by the code regardless of their HCA status and their fitness to practise could be called into question if they were found to be in breach of any of the terms. The code states that nurses and midwives are required to “provide a high standard of practice and care at all times”

The code states:

“you are personally accountable for actions and omissions in your practice and must always be able to justify your decisions”

“you must be able to demonstrate that you have acted in someone’s best interests if you have provided care in an emergency”

Therefore, in an emergency situation, there may be occasions, where a nurse or midwife could be required to work outside the scope of the HCA role parameters. As a registered nurse or midwife they would be expected to use their professional knowledge, judgement and skills to determine occasions where it would be appropriate to work outside their HCA role parameters and should be prepared to account for their actions should they make the decision to do so.

Second quote:

Vicarious liability

Vicarious liability means that the employer is accountable for the standard of care delivered and is responsible for employees working within agreed limits of competence appropriate to the abilities of that employee. To remain covered by an employer’s vicarious liability clause, an employee must only work within this area of assessed competence and within the responsibilities of their role and job description.

Nurses or midwives who undertake HCA roles should therefore, inform their employer that they are on the NMC register as a nurse or midwife and that in exercising their professional accountability, they may be required to step outside their contract of employment as an HCA. They should also seek to ensure that their contract recognises the extent of their role and that the job description is clear as to what would be expected of them in this role.

End of quotes.

It’s well-known that HCAs are not regulated.  A system of voluntary registration will not be good enough.

Dr Peter Carter, head of the RCN (Royal College of Nursing), said recently that the NHS is too reliant on  HCAs who are asked to pick up nursing skills as they go along.  Untrained, unregulated, cheap labour.

“Many hospitals employ healthcare assistants as opposed to registered nurses, and many of them don’t give them as much as an hour’s training.

“This happens in some care homes and domiciliary care too.”

“It is wholly unacceptable that the elderly should be cared for by people who are not given the rudimentary training.”

He also said “Cheap care is poor care.  Poor care ends up being more expensive.”

The RCN refers to itself as ‘the voice of nursing across the UK and the largest professional union of nursing staff in the world with more than 400,000 members’.  It also invites Nurses qualified outside of the UK working as health care assistants, ‘who are not and have never been registered with the Nursing and Midwifery Council (NMC)’,  to join the RCN at a concessionary rate for the first year.

The RCN offers advice to registered nurses and midwives who do not meet NMC requirements, providing information for overseas nurses who cannot register to work as a registered nurse or midwife but who are currently living in the UK.

On 11 January 2012 the Guardian featured an article about ‘Healthcare Assistants working out of their depth’ and mentioned several respondents to a survey conducted by Nursing Standard magazine who said that HCAs monitored patients’ vital signs but did not understand the results.

‘ One nurse in the survey said: “There is sometimes an attitude from unregistered staff that it doesn’t matter what they do because ultimately it is the registered nurse looking after the patient who will take responsibility.’

Are some care home providers in the UK employing NMC Registered Nurses ‘on the cheap’ by contracting them to work as HCAs and thus by-passing regulatory requirements?  Are some care home providers in the UK doing so because they are fully aware that the registered nurse is not ‘fit for purpose’ as a nurse?  Are some care home providers in the UK employing staff  as HCAs but still allowing them to perform the functions of a registered nurse even though the care provider is aware of the inadequacy of the registered nurse in question?

Vulnerable care home residents are placed at risk.

“Cheap care is poor care.  Poor care ends up being more expensive.”

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NMC hearings schedules – aka close to Care in the UK

I omitted to post this :  NMC Hearings Schedule – 6th to 17th February 2012 – at Euston House, London.

All in the best interests of Care in the UK.

More later, but click here for the charges.  Same as above link – but I wouldn’t want anyone to miss it.

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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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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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Hospital put dying dementia sufferer in storage cupboard “for being too noisy”

The treatment of Dora Duggan, 81-year old terminally ill dementia sufferer is unforgiveable, despicable, inexcusable abuse  – and criminal.

WHICH MEMBER OF OUR COALITION GOVERNMENT REALLY CARES?

WHICH MEMBER OF  OUR CARE QUALITY COMMISSION REALLY CARES?

Which of them cares enough

…. to make sure we demolish the system of neglect currently masquerading under the umbrella of ‘care’, allowed to  kill and to inflict pain and suffering on vulnerable elderly people in need of  CARE.

If any single one of them really cared, then by now there would be in place a system of genuine care, ensuring quality of care.

Dora Duggan was a mother, grandmother to 15, great-grandmother to 7.  And above all else, a decent elderly person who was vulnerable and who deserved better care.  She was also terminally ill and in need of care and comfort in her dying days.

The full article is here for anyone to read, and it quotes Jenny Leggott, deputy chief executive and director of nursing at Nottingham University Hospitals NHS Trust, which runs the hospital in question, as having said : ‘We are deeply sorry and apologise unreservedly to Mrs Duggan’s family for the shortcomings with the care provided.

‘We have investigated the concerns raised and have assured the family that we will do everything possible to avoid future occurrences of the difficulties they brought to our attention.’

I am prepared to raise my hand – or both hands and both legs if need be – and to say that I am sick and tired of hearing the phrase “lessons will be learned”, or “we will do everything possible to avoid future occurrences of the difficulties they brought to out attention”, or even the one that came my way “we will do everything we can to make sure this never happens again”.

They are meaningless words.  They are just that – words.  The actions required to prevent these crimes happening again and again and again never seem to follow the words.

Without action, the words will forever remain meaningless.

We now need action.

And remember, tomorrow that vulnerable elderly person in need of care may just be you.

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Joyce Mason ‘would probably have lived if the care home had called a doctor sooner’

The parallels between what happened to Joyce Mason and the circumstances surrounding the death of my own relative are so very similar.  Change the names of the vulnerable elderly adults with dementia and with very similar medical problems, change the names of the the care home, change the location, change names of the ‘care’ provider – the circumstances are exactly the same.  Sub-standard, shabby, shoddy care, also known as neglect.  Resulting in the demolition of two lively lovely people who enjoyed life.

Coroner Catherine Mason said: ‘If Mrs Mason had been taken to hospital earlier, either when the family asked for a medical review or when Mrs Mason became agitated, or even when the GP attended, on a balance of probabilities Mrs Mason could have survived.

The Coroner also said: ‘ … at 86 years of age, the elderly deserve the right to be treated with respect, dignity and care. Mrs Mason and her family had the right to expect that the health care professionals within whose care she was placed would practise a high standard of record keeping and delivery of care. This did not happen.’

The coroner said about the GP providing health care to the residents of Braunstone Firlands Care Centre, Leicestershire, run by Prime Life Limited (why do care home providers come up with such misnomers?): “He (the doctor) said that had he been aware of all the information held by the care centre at the time of his attendance, he would have admitted Mrs Mason to hospital at that time.”  I have a real problem with this, Doctor!  A GP has a duty to conduct a full assessment of a patient, and that includes asking the care home staff for information about the patient and his/her known medical history and events in recent days/weeks.  A doctor is in the most senior role, on the day of his/her visit to a patient, so s/he should ask the relevant questions.

But it’s the words of Joyce Mason’s son, Christopher, that could be my own words almost: ‘We put our mother into care with people we thought we could trust. They let us down completely.

Over the last month, there has been one report a day about sub-standard, shoddy, shabby care of elderly people in care.

I will come back to the story of Joyce Mason, another day, because it is so very close to my own experience.  I am finding it shocking to read so many articles that just make me question the value of the CQC, and like it or not, many people place their trust in the CQC inspection reports.  Not me.  Never ever again.  And never again will I trust a care provider.  They will need to earn my trust – it will never be offered unless and until I have reason to trust them.

I would like somehow to send my thoughts to the family of Joyce Mason.

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Trading Standards care about goldfish – who cares about the elderly?

Common sense ruled, and Joan Higgins, aged 66,  no longer has to wear a tag like a criminal.  Her son, Mark, no longer has to carry out community service.  Partners in the crime of selling a goldfish – valued at £1.50 –  to a child aged under 16.  Mrs Higgins was entrapped by trading standards officers who staged an undercover sting at her pet shop. They were also accused of causing unnecessary suffering to a cockatiel at the shop by failing to provide appropriate care and treatment.

Charged under the Animal Welfare Act 2006, they both pleaded guilty. Mrs Higgins  was required to observe a curfew from 7pm to 6am, hence the electronic tag.   Her son was ordered to carry out 120 hours’ community service.

Following an outcry, they returned to court where Judge Smith quashed the curfew on Mrs Higgins, as well as the community service order on her son because of his poor health. Instead he imposed a 12-month conditional discharge on both, describing the punishment as ‘inappropriate’ for ‘a respectable lady with no previous convictions’.

So-called professional care workers in a careless Care UK care home neglect a very respectable, gentle 80-year old lady to such an extent that she died as a result of their sub-standard care.   She was a solidly reliable, law-abiding citizen and never harmed a goldfish or a cockatiel in her life.   Her value far exceeded any number of goldfish or cockatiels.   The local authority carries out an investigation.  Irresponsible staff are ‘allowed to resign’.  The ‘dust-collectors’ are despatched en masse to the care home to suck up every single speck of dirt they can possibly find.  All behind closed doors – in secret, concealed and filed away.

A Trading Standards Department for Elderly Care would have resulted in a few people being charged with causing ‘unnecessary suffering‘ to an elderly person ‘by failing to provide appropriate care and treatment‘.  We have the Human Rights Act, but where’s the Human Welfare Act when you need it?  Where are the rights of a dead person’s family to be given the full information they need to evaluate all the circumstances of the neglect their relative suffered?  How low can a local authority sink?  Self-preservation at all costs seems to be their motto.  The same could be said for one of the biggest care providers in England.

All will be revealed.  In the public interest, and in the name of caring care for the elderly.

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