Care in the UK – 5 years on – Part 5

The day of your funeral arrived.   It took place late on a cold and dark January afternoon.  It was always destined to be a quiet occasion because you had outlived most of your relatives and friends, so it was to be just a small family affair.  The Service was elegant and personal, with a sprinkling of your good humour and more than a dash of our family history.

Your unexpected and sudden admission to hospital and death there had caused us enormous pain.  We knew by now that there would be a full investigation into the circumstances surrounding your admission to hospital within 10 days of arriving in the care home.  We had hoped to have the time and space for our last farewells to you at the funeral.  We were not even allowed that.  Care UK chose to intrude again in death as it had done in your life.

The Service ended and we followed the Minister out of the Chapel, only to see two people sat right at the back.  The care home manager and another person had chosen to invite themselves to your funeral.  Representing the care home Lennox House and the care provider Care UK  that had failed to care for you.

One of your family had already told the manager that she would not receive a warm welcome at the funeral, so it was disturbing to see that she chose to ignore that advice and that request not to attend.  The Minister spent quite some time talking with us all before he departed, as we stood outside, almost in the darkness, looking at the floral tributes.  Strange though it seemed at the time and strange though it still seems to us, the care home manager went to her car to get her mobile phone and took photographs of some of the flowers that had been designed to reflect part of  your origins.  You’ll know the images I’m talking about here.

Little did we realise though that her motivation for attending your funeral went far beyond the usual reasons for attending a funeral, albeit uninvited and unwelcome.

You remember that ‘Complaints Form’ that I mentioned here before?  The one that allegedly came into being on 31.12.2007 when we chanced to bump into the manager at Lennox House.  Well, after the funeral service  the manager must have driven at speed back to the office, where she signed off the Complaints Form at 18:00 hours, with the words “Resolved” and making references to things that were allegedly said at the funeral.  The form indicates that no further investigation would be required by Care UK as the complaint had been ‘resolved’.  Wrong, wrong and wrong again.

The same Complaints Form made reference to things that she could not possibly have known then, because even we didn’t know then some of the things mentioned on this form and we were the first to know them, later.  Nobody else knew these facts then when the Complaints Form is supposed to have been created and completed.  Contemporaneous?  I doubt it.

But we didn’t know about all of this until July 2008.

Almost her parting words as she left the cemetery, the manager said again “We’ve taken steps to ensure that this kind of thing never happens to anybody else”.  The same words she’d used twice before and said to me on 31.12.2007.    They resemble those oft-used but empty words “lessons have been learned”.  Except that the lessons are never learned well enough to ensure that this never happens again.

I wanted to say to her that – while I could appreciate the benefits others would undoubtedly derive from those steps – they  are steps that should have been taken long before you arrived in that care home.  They’re the most basic elements of care, fundamental to a place that calls itself a ‘care home’.   The elementary fundamentals of care.  Without them being firmly in place, nobody has the right to use the words ‘care home’.

The Investigation would take its course, I said, so we should wait for that before making any comments on it all.  It was a funeral, after all, so everyone was polite, as you would expect of us.  We didn’t know then that there would be two Investigations, both of which revealed much of the same, but with one revealing far more than the other,  including many of the most basic lessons that needed still to be learned.

You only had one chance in that care home.

You deserved better care.

(To be continued)

Care in the UK – 5 years on – Part 3

This day five years ago, 31 December 2007, was a difficult one for many reasons.  I know that you won’t wish me to go into the detail of some of those reasons here.

We drove to London again and spent 4 hours at the Whittington Hospital dealing with various formalities. Most of the morning we spent in the PALS office (Patient Advice and Liaison Service) and talking on the phone with the Coroner’s Office and with one of the hospital doctors involved in your care.  We grabbed a coffee and  left at about 1 o’clock, having decided that we did not want to have to return to that part of London again in the near future.

That’s why we went – on the spur of the moment, unplanned and unannounced – to Lennox House to collect your belongings and avoid the need to go back there again.  While you were still alive, just, I’d already asked the manager to send me a copy of everything on your records.   On 20 December 2007 I received a copy of a document that Care UK calls the ‘Daily Record’ .  It was only 9 pages so I asked the manager to copy and send everything else.  It was the only document I’d seen then, but it gave a good indication of the very days when you must have been desperate for help, but no indication of any help being given.

We parked the car and were able to walk straight into Lennox House.  So much for security.  The manager was at reception, but she didn’t recognise us.  She’d only met us once before,  back in August 2007 when we went on a recce to Lennox House, just one of the care homes we looked at.  There was no reason she should have recognised us.  I introduced myself and explained that we’d come to collect your belongings.  She said she’d just been speaking with your niece on the phone and she was planning to collect your things.  It was easier for us to do it there and then, as that niece doesn’t drive.  She also said that she was just writing a note to me, to accompany the paperwork I had asked for.  I said I’d take it all with me and save her the trouble of posting it.

We went to your room, and packed your things; a few were missing, especially two rings.  I asked for them – but I was assured you had not had any rings on your fingers when you arrived in Lennox House.  It was an uncomfortable thing to hear, because we ‘d bought one of those rings, the ruby ring, for your 80th birthday.  The sapphire and diamond ring had been on your finger for the last 60 years –  more years than I care to remember.  I’d noticed you were wearing both rings when we last saw you there, in November.  Eventually, the staff managed to come up with one of the rings.  The other one never surfaced.

We went down to reception.  I was asked to go into the manager’s office, while “His Lordship” as you always called him took your things to the car, before returning.  In that office, I was subjected to an inquisition.  I was expected to go through every single line of the Daily Record and explain my concerns to the manager, as she wrote alterations on the pages.  I thought I’d already done that on the phone earlier in December, but I still had to go through it all again.  It became impossible for me, and I left the office in tears saying I just couldn’t go on with it.  We had spent 4 hours at the Whittington Hospital, and I was exhausted.

I told the manager much of what we’d been through when you were in hospital, including being asked to explain how your diabetes was so out of control.  I’d already spoken with the GP who hadn’t bothered to look at the meds you were taking, when she’d been called to the home, and who told me she was not aware that you were a diabetic.  If she had been given a list of the meds you were taking it would have been obvious to her that you were a diabetic.  If one of the nurses had told the GP you were a diabetic, she might have treated you differently.   (She’d never met you before, as you were new to the care home and new to the surgery providing services to that care home.)  Interestingly, it was only from that Daily Record that I discovered the GP had spoken with Lennox House (on 14 December 2007, while you were in hospital) before she returned my call to her that day.

The manager told me that there were no available glucose strips in that home,  because the GP does not prescribe them.  The manager told me that Care UK wouldn’t provide them either.  To say that I was shocked, again, would be an understatement.  I volunteered to pay for a year’s supply so that no other person with diabetes would ever arrive in A&E in a diabetic coma, like you did.  With much of your bloods and tests ‘deranged’ .

I’m still trying to work out why those same words about glucose strips being unavailable are written in your care home notes, in the Daily Record for 7 December 2007.  It’s such a strange few lines to have been added to someone’s personal care record.  After all, you weren’t the only resident with diabetes, so  it strikes me as a very strange addition to your records.  Contemporaneous?  I doubt it.

The manager said “we have taken steps to make sure this never happens again”.

That was too late for you.  You only had one chance.

What I didn’t know until much later (namely July 2008)  was that a ‘Complaints Form’ came into being on this day, five years ago.  Its purpose was to indicate that ‘a meeting had been arranged’ to discuss my concerns, all of which appear to have been resolved that very day.  I learned from CSCI (Commission for Social Care Inspection) that a ‘meeting had been arranged’ this day, 5 years ago, to discuss my concerns.   It must be the first ‘meeting’ where people stood to ‘discuss’, rather than sat comfortably.   CSCI asked for a copy of the minutes of that meeting.  CSCI is now the CQC (Care Quality Commission).  There were no minutes – because it was not a meeting.  It was a chance encounter.   (More about this all another time.)

I left Lennox House in tears.  This day 5 years ago.

You deserved better care.

(To be continued)

Treasury sends back Lansley plan to give GPs control of £80bn

Thank you, Treasury!  Thank you, for sending back Andrew Lansley’s plan to give GPs control of £80bn.

“Lansley’s white paper, the biggest shake-up for a decade, was due to be out next week but the timetable has slipped after Treasury officials said there was not enough provision for making GPs accountable to the public, given they would control 80% of the £100bn NHS budget.”

“The white paper got bounced back because there was no way the Treasury could sign up to a proposal which handed £80bn of public money to 35,000 GPs who are basically unaccountable private businesses,” said one official.”

Otherwise it could be the thin end of a wedge.  Private businesses involved in providing care should all be accountable, each and every one of them, and that includes private care home providers.  But they are not at present.

Welcome, Paul Burstow

I welcome your appointment, Paul Burstow, as our new care services minister.

Like many caring people, I’ve been watching your emerging emergence (!!) over recent years, and that may be why I am open-minded and open-hearted to your appointment.  Please do not disappoint me, especially when it comes to long-term care of the elderly.  Please do not disappoint.

Stand up and be counted, Paul Burstow.

Look left, David Cameron, look left

A sad evening for those of us who wanted to see a genuinely caring political scene and world emerge, and I’m beginning to think that may not be the reality that we have achieved.

The electorate got it right by wanting a caring coalition with solidly reliable communication between each and every person involved – but we failed to understand the machinations that go on ‘behind closed doors’.  A relatively minor influence may have been able to achieve a major  policy change.  That’s not what we were given to understand.  Many things that formed part of the Tory manifesto and formed the basis upon which many people will have voted, are now thrown out of the window.  Many who wanted a  grand coalition will now be disappointed.

But there is yet hope.

As the car carrying David Cameron approached Buckingham Palace, it passed alongside a road marking which read:

LOOK LEFT

In the best interests of the parties

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

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

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

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

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

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

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.

NHS Continuing Healthcare and cruel care

A confusing day here, and not of my making.  I’ve just watched another pre-election TV ding-dong aka The Health Debate, between Andy Burnham, Andrew Lansley and Norman Lamb, all being cross-examined by Andrew Neil and Bronwen Jeffreys, on their plans for the NHS and care, should they be elected.  Lots of predictable hot air, very little substance.

Yesterday, I read that nurses are bemoaning the fact that patients and their families ‘expect miracles and are too quick to launch legal action when they do not happen‘.   The blame for this was placed on unrealistic expectations fostered by TV shows like Holby City, according to the Royal College of Nursing conference.

Well, RCN and Burnham, Lansley and Lamb, I’d like to invite you all to think about the following story and see who you think is to blame:

A friend of mine, fully supported by her husband, is caring for her 90 year old mother, and has done so for the last 15 years.  The mother has advanced dementia and a whole host of other problems, as a result of which she was ‘graciously granted’ fully-funded NHS Continuing Healthcare.  The family do not want the mother to be placed into residential care – they wish to continue to care for her in their home, where they have lived together for the last 15 years, ever since the mother first developed problems.  The care being delivered by the family is superb and far exceeds anything that could be offered in a care home.

Unfortunately, the mother has become incontinent over the last year.  The NHS Continence Nurse is rationing the supply of continence pads to 4 per day, and offering absolutely no valid reasons other than the old chestnut ‘that’s all you’re allowed’.  And yet,  the Department of Health expects Primary Care Trusts (PCTs) to provide pads and other continence products in quantities appropriate to the individual’s continence needs.  ‘Good practice in continence services’ published in April 2000 and still in force today, made it clear that it as long ago as 1997 there was an  ‘unacceptable variation between trusts in the limits on the number of pads supplied in each delivery cycle’.  So the PCT is forcing a 90 year old woman to suffer.

The Department of Health launched what it called The Dignity in Care Campaign with a mission to end tolerance of indignity in health and social care services through raising awareness and inspiring people to take action, with Sir Michael Parkinson as the National Dignity Ambassador.

Who needs to be inspired to take action to help people who are being subjected to such indignity?

Where is the dignity in the rationing of continence products to someone with such severe health problems?

Someone is caring more about the health of their budget than about the health of their patient.  What is the point of a budget if you fail to meet the most basic of needs in a caring, compassionate and dignified way?

Sharon Shoesmith

I’ve been sitting on my hands (or mouth!) since hearing that Sharon Shoesmith, the former Head of Children’s Services at Haringey Council  has lost her claim that her dismissal was  unlawful.  It wasn’t.  Her dismissal is now declared to be lawful.

The case of Baby Peter saddened and distressed most people with a caring heart, even though we may not have been connected directly to Baby Peter and/or his family circumstances.  It sure did hit me with a thump.  Not because I have had anything to do with Children’s Services, but I have the equivalent of Baby P in my own life.  She could be called Grannie E, or Grannie K, or even Auntie D, or Auntie W.  Or it could even have been Grandpa B,  Uncle H, or Uncle B.    So I’ll plump for …. Auntie W, as the equivalent in my own life.

I read that Sharon Shoesmith is suffering ‘post traumatic stress disorder’.  And now I read that she is perhaps in line for £1.5m compensation because she ‘may not have had a fair chance to put her case’ forward.

I wonder whether anyone has ever considered the post-traumatic stress disorder that many of us are also suffering as a direct result of neglect in care.  Neglect of our own relatives in care.  Our relatives are more likely to have been far older than Baby Peter, and they were all placed into the hands of the caring care services, charged with caring.

Where do we all go to put our case forward, fairly and honestly and decently?  Not to achieve anything like a £1.5m payout, but just so as to achieve recognition and justice for those we cared about, who were neglected by the caring care services.  If only so as to ensure that it never happens to another Auntie W,

Where does my Auntie W feature in this caring world of ours?  Auntie W was also once a smiling, cheeky, chirpy little baby.  She grew and grew and grew.  She provided for herself and for others, doing all that was required of her. She was solidly reliable.  Which is more than could be said for the care service that came her way, and that eventually led to her death.

I’ll return another day to the story of Auntie W.

Man hid lodger’s body for 10 years

A very sad story of Alan Derrick, a man with learning difficulties, who was living in so-called ‘sheltered housing’ and took pity on a former colleague, Dennis Pring, after the death of his wife.

The events are disturbing, but perhaps the most disturbing comment is from Jon House, the deputy chief executive of Bristol city council, who ‘conceded that when officials visited the flat they should have asked more probing questions. He added: “A more active intervention nine or 10 years ago, and a healthier dose of common sense, might have stopped Mr Pring’s death lying undiscovered.”

He admitted it was not possible to say exactly how many times the flat had been visited because of the way records were kept. Extra training had been given to make sure such a tragedy would not happen again. Derrick had been rehoused and was being given the support he needed.’

Poor Alan Derrick didn’t receive the shelter he needed.  Nor did he receive the care that he needed.  Social Services, the Sheltered Housing, the Council all failed in their duty of care.  It’s not good enough to describe Mr Derrick as a ‘no-call’ tenant, meaning that residential officers were not permitted to enter his flat without permission.   Did he never receive any visits from support services?  Did nobody notice before that he had no running water, electricity or gas?

And a more active intervention nine or ten years ago, with just a modicum of common sense would have spared Mr Derrick from living in unacceptable conditions.

As for the lack of records to show how many times the flat had been visited by the support systems – no comment!  Record keeping is a basic requirement – not a shield for the irresponsible to hide behind.  Come out of hiding, please, and explain why your lousy record keeping existed.

What is the meaning of ‘sheltered’ housing to Bristol City Council if it provides no shelter, no care, no support?  On 17th March 2008 Bristol City Council’s Quality of Life Scrutiny Commission met to discuss reclassifying its sheltered housing to become either ‘Supported Housing for Older People’ or ‘Elderly Preferred’, with current residents continuing to receive ‘floating support’ (!) where needed, and also enabling those in ‘Elderly Preferred’ accommodation to opt out of support services.  Prior to that date, they were apparently all unable to opt out the support element of their accommodation for which they were charged.

Where was the care and support for Alan Derrick?  Absent without leave.