Tag Archives: Andrew Lansley

Fine words butter no parsnips in residential care

Andrew Lansley has come up with the revolutionary concept that there will be a code of conduct and minimum training standards for all care workers operating in the field of adult social care.  Or is it perhaps a slow evolution of care?

He said, allegedly: “Good local supervision offers support every day. Distant national regulation can often only react after the event.  Employers must always take responsibility and be accountable for the staff they employ. But, we recognise that more can be done to support employers in this and a code of conduct and clear minimum training standards will provide important clarity in this area.  These measures will help employers to better consider the skills profile of potential employees and ensure that patients and service users get the care and support they need.”

Somewhat late in the day, for some of us, so forgive me for shouting ABOUT TIME TOO!!

But, it’s the response from Care UK and its  Managing Director of Residential Care, Toby Siddall, that has caused me great discomfort :

 “Directors at Care UK see codes of conduct as only part of the solution.   Matters of technical competence and behaviour are already an important part of the employment contract for Care UK employees. Whether or not a member of a care home team treats people with dignity is about the leadership, training and recruitment of people with the right personal values – not about a line in a contract.”

Well, well, well!!!  Perhaps, Mr Siddall, you would care to explain just how long it is that ‘matters of technical competence and behaviour’ have been an important part of the employment contract for Care UK employees.  Since when?  Tell me the date! 

They certainly weren’t in place in Care UK and at Lennox House care home at the end of 2007 and in 2008, when Lennox House was ‘investigated’ twice within 8 months   and not allowed to accept new residents for a year while a whole host of measures enabled Care UK to  drag itself from the gutter to an acceptable standard of care provision. 

As for treating people with dignity – that was absent too when those residents were left dead in their beds for days, as the Islington Tribune reported. 

Of course, the Reports of three (or more?) investigations are all held behind closed doors – far away from daylight, so as to protect the best interests of Care UK.  The best interests of the Leadership of Care UK including Mike Parish, Chief Executive, and the then MD of Residential Care Tony Hosking, and the Managers and Deputy Managers of the whole not-fit-for-purpose care providers, of those in Islington who commissioned and allowed Lennox House to function when it was not fit for purpose, the then CSCI (now CQC) to name but a few.  Their best interests are forever preserved by the hiding of those reports.   

 If leadership can be held responsible, as Care UK now seems to understand, how come heads never roll when people die as a result of sloppy leadership and sub-standard care? 

Unless and until it is a requirement for all those Reports, and others too of similar investigations, to be published and available in the public domain so that everyone can see what went on behind closed doors – nothing will ever change.

Or could it be that too many Directorships spoil the concentration?  9  for Toby Siddall alone.  And for Michael Robert Parish …….

 

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CQC and Castlebeck and whitewash

The Care Quality Commission (CQC) has yet again almost managed to airbrush itself out of existence.  If only it could finish the job properly and be done with the constant whitewashing of the responsibility of the Regulator.  Then the world of care might be a better place.

It took a BBC Panorama programme to open CQC eyes to the abuse that was going on at Winterbourne View hospital in Bristol, and for the CQC then to realise there were ‘serious concerns’ about the quality of care being provided by Castlebeck.   It took an undercover reporter to force the CQC to do the job it should be doing: inspecting thoroughly, reporting efficiently and demanding that action is taken to prevent any care provider from providing neglect rather than care.

When I first contacted the CSCI (as CQC’s predecessor was called then) about my serious concerns about the care my relative received in a care home, CSCI’s Inspector told me that she would contact the manager of the care home.  I heard nothing from the CSCI, so I chased for a progress report.  Much to my surprise, I was told that the manager had informed CSCI that a meeting had been arranged and that “all my concerns had been resolved at the meeting”.  The CSCI believed the manager and closed the book.  There was no ‘meeting’ and my concerns were not resolved.  Far from it.

Then, the mental health care of older people team carried out an investigation into the circumstances surrounding the death of my relative in care.  I was excluded from all meetings, from everything other than an initial ‘interview’ with the investigator.

Then, the Local Authority ‘claimed ownership’ of the report – and continued to exclude me from all meetings.

The CSCI took a back seat, knowing full well that it would bring a cloud over the care provider, the CSCI inspectors, the Local Authority commissioning department etc. if all the details were to be ‘in the public domain’.  It all remains closeted behind closed doors.

How many similarities are there between the report into the circumstances surrounding the death of my own relative and the CQC report on Castlebeck ?

Try these for starters, although I have paraphrased some:

  • problems that need to be addressed at a corporate level – the company needs to make root and branch improvements to its services and processes
  • we have demanded improvements
  • Where there were immediate concerns about people’s safety action was taken.  In the case of Winterbourne View this action led to its closure.  In the case of the care home I was dealing with, it was not allowed to admit new residents for a year, a massive improvement plan came into existence which had to be worked through before any new admissions were allowed.
  • lack of staff training,  poor care planning, failure to notify relevant authorities of safeguarding incidents
  • The registered provider did not have robust systems to assess and monitor the quality of services provided in the carrying on of the regulated activities.
  •  The registered provider did not identify, assess or manage risks relating to the health, welfare and safety for the people who use this service.
  • The registered provider did not operate effective recruitment procedures.
  •  The registered provider failed in relation to their responsibilities by not providing the appropriate training and supervision to staff, which would be required to enable them to deliver care and treatment to the people who use the service.
  • Medication issues
  • Communication issues
  • There was a lack of leadership and management and ineffective operation of systems for the purposes of monitoring of the quality of service that people receive.

As for staffing issues, there are so many people in the real world aware of the fact that care homes are endangering people’s lives by running their operation with too few staff, poorly trained, badly paid, unsupervised staff.  Families are aware of it – what took the CQC so long?

How many Castlebeck’s are there in the world?  I know of one providing Care in the UK!  An animal that is growing daily, getting bigger and fatter and likely to become even fatter.  As long as everything shabby and shoddy is kept hidden, the world will never know.

It took an undercover reporter to shock the CQC into action!  Disgraceful.  I know I’ve banged on about this one before, but it really does begin to make the CQC look even more ridiculously toothless than some of us know it to be.

Why should the Castlebeck report be in the public domain – yet the damning report into the neglect of my own relative is concealed from view?  I wonder whether Andrew Lansley might like to comment on that one!!

As for Paul Burstow’s statement, “as a Government we intend to ensure that that doesn’t happen again” – I’m sick and tired of hearing that one.  Because it does happen again – and again – and again.

Helga Pile, Unison’s head of social care, said: “Elderly care is a service where mandatory regulation is vital to protect their interests. The privatised model means that the time carers can spend with each person is minimal, forcing corners to be cut, and employers see basic training as an expensive luxury.”

“It is not right to try to get elderly care on the cheap.”

The rich care providers grow richer – the people in need of care are neglected and die as a result.  The CQC is part of the problem.

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A care home or a disaster waiting to happen?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

But nobody noticed.  Until it was too late.

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

Unsurprisingly, the ship hit the rocks.

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

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

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

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

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

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

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

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

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

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

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

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

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Panorama – Undercover Care: The Abuse Exposed

It must be impossible to have watched the Panorama programme last evening without feelings of disgust, revulsion, horror and utter disbelief.  The torture inflicted by so-called support workers on adults with learning disabilities was reminiscent of a horror movie.

It’s available here if you missed it, and if you feel strong enough to watch it.  It certainly comes with a warning

Joe Casey, the investigative journalist working undercover as a support worker at Winterbourne View, shot footage on his hidden camera that is almost impossible to describe.  His article in today’s Daily Mail puts into words the scenes transmitted.

Winterbourne View is described as a hospital, run by Castlebeck, a company I’ve never heard of before.   Joe Casey uses the words ‘state-of-the-art’ hospital – I’ve developed an allergy to such descriptions now, because it was a ‘state-of-the-art flagship’ care home that was responsible for the neglect and death of my own relative.

According to Castlebeck’s website, Winterbourne View ‘is a purpose designed acute service, offering assessment and intervention and support for people with learning disabilities, complex needs and challenging behaviour’.

It is the staff at Winterbourne View who are in need of immediate assessment and intervention because of their own acutely challenging behaviour.  Now that some of them have been arrested and placed under police investigation they will hopefully receive a full assessment of their own needs for care, long-term care, with fully trained supervision, support and care.  Their mental health needs should have been addressed beforehand, by Castlebeck who employed them as ‘fit for purpose’.  I hope that not one of them will ever be allowed to work in the world of care again, once they have been dealt with in an appropriate fashion by our system of justice.  They are thugs – not support workers.  They don’t know the meaning of the words ‘support’ or ‘care’.

The management – if there is any – cannot plead innocence and ignorance of the situation.  Local and senior management must have known what was going on, but they ignored the whistle blown by a former senior nurse, Terry Bryan.  He tried to get them all to act – but they all failed to listen to his whistle.

As did the Care Quality Commission.  The horse has always bolted before the CQC gets anywhere near the door.  The CQC does not respond to complaints brought to it by us, mere human beings.  The CQC merely hands those concerns down to the very service that is at the centre of the concerns.   The CQC needs to establish a unit that deals in depth with each and every concern brought to it – and not just as another paper-exercise, which appears to be the only thing that the CQC currently has the ability to handle.  It only takes the CQC to ignore one single concern, like this one highlighted to the CQC long ago by a Senior Nurse, and you can end up with a torture setting being allowed to flourish.  That’s nothing to do with care – it’s all to do with neglect.  I accuse the CQC of neglect in the case of Winterbourne View.  To mention just one establishment that the CQC has neglected.

What is the point of a regulator if a regulator is incapable of regulating?

This was institutional abuse.  Abuse that was seen to be happening and so should have been prevented.

There are other kinds of institutional abuse that can never be seen until it’s too late, but they too can result in the destruction of life.  But the very systems within any care setting – that that the CQC and local authorities are meant to ensure are in place – can be absent and impossible for the person in need of care and/or their relatives to identify as being absent.  That’s what a regulator is supposed to be doing.  Ensuring that every single system is in place to protect those people who are at risk.

The Castlebeck website claims to be proud of its staff trainingCastlebeck has a very strong training and development programme. Staff are encouraged to improve their performance and the performance of others.

The company has appeared in the top half of the Nursing Times Top 100 Employers survey for the last three yeas.

Shame on them all, and heaven help those in the bottom half of the NT’s list.

Unless and until there is widespread recognition that the care system needs a thorough overhaul, nothing will change.  I’m sick and tired of hearing apologies, and “this will never happen again”.  It does.  It continues to happen.  Day by day by day – somewhere in the UK.  Oh yes, I have no doubt that there are good hospitals, good care homes, good care workers out there, but there are also too many shabby, sub-standard operations that are allowed to abuse people.

Alongside a radical shift in attitudes, the language of care also needs to change – I hold the CQC and its predecessor the CSCI responsible for the fact that the language of care is enabling abuse.

CQC statement:  “We apologise to those who have been let down by our failure to act more swiftly to address the distressing treatment that people at this hospital were subjected to.”

CQC has “spoken to the former member of the hospital staff, apologised for not contacting him earlier and offered to discuss his concerns.”

CQC says “We have asked Panorama to provide us with detailed information about the hospital to help us in our continuing regulatory work. We have also suggested that in future we would welcome earlier involvement by the programme in cases such as this so that we can step in to protect people as early as possible.”

Why would the CQC listen to Panorama any more than the CQC listens to people who bring concerns to the CQC?  Panorama is not the regulator.  The CQC doesn’t care enough to listen to those who are in the frontline and that includes staff blowing whistles, residents or patients complaining,  and relatives of those in care who are concerned.  But Panorama has the power to name and shame those who pretend to care.

‘National Minimum Standards’ – ‘Essential Standards’ – ‘Regulatory body’ – all meaningless words.

How about a new standard: Guaranteed Quality Standard without which no care home will be allowed to operate, without which no manager will be allowed to manage, without which no nurse or support worker will be allowed to work.

Where are the Required Standards?  Required standards of training for all support workers before being let loose to work in care?  Required standards of supervision of all staff?  Required standards of regulation?  Required standards of career progression for all care workers?  Required standards of respect for all care workers who provide good standards of care?

One of our esteemed (not always) MPs – was it Iain Duncan Smith? – suggested that  unemployed people in receipt of benefits should be forced to work in the community in places like care homes.  Well, my message back would be that you show no respect for the world of care, no respect for staff who might be good support workers if given support themselves, and no respect for the people in need of care.  Because you could end up with utter chaos – but, I am presuming that all the staff working at Winterbourne View were carefully selected, CRB checked, trained and supervised, especially the most senior thug of them all.

And all this on the day that Southern Cross is in desperate trouble, with the begging bowl out now, all because Southern Cross failed to get its priorities right.  It failed to remember that it’s there to provide care.  If Lansley and Burstow and our Demolition Government don’t care enough to care, they should be ashamed of themslves.

How about begging for guaranteeed standards of decent care for those in need of care?  But we shouldn’t need to beg for that, should we.   It should be a basic provision made available by a civilised country.  If we really care.

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Save the Cleveland Street Workhouse – we’re going to need it

What a depressing week last week was when considering care in the UK, and this week is heading in the same direction.

A short week ago, I was about to return to my obsession with the number 7 in the world of care, dementia care, political manipulation (aka demoliton) of the welfare state – and I had planned to start blogging my own personal ‘Seven Story’ of the lack of care in the UK as my family has experienced it.  I’ve decided to put that personal account on hold for now, because I have no wish to divert my attention away from the latest evolution of care in the UK.

1.  First, I came across a ‘seven’ :  Seven steps to driving down prescribing costs via Pulse and via the National Audit Office, but not necessarily in that order.  A saving of at least £200million is the estimate.  It’s not rocket science – so I’m somewhat amazed to discover that it needs a National Audit Office report to make seven ‘common sense’ suggestions.

2.  Then, I came across a variety of written answers to questions in Hansard – 10 February 2011 Written Answers detailing  meetings that  Ministers and senior officials in Andrew Lansley’s department  have had, since Lansley’s appointment, with independent sector organisations where Care UK representatives were in attendance.  There are only 5 listed, and there are more to come – but the latest written answers haven’t appeared yet.   But Grahame Morris did get a half-hearted answer from Simon Burns to his question as to how many health contracts had been awarded to Care UK in each month since May 2010 :

“We do not hold information centrally about local national health services and social care contracts. Primary care trusts and local authorities are responsible for their own contracting arrangements and decisions.

We can confirm that, as at the close of the last accounting period on 31 December 2010, the Department has not entered into any new contracts with Care UK since May 2010.”

John Trickett asked about the monetary value of the contract given to Care UK for the treatment of prisoners; and what assessment had been made of the compatibility of the award of that contract with  procedures and guidance on tendering – another non-answer followed from Paul Burstow.  It was the Hansard heading of Care UK: Prisoners that caught my eye.  But more on that one another day, and I’m sure I’ll come up with more than seven!!!  You can do the mathematics for yourself!  I’ve done my sums already.

There are still more written answers to come – eventually – so we will just have to hope that they are answered, rather than fudged.

3.  A serious case review found that residents of Summer Vale Care Centre, a Leicester care home for 26 people with dementia and mental illness had been “badly failed”.

“The report commissioned by Leicester City Council found patients were subjected to physical and sexual abuse from fellow residents. Summer Vale Care Centre in Mowmacre Hill closed in October 2009 after a whistle-blower alerted the authorities.  A police probe uncovered 65 “sexual or concerning” incidents at the home. The force said just seven incidents had been reported to them prior to their 2009 investigation, three of which had sexual connotations.  It is very clear to everyone involved with this review that all agencies badly failed the residents and their families.

“There were lots of incidents and concerns and even though there were around 60 professionals involved in making sense of this information, all of whom agreed that something should be done, no-one asked searching questions and no-one assumed the lead role“, added Dr Margaret Flynn, the report’s author.

No prosecutions so far due to insufficient evidence, but one still pending involving a senior member of staff.

26 vulnerable people with dementia and mental illness v. 60 professionals who failed them, but not one single prosecution thus far.

And the best that Minster Care can offer is “It is regrettable that the quality of care at Summer Vale Care Centre did not meet the high standards expected by ourselves and the local authority partners, and deserved by our residents.”  Note that the residents come last in that Minster Care statement.

4.  The Report of Ann Abraham, Health Service Ombudsman on ten investigations into NHS care of older people is incredibly hard to read – not because of its language but because of the distressing content.  It  carries the title ‘Care and Compassion?‘ – and if you get to the end of it, you will certainly be wondering where the care and compassion were, and whether the NHS still knows the meaning of either word.  The use of a question mark says it all.  Just ten stories of neglect – ten desperately sad stories – and probably just a brief snapshot of the way our so-called civilised society has decided to neglect a whole section of the population.

5.  Then, when you are trying to work out what the heck is going on, you read that “A Conservative MP and former GP who claims coalition Government whips attempted to gag her and prevent her from speaking out against the NHS reforms has warned health secretary Andrew Lansley he is ‘losing the profession’.

Dr Sarah Wollaston, the MP for Totnes in Devon, said she refused to sit on the committee of MPs considering the health bill after being told she could only take part if she agreed not to table any amendments and always voted with the Government.”

Gradually, it all becomes clearer.  They’ve all lost the plot!  And the only ones who will suffer are the older, vulnerable people in need of care.  There’s no sign that Cameron and Clegg care much about the real world; they just won’t listen to any comment or criticism.  I hope they open their eyes and ears and, more importantly, their hearts soon.  This destruction is not necessary.

6.  Today brings a report in the Daily Mail claiming that ‘Trespassing laws are to be used to evict elderly patients who ‘block’ hospital beds.   Pensioners reluctant to go home – often because they are too frail or confused to cope on their own – will be given 48 hours to leave. If they refuse, NHS trusts will seek a court order for possession of their bed.

The ‘bed-blockers’ could even be forced to pay the legal fees incurred.’

Not being a natural Daily Mail reader, I hesitated before mentioning this report – but I know for a fact that this kind of ugly threat is being carried out.

Frail and confused?  That normally means older people with dementia.  And that is precisely the situation that I have in mind: someone who has been in hospital now, waiting for the NHS and the PCT and the Local Authority to get their act together and carry out the required assessments so that one 87-year old can leave hospital.  The 87-year old can’t carry out those assessments himself, and neither can his family.  The 87-year old can’t care for himself, and neither can his family provide that care.  But that is precisely what the NHS and the PCT and the Local Authority are wanting.  Meanwhile, they are threatening eviction.  Well, bring it on!! Let it happen – and then we’ll name and shame you all.  Meanwhile, his family are complying with every single request that comes their way – but every question they ask is being ignored.  So perhaps we have arrived at a One-Way-Street of Care in the UK.

7.  Meanwhile, the Cleveland Street Workhouse – originally built in 1775 and the likely inspiration for Charles Dickens’ Oliver Twist – is under threat.    ‘Complete redevelopment of the workhouse site has been proposed. If these plans go ahead, this important historical building will be totally demolished.  A very large-scale private residential development, quite out of character with the street and its historical surroundings, will take its place.

But if the thugs in the ConDemOlition Coalition get their way and demolish everything in sight, we may well see a return to the Workhouse.  So perhaps The Cleveland Street Workhouse needs to be preserved and renovated for future use.

Well, that was an unplanned Seven and certainly not a Magnificent Seven.

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Seven Ps for the Vision for Adult Social Care

A while ago, I mentioned the The Seven Ages of Man, and continued the theme with The Seven Stages of Dementia .  Then came the Seven Steps to end the scandal of malnutrition.  I did consider then that the number 7 might be powerful, magnificent even and so would emerge again.

Then, along came The Seven Ps, all listed within The Seven Principles of the Vision for Adult Social Care: Capable Communities and Active Citizens.

Prevention – Personalisation – Partnership – Plurality – Protection – Productivity – People

I now have a vision of the brainstorming session that must have accompanied the conception of The Seven Ps.  A kiss (Keep It Simple, Stupid!) was passed round the room, attracting and enticing members not to overstretch themselves.  The Dictionary of Management-speak was lifted from the bookcase; it fell open to reveal the page of Ps.  The Seven Ps were conceived immaculately, provided with perfect pre-natal care and delivered without pain relief.

The Dalai Lama said that if one’s life is simple, contentment has to come.

It’s somewhat strange to see People at the end of the list of principles, but I’m sure our Coalition writers have their reasons.  Shouldn’t People come first?

There are a few missing Ps, as far as I can see, the first being the paradox.  Is it possible to strip and slash local authority funding and budgets while demanding that local authorities assume responsibility for certain functions that were previously the responsibility of National Government?  It does not make sense.

Creating capable communities is a great idea, but the word capable appears just once in the full text – apart from the title and as a heading on every page – on page 32 Delivering the vision demands a capable and well-trained workforce.

This capable and well-trained workforce has yet to emerge, and may struggle to emerge with all the cuts being in place overnight and without much in the way of consultation by our Con Dem Coalition.  I almost resisted the temptation to mention the lack of mandate given by the Great British Voting Public (the real Big Society – the fictional Big Society remains a mystery to me) to this minority-marriage-of-convenience Government – but that really is another story, another irresistible temptation.

New career pathways will be developed, including more apprenticeships and a new care worker role in home and residential care, as well as more PAs.

Is this yet-to-be-trained capable workforce going to create the capable communities?  Will there be a flurry of independent (for-profit private) providers emerging to provide the training?  Will there be a move to create a genuine career for care workers?  Will there be a decision to pay more than the basic minimum hourly rate of pay so as to attract care workers to care about the work they do?  Or will the private profit preferences prevent progress?  (Sorry, that’s only five Ps.)

Is the capable community to comprise family, friends and neighbours only, with the capable and yet-to-be-trained workforce retreating into the background?   An ever receding professional workforce?  The emphasis throughout the whole Vision is on informal support via kind and caring neighbours, willing and able to provide sufficient support to those in need; a Timebank reminiscent of the bartering of old (not much use to those who are already too frail/old/incapacitated to be able to give the little they can now in return for what they need now!).  Active citizens?

The Royal Borough of Windsor and Maidenhead, one of the four ‘Vanguard Communities’ for Big Society, will test a web-based complementary currency approach for care and support, to assess the potential benefits both in reduced demand for formal care and in people’s quality of life. That might work in Windsor and Maidenhead, but it won’t work where I live!  It may work in many places where an existing community spirit and involvement already exists – but it won’t work in areas where there is no community spirit.  Recent decades have demolished communities in some areas; it could take as many decades to create flourishingly caring communities again.  What happens to the people living with needs who happen to live in those decimated communities?

Personalisation and choice sound great, and both are long overdue.  But I’m not convinced by the plan to increase rapidly the availability of Personal Budgets ‘preferably as Direct Payments’.  Personal Budgets ‘preferably as Direct Payments’ won’t suit everyone in need of care.  They will undoubtedly suit some recipients who have the physical and mental abilities and energies (or the family/friend/neighbourhood support) to become an employer, to research and search for a PA if that’s their wish, to hire and fire (if need be) a care worker/PA, to manage the financial aspects  – and good luck to them.   The Vision might be less rosy for someone with mental capacity problems, such as dementia, and who may not have family/friends to support them.  Can the Vision envisage vulnerable elderly people coping comfortably to set up their own care package?

According to Pulse: patients shun personal health budgets

As for Demos: Personal budgets will revolutionise social care delivery, but only if local authorities are fully prepared

The Charities are changing rapidly, too – so if the reliance on charities increases just when some charities are crumbling, what then?

File on 4 programme on Charity funding and fraud  – grassroots rebellion is underway

Transcript available  if the programme is no longer.

The Oxford Student – ‘tax the rich minority and give to the poor majority’ – is on the right track.  ‘The electorate have sleep-walked into a cannibalisation of public services and welfare that will push Britain back seventy or so years, as £8.1 billion of public spending has been cut.

To the people who voted for the Tories in May, think about this: who paid for the Conservative election campaign? Who bankrolled the triumphalist swagger of these men into Whitehall? Tax evader Lord Ashcroft donated £5.3 million to the Tory campaign. That’s a lot of money, and it doesn’t come without strings attached. Nor does the £1 million donated by hedge fund manager Michael Hintze, whose finance group CQS is based in the Cayman Islands tax haven. Nor still does the £500,000 donated by John Wood, boss of SRM Global, which also has 7 hedge funds registered in the Caymans. These donations makes it difficult to believe that the Tory promise to crack down on tax evasion is anything other than shallow rhetoric. And the fact that the chairman of Care UK, one of Britain’s largest private healthcare providers, donated £21,000 to Health Secretary Andrew Lansley also makes it difficult to believe that the (real term) cuts to the NHS were made in good faith.

Is the Vision the first step towards the privatisation of social care?  The LibConDemolition of the Welfare State, of the NHS, of Social Care?  Who gave permission for that?  Not me.

So, Seven Ps from me to the ConDem Coalition:

Properly procured popular permission prevents public protest.

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Care UK’s former chairman joins Osborne spending panel


No surprises here:

George Osborne has recruited four City figures to join a “red team” of experts to puncture the Treasury consensus on the spending review, as he seeks inspiration for cuts that are causing mounting friction in Whitehall.

The chancellor has asked the bankers and financiers to act as the main figures from outside government on his “independent challenge group”, which has a remit to question the unquestionable in the Treasury’s austerity drive.

The four are Adrian Beecroft, one of the founders of Apax Partners, the private equity group; Douglas Flint, finance director of HSBC; Richard Sharp, the former head of the Goldman Sachs European private equity arm; and John Nash, a founder of the Sovereign Capital buy-out group and  chairman of Care UK, the nursing home group.

Mr Beecroft, Mr Sharp and Mr Nash are Tory donors, and some of them have been on good terms with Mr Osborne for some time.

I’m not too sure about their ‘red’ credentials though.   Correction: Nash was until recently chairman of Care UK; he stood down in March this year, very recently.

The FT forgot to mention the mounting disgust in territory outside of Whitehall.  That pre-nuptial agreement between Clegg and Cameron may need to be dusted off soon – due to mounting friction elsewhere too.

The Cameron Clegg Coalition.  The CCC isn’t working the way it could have worked.

Cameron, Clegg and Co plumb the depths, as Andrew Lansley rests on holiday, but soon to return – Lansley is being blamed in No 10 for failing to spot the political consequences of scrapping milk for the under-5s.

Seventeen Lib Dem MPs are fairly fragile – apparently – and that’s one third of your Parliamentary Party, Nick Clegg.

The mood of the public is …. moodily swinging against the Coalition.  At the risk of repeating myself: no surprises there!

What a bunch!  Are they all aliens from another planet, with no feeling for us, mere earthlings that we be?  A new broom sweeps clean, but this broom will soon begin to shed bristles.   The lost souls of the electorate will all need  a strategically positioned upward-pointing besom broom to ward off witches and to protect from evil spirits.

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Toxic dementia care in the UK – and my thanks to Tim Farron MP

Thank you, Tim Farron Lib-Dem MP, for your recent use of the word ‘toxic’ when describing some Tory MPs and parts of this peculiar Coalition government for which we did not vote and so did not elect.  I share your concerns, also about the behind closed doors’ arrangements that failed to feature in the pre-election sales pitch to which we were treated.  And, yes, I think you have already been ‘politically compromised’, Mr Farron.  There’s a far less politically correct phrase I could use, but were I to do so my language would sink to the low level attacks that flow from the mouths of some Tory MPs – Michael Gove and Andrew Lansley to name but two – in their attempts to respond to questions in the House of Commons.

So, Tim Farron’s unexpected prompt to consider the word ‘toxic’ and the various definitions of ‘toxic’ and ‘toxicity’ is enabling me to see more clearly.  To see and to understand better what happened in my own experience of dementia care in the UK, courtesy of a well-known local authority and a well-known care provider.

  • A toxic substance is one that is capable of causing injury or damage to a living organism, especially one that is vulnerable.
  • A toxic substance is one that can cause death, abnormalities or disease in an organism, especially one that is vulnerable.
  • Toxicity is the degree to which a substance is able to damage an exposed organism, especially one that is vulnerable.
  • Toxic assets played a fairly significant part in the recent and ongoing financial crisis, resulting now in proposals for drastic changes  to everything some of us have ever cared about, and over which we will have no democratic voice.
  • Toxic = poisonous = deadly.

And my own favourite and particularly personal definition:

  • Toxicity = toxic or poisonous quality, especially in relation to its degree or strength.

As long as you remember that the word ‘quality’ can just mean a characteristic, rather than a measure of value, and as long as you remember that ‘strength’ is one of those changeable qualities, you’ll see where I’m coming from.  But maybe not where I’m heading.

Tim Farron’s ‘cover’ is also something with which I can identify– except that I might need to add the word ‘up’.  There’s not much difference though; they both conceal.

Anyone up for a ‘toxic contract’?    This time in Derbyshire, at the Barlborough Treatment Centre, where “NHS bosses have been forced to pay out more than £8m to end a contract with a controversial independent Derbyshire hospital.”

“Over the last five years it received £21.9m from health trusts in Derby and the rest of the county – but carried out only £15.1m-worth of surgery on local patients.

The Telegraph revealed in January this year that the NHS had decided to end its contract with Barlborough operators Care UK and seek a contractor who would be paid on a patient-by-patient basis instead.

Last month it was announced that the new deal – for 30 years – had also been awarded to Care UK.

But now the Telegraph has discovered that the NHS is paying a further £8.2m to Care UK to buy the centre, with Care UK as a tenant.”

Yes, I’ve mentioned this contract before; it will no doubt surface again at some point in my future.

The words ‘not fit for purpose’ are words I’ve used often in my as yet incomplete struggle to understand the peculiar world of dementia care in the UK, as experienced by my relative and by me.  Toxic would have been a far more fitting description.  But when there emerges  a peculiar coalition of potentially destructive forces, each in their own right, then you may achieve a toxicity that had not previously been envisaged.

  • Take one toxic local authority;
  • add an enormous dose of a toxic mental health care of older people team;
  • add months in a grim and extremely toxic assessment unit, where the toxic staff could have done with a full assessment;
  • stir fiercely but don’t shake yet;
  • then add an unexpected dollop of a toxic care home provider;
  • the real shaking comes in a toxic care home,
  • with the lethal brew administered by the toxic staff.

As I continue to understand the toxicity of it all, so I will begin to remove the cover.

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Coalition plans for the NHS

A few comments on the Lib-Dem-Con plans for the NHS~:

from Liberal Conspiracy concerned about the dismantling of the NHS – me too!

from askcliff concerned about Andrew Lansley’s possible hidden agenda – no, Cliff Hagen, I don’t think you are scaremongering;

and, yes, How very odd, Mr Lansley – from Tax Research UK.

David Cameron is apparently terrified, as a parent, by the lack of good state schools, especially in Westminster –  well, David, why not try the Pimlico Academy – courtesy of John and Caroline Nash, of course, c/o Care UK again.  Wait a minute?  Wasn’t Westminster the scene of Shirley Porter’s creations of a suit of clothes to suit the Tories?  Yes, course it was!!!  That turned out to resemble the Emperor’s New Clothes …. unfit for viewing by the uninvited, but eventually all was revealed.  What a thought!!!

Nick Clegg, I’ve said it before and I’ll say it again: I’m disappointed.

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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.

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