Tag Archives: BBC Panorama

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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Anti-psychotics and vulnerable elderly people in care

This week’s BBC Panorama programme What Have The Drugs Done To Dad? has caused more questions than it answered for me, in some  ways, and it’s left me with a feeling that we really could do better, if we cared.

The programme began with the statistic that 180,000 people with dementia are being given – as a matter of routine – powerful anti-psychotic drugs which in the majority of cases harm them and may be shortening their lives.  It was described as the scandalous abuse of some of the most vulnerable people in our society.

I must add a qualification here: some people are content that their relative with dementia is being prescribed anti-psychotics, both in residential care and in their own home.  It is not my purpose to deny them the right for that to be seen as appropriate in their own circumstances.  But the programme’s purpose was to look at the inappropriate over-medication of people in care, and the over-prescribing of anti-psychotic meds that were never designed or legally licensed for dementia.

Paul Burstow, Minister for Care Services, used the words ‘shocking’, and ‘unacceptable’, stating that these drugs kill people, cutting their lives short once they have already reduced the quality of their lives.  I have no reason to doubt Professor Sube Banerjee’s assertion that the drugs are being used much too often and much too freely.  If their use is beneficial in only one-fifth of cases, it’s serious cause for concern.

I have no personal family experience of the use of such powerful anti-psychotics for people with dementia, but I do have personal family experience of powerful drugs being prescribed for my own relative with dementia, and with a few other physical problems that were causing pain and distress.

Like Cheryl Byrne and Glynne Thompson who appeared in the Panorama programme, I too noticed a dramatic decline in the general well-being of my relative – even though I had no idea then what had been prescribed.  Within a matter of weeks, all conversation stopped; there was a huge change in awareness and sociability; posture went from upright to stooped; the ability to engage with anything at all was non-existent; agitation; insomnia; disinhibited behaviour; and the remains of what once was a definite joie de vivre went right out of the window.

My request, in the mental health assessment unit, to be allowed to know which medications my own relative was being given, was met with verbal abuse by the deputy in charge of the ward. No matter how much I explained that I was shocked to see such a huge decline in such a very short space of time, the brick wall of refusal came my way.  She refused to give me any information at all, even though I was listed as one of only two close relatives still alive and caring about a very vulnerable elderly person with dementia.

It was only after the death of my relative that I discovered – when I obtained a copy of the medical  records – that a doctor had written into those notes “this is a massive amount of NSAIDs and anti-depressants for a frail elderly person”.  They had prescribed  an opioid drug to control the pain and the patient.  Then, the anti-depressant was introduced to someone who had no history of depression at all – it was prescribed as a way of controlling the manifestation of ever increasing physical pain, discomfort and distress.   It made it easier for the staff in the mental health unit to manage – they could then manage to huddle round and watch TV, rather than needing to interact with their patients.

Neither the opioid drug nor the anti-depressant controlled the pain.  Did they control the patient sufficiently in the best interests of the nursing/care staff?  Did they contribute to a sudden death?

After watching Panorama, I looked around for more information about the use of anti-psychotics to control, to quieten, to make manageable those vulnerable elderly people with dementia and living in care homes.  What did I find?  This from the Alzheimer’s Society dated 3 December 2007, which was when Panorama last looked at the abuse of elderly people in residential care homes by over-medicating them.

Neil Hunt, then Chief Executive of the Alzheimer’s Society, said:

Today is D-Day for dangerous drug prescribing.  Sedating a person with dementia should be a last resort but too often doctors are turning to the medicine cabinet without considering the alternatives.   Today Panorama is shining a light on the widespread drug abuse of people with dementia, which has been hidden away for too long.  The first parliamentary inquiry into the practice is also an important step to uncovering the true scale of the problem, and we look forward to its findings.

Over 100,000 people are being prescribed these drug treatments that leave people with dementia in a zombie like state, robbed of their quality of life.   Research shows that anti-psychotics have minimal benefit and drastically increase the risk of death and stroke. It is absurd that we are wasting millions of pounds prescribing these drugs when this money would be much better spent training health professionals in dementia care.

Dementia isn’t only about memory loss; more than half of all people with dementia experience behavioural symptoms as part of their condition.

But I can’t find a statement from the Alzheimer’s Society commenting on this more recent  Panorama programme.

Three years on from 2007, when the Alzheimer’s Society called for an end to the widespread drug abuse of people with dementia after the 2007 BBC Panorama programme, we are now promised that within another year, by November 2011, the use of anti-psychotics prescribed to people with dementia will be reduced by two thirds.

Why should it take so long?  How many more people will have died before action is taken?

And finally, for anyone with an interest in the shocking statistics of medication abuse of vulnerable elderly people in need of care, click here for a read of this document from 31 March 2008, which also bears the name of Paul Burstow, then in  Opposition  and MP for Sutton and Cheam:

Keep Taking the Medicine 4 The scandal of the inappropriate medication of older people in care

Had it appeared just one day later, it would have appeared on 1 April.

No excuse for lack of action is acceptable, said Paul Burstow in Opposition.  He’s been arguing his point since 2001, and probably before that.  He was lonely in the House of Commons then – nobody listened to him, championing in debate the cause of vulnerable elderly people.  Now that he’s in Government and Minister for Care Services, he says that he stands by that statement, it is now his mantra,  and he nodded when told that he would be held to account in the future.

Please widen the scope of your concern, Mr Burstow.  Look at the abusive over-medication of elderly people, especially those with dementia and in care, in its entirety.   In fact, widen the scope of your concern to the abuse of elderly people with dementia in care.  Full stop!

Nobody listens to us either, so you should know how we feel.

Let’s hope that you are not Home Alone now, and that people listen and act.

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