Tag Archives: behind closed doors

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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Filed under abuse, Care UK, dementia care, growing older, neglect, professional responsibility

Briars Retirement home / Briars Care home – and other examples of neglect

The owner and manager of Briars, a ‘retirement/care’ home in Southampton, have been found guilty of ill-treating and neglecting sixteen vulnerable elderly residents with dementia, aged between 77 and 96.  At Southampton Crown court, Annette Hopkins, the 63-year old owner of Briars, was found guilty on 10 charges of wilful neglect, and Margaret Priest, the 54-year old manager, on four.

Both of them had denied all 16 charges.

The Daily Echo reports that Defence barrister Amanda Hamilton asked for Priest to be conditionally discharged, saying she had devoted her time and attention to The Briars.

“She is a kind, caring and altruistic person. She has lost her job, she is unlikely to get another one and she is claiming state benefit.”

That ‘state benefit’ may now be transformed into a different kind of ‘state benefit’, whereby the state places Priest and Hopkins into secure custody, in the best interests of all.  They are both approaching an age when they may need residential care themselves, so I only hope they get the kind of care they deserve.

This is Hampshire, 28 May 2010 reports: “IF ONLY we had had more help.”  Those were the words from the owner of a care home that was closed down over allegations of neglect.    And soon, if she is to receive a prison sentence, that same owner, Annette Hopkins, may well be able to understand that those very words applied to the vulnerable people she was supposed to care for.  They were all desperately in need of care, support and help – that is what they deserved.  But all they found was neglect.  If only they had been given the help they needed.

25 September 2008, and the Daily Echo reported the early beginnings of this case, and that Annette Hopkins, 63 then, admitted she may have made mistakes but denied any allegations of neglect. Mrs Hopkins said a district nurse had assessed up to ten patients – almost half the residents – as needing specialist nursing care after finding they were suffering from bed and pressure sores. That is neglect – and nothing to do with ‘mistakes’.  CSCI had carried out an inspection the previous November.

24 September 2008: Channel 4 news covered the same story in much the same way, as did the Daily Mail.

The list of horrors surrounding the lives of the residents is gruesome reading, again from This is Hampshire:

Police told how the full disturbing catalogue of failures included how:
■ Residents were malnourished and dehydrated
■ The place they called home had a strong stench of urine and the floors were filthy and faeces-stained
■ Dirty bedding and incontinence pads were left lying on the floor, mixed with clean clothing
■ Medication would be handed out by unqualified staff and was sometimes given to the wrong people
■ Bosses were not qualified but claimed they were through years of doing the job
■ Staff didn’t have the right equipment to lift residents who needed to move
■ The wrong beds were used, leaving residents with severe sores
■ Some were so ill or incapable they should have been in a nursing home

The Basingstoke Gazette yesterday has several items of interest.

The first The Briars: What to do if concerned about a relative gives the contact details for you to voice your concerns, in the hope that your concerns will be thoroughly investigated.

The second The Briars: Could it happen again? mentions Southampton City Council’s newly formed ‘Safeguarding in Provider Services Team’, and also gives the impression that CQC are a completely new kid on the block, replacing the old CSCI with massively improved powers.

The third I always worried about my Mum at the Briars gives the views of Sue Rennie who placed her trust in the Briars when her mother became a resident there in 2004.   Now Sue is calling for six-monthly anonymous spot checks at all care homes and nursing homes.

“They shouldn’t just be checking the facilities and what entertainment is on offer. Qualified doctors and nurses should be checking individuals who are bedridden, incontinent and prone to skin conditions to make sure they are being cared for on a personal level and the appropriate treatment is given.”

I agree with you there, Sue Rennie.  But there’s more to it than meets the eye, and it can take the novice, the beginner, the concerned relative, several years to unravel what goes on behind closed doors.  (see below!)

But what worries me most is the Inspection that the then-CSCI (now CQC) carried out in November 2007.  It’s no longer available on the CQC website, of course, because the home is now thankfully closed.  But the Basingstoke Gazette from September 2008 has a link to that inspection report from 24 November 2007.  It’s deeply concerning to read the following:

  • Feedback obtained from professional sources indicate that people feel the staff are knowledgeable, that staff are available to assisted with visits and that overall the service provides and satisfactory level of care.
  • Service user and relative surveys continue to raise concerns over the lack of entertainment and stimulation provided within the home, with people commenting ‘not enough activities, the notice board states that residents will be taken on day trips, this has not happened’ and ‘ this is a very nice care home, the only fault being there is literally no stimulation for the residents apart from a pianist once a month’.
    People met during the visit also criticised the lack of social stimulation saying that they prefer to remain in their bedroom as the opportunities to interact or socialise are limited.
  • During the fieldwork visit it was noticed that people were eating their lunch in the lounge as apposed to the dining room, which initially seemed the result of personal preference. However, during the tour of the premise it was noted that the home has limited dining spacing, with small dining rooms located adjacent to the main lounges, both rooms only capable of sitting approximately ten to twelve people.
  • The dataset also contains information about the home’s complaints activity over the last twelve months:
    No of complaints: 18.
    No of complaints substantiated: 0.
    No of complaints partially substantiated: 0.
    Percentage of complaints responded to within 28 days: 100%.
    No of complaints pending an outcome: 0.
  • The Dataset again establishes that policies for the protection of the service users are in place: ‘Safeguarding adults and the prevention of abuse’ and ‘Disclosure of abuse and bad practice’, however as with the complaints policy no review date is indicated.
  • Following the last inspection the manager has commenced meeting with each service user for approximately five to ten minute a day, discussing their wellbeing, any concerns or issues which they feel are affecting them. The manager documents each meeting and where necessary actions are taken to address any concerns or comments made. During the tour of the premise one service user mentioned her daily meeting with the manager and expressed a concern that this level of commitment could not be sustained due to the manager’s other responsibilities.
  • However, the manager was quick to reassure the service user that ten minutes each day was more than manageable for her and that she enjoyed the one-to-one interactions with people.

There were enough ’causes for concern’ when the inspector called – but the inspector merely ticked all the boxes required and went away.  Mission accomplished!  Or not.  Too many occurrences of “indicated” and “the manager/she stated that” for my liking.  An inspector is supposed to find positive evidence, not indications.  An inspector cannot take for granted that whatever the manager ‘stated’ was fact.

The manager managed to convince the inspector that she could spend 5 to 10 minutes, each day, with each of 34 residents – and document her meetings.  That would consume an awful lot of hours – leaving the manager no time to manage.

There are many other areas within that inspection report that should have rung alarm bells.

Why have I been following the story of Briars?

Because it first came to light in September 2008, just a month after another story of neglect surfaced, at Lennox House, Durham Road, Finsbury, Islington, North London.   Another care home run for profit, this time by Care UK.  The then-manager was ‘allowed to resign’ after she had managed to fail to manage a care home where the bodies of residents who had died were left in their rooms for days after their death.

And that story of neglect came only 8 months after yet another story of serious neglect and sub-standard care emerged.  The Deputy Manager and several staff members were also ‘allowed to resign’.  The world at large will know nothing of that story, because it does not feature in any CSCI/CQC report.  Nor does it feature in the headlines any longer.

The  CSCI/CQC inspection reports for Lennox House:

23 October 2007: brand new care home so this was the first Key Inspection: no major problems are noticed; there are 7 Statutory Requirements made, but nothing to indicate any serious problems.

24 June 2008: 11 Statutory Requirements were made – there were also outstanding Statutory Requirements from the previous inspection of November 2007 when 7 Statutory Requirements were made; Enforcement Action was being ‘considered’ and was taken.

3 December 2008: when the home was still subject to Enforcement Action and still not allowed to accept new residents; 2 Statutory Requirements and still outstanding requirements from the previous inspection;

9 June 2009: and the home is allowed to admit new residents;no outstanding Statutory Requirements from the previous inspection, but a now a further 3 Statutory Requirements made, and 9 recommendations.

You will need a very fine-toothed comb to work your way through what actually was happening, between 23 October 2007 and 24 June 2008, not to mention June 2008 to June 2009.  And you still will not find it in the CSCI/CQC documents – or any other document – easily available to potential residents and their family.  It is all concealed.  The massive Improvement Plan/Action Plan imposed on a care home run by one of the biggest care providers in the country is a real eye-opener.

Behind closed doors much can be concealed from view.  Enough holes to build a golf-course. 

The gaping holes of care in the UK.

And that will be the subject of the next instalment.

No secrets.

These are not isolated incidents.

Sad reflection on the state of care in the UK, but a true one.

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Filed under abuse, care homes, Care UK, dementia care, neglect

Pamela Wells – ‘Campaigning for Quality Care in Care Homes’

The following are words from Pamela Wells’ report, Campaigning for Quality Care in Care Homes, published today via Counsel and Care, as she calls on the new commission on long-term care to consider how to improve radically the quality of care as well as how the care system will be funded in the future:

“These people need us to fight for their rights. They are the same people some of whom fought for our right to live free from fear and tyranny during the second world war.

These are the same people who went without to bring up a family paying their own way and seldom asking for any help. To these vulnerable and defenceless people all hope must seem gone. ‘No Knight in Shining Armour’ to rescue them from ‘God’s Waiting Room’. That is how many residents referred to the care home.

So, why isn’t there any public outrage?

Is it that people find it hard to believe that this could be happening or is it that they feel nothing can be done? Perhaps it is just too uncomfortable to face because it reminds them of their own mortality. Or is it that the abuse is so well hidden that it is –

Out of Sight and Out of Mind – Behind Closed Doors

Well it is not out of my sight and I will not close the door of my mind to their plight.”

‘Behind closed doors’ is a phrase I have used repeatedly in recent years, because of my own struggles to achieve an understanding of the lack of care provided in a certain care home that was most definitely not fit for purpose, when my own relative was living there.  CQC, please open the doors so that everyone, but especially those in need of care and those who care about them, can understand and can contribute to the improvement of care.  As long as it is all kept ‘behind closed doors’, there will be no confidence whatsoever in any of the empty promises that come our way.

What happened to my own relative in a so-called care home will never leave my sight either.  Eyes open, or eyes closed – those images will always remain, with me.


Filed under care, care homes, Care UK, dementia care