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.

…. Care home providers & their conveniently selective memory ….

There’s spin – and there’s spin.  There’s careful choice of words – and there’s very careful choice of words.  There’s spreading the message you want people to hear – and there’s spreading the message you know that others will repeat and spread for you.

This piece by Mike Parish, Chief Executive of Care UK, appeared on Care UK’s website on 1st June 2011, the day after transmission of the BBC Panorama programme ‘Undercover Care: The Abuse Exposed’ showing the torture of people living at Castlebeck’s long-stay hospital/assessment/treatment hospital Winterbourne View.   The day that Southern Cross was sinking further into the pits.  Parish expresses his disappointment and frustration “at the recent unfavourable media coverage of the care sector”.

The same article has appeared elsewhere  since then – spreading the message, just as Parish intended it to be spread.

Parish says “It’s undeniable that the news relating to Southern Cross’ financial difficulties and the disgraceful events at a Castlebeck home are deeply distressing.  However, these are not at all typical of care providers whether public, private or charitable, who generally provide outstanding quality of care.”  All care homes should always provide outstanding care – not just ‘generally’.

He goes on “We are entrusted wtih the ultimate responsibility of caring for vulnerable people ….”   It is indeed a matter of life and death.  Or does Parish mean the moral responsibility, for which of course there would need to be a sense of morality present in each and every employee of Care UK, including those workers being paid less-than-the-minimum-wage, not even a living wage by Care UK.  Are they also required to demonstrate their sense of moral responsibility?

“….. Investing in the skills of our staff and in our quality controls makes a difference to our customers and to our staff.”  It’s good to know that quality controls might be emerging in Care UK.

“…. Care UK’s quality ratings, as assessed independently by the Care Quality Commission, places it at the top end of the industry, with virtually all its services being rated good or excellent.”  I’m not sure why Mr Parish should show such pride in the CQC, right at the time when the CQC is desperately in trouble for many reasons.  Or perhaps it suits Mr Parish that the CQC can no longer be seen as fit for purpose, starved of staff and resources, abandoning inspections, and relying on the likes of Care UK to assess itself.

“….. We’ve maintained double digit annual growth rates for over two decades ….”  Great news – but only if Parish can put his hand on his heart and swear that he has never never never (triple negative!) cut corners to save a few (million) bob, on any aspect of care in any one of his care homes, starving the staff of the training and monitoring and even basic equipment (such as capillary blood glucose monitoring strips), let alone the knowledge of how to communicate effectively with the local GP.

“…. We can only achieve this by maintaining the quality of our care and thereby the trust and confidence of our service users ….”  See triple negative above!!

Parish has a very selective memory, or is it selective memory loss?  Has he chosen to forget another BBC Panorama programme from 9th April 2009 – Britain’s Homecare Scandal – where  “After thousands of complaints and over 900 missed calls Hertfordshire Council got rid of Care UK, just 10 months after they had been awarded the contract”.   Many other contracts have also been lost by Care UK.

Has he also pressed the delete button on events at Care UK’s Lennox House in Islington, July/August 2008, and earlier too,  the care home where the then-manager was suspended and allowed to resign after the bodies of two residents were left in their beds for days?  As reported here in the Daily Mail  –  other reports are also available, such as this one from the Islington Tribune.

Or even the fact that the same Lennox House – which opened as a brand new flagship care home in the summer of 2007 – was subject to enforcement action and a massive ‘action/improvement plan’ and not allowed to accept new residents until May 2009, thanks to that wonderfully independent CSCI.   That was nothing to do with the residents’ bodies being left in their beds for days. Things were always seen to have gone very wrong in December 2007, just months after Lennox House opened.    CSCI/CQC reports available on the CQC website:

• here in particular pages 6-8, 30-32;
• here  in particular pages 6, 8, 13-15, 26-27;
• here in particular pages 7-8, 13-15, 25, 27-28

In other words,  Care UK’s Lennox House was not fit for purpose when it opened and received residents.   Had it been, it would not have taken two years for it to demonstrate that it “continues to improve”, as noted by the CQC inspectors, and for it to drag itself up from a rating of  ‘adequate’.

I’ve never been enamoured of the CSCI/CQC for personal reasons and because of my family’s experience of care home care.  Their inspection reports have always taken 3 or more months to appear, rendering them even more meaningless than the toothless tick-box exercise they appear to have always been.  As some of us have had to find out, the hard way, a care home can go from ‘flagship’ to ‘wreck’ in the blink of an eye, or even from good to bad to absolutely disgraceful, to use a word from Mr Parish’s comments above.  Not that the CSCI noticed – until it had no choice but to be aware.

Mike Parish may also have chosen to forget this very recent revelation dated 6 May 2011:  ‘An elderly woman from Worcester Park, was left in severe pain from injuries caused by care home negligence while staying at Appleby House, a care home operated by Care UK, a leading independent provider of health and social care services. The company has now paid the woman’s family compensation as she has since died.’  ….. ‘

Mrs Cunningham’s daughter Janice commented: “I think this incident highlights the casual way the elderly are treated in some residential care homes. I believe Epsom General Hospital shouldn’t have discharged my mother to such a poor home.

“It is terrible my mother had to endure the pain of the pressure sores.  People need to be vigilant when it comes to the care a home is providing and not believe all you are told by the homes’ employees. It pays to investigate yourself.”

The above is taken from the website of Russell Jones & Walker  the firm of solicitors who represented the very best interests of Josephine Cunningham and her daughter.

There’s no smoke without fire could be a message for Mike Parish to remember.

Today’s Today programme featured a good interview with Christopher Fisher, Chairman of Southern Cross.   It’s worth a listen to hear what John Humphry’s describes as ‘semantics’, and what I’ve called above ‘very careful choice of words’.   Fisher squirms, as to be expected, accepts his full share of responsibility, still defends his ‘business model’, but can’t bring himself to say sorry for his actions over recent years.  He claims to have improved the standards of care over recent years – well, he’s also got a very conveniently selective memory, bearing in  mind that almost 30 per cent of Southern Cross’s care homes have breached minimum standards and have been served ‘improvement notices’ by the CQC.  He says that there were ‘issues in dealing’ with those standards of care, claiming to have invested heavily to improve training and support to employees.  He talks of ‘people occupying beds’.  Those people are not just occupying beds – the care homes have become their only home, where they expect to be assisted to live life to the full.   They didn’t realise they were meant to be contributing to your profit margins, whether or not you chose to sell off care homes, lease them back, and then all sell off your shares to make big profits to the tune of £millions.

For goodness sake!  The mealy-mouthed words of a weasel.

Nobody can blame all of the above on ‘unfavourable media coverage’ – not even Mike Parish.

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 training.  Castlebeck 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.