Tag Archives: CQC

Care Circus is back in town next week

Well, here we go again.

Next week the Care Circus is back in town.

The latest batch of NMC hearings is about to stir its loins again and get on with the work that it was charged with handling long ago on 1 October 2008.  That was only a few very short months after you died, thanks to the rubbish care that came your way, courtesy of Care UK and Lennox House so-called care home in Islington, London.

It was also a few very short months after I’d asked so many questions of Islington’s Mental Health Care of Older People team, and then Islington’s Social Services, and then the CQC (or CSCI as it was called back at the beginning of 2008), and the Coroner’s Office, and Islington’s Safeguarding of Vulnerable Adults Team, and  most of all of Care UK … well, you will know how many questions I asked of them all, each and every one of them.

They don’t like answering questions, do they?  Especially if those demanding but necessary questions are likely to cast a very dim and dark shadow over their (lack of) accomplishments.

Last December 2012, the NMC decided that one nurse involved in your demise should be struck off, from their register of nurses allowed to nurse in the UK.  Another nurse was delivered a 3 year caution order, requiring her to be on her best behaviour.

Next week, 15 to 19 April 2013,  the Circus is back in town.  Fifteen months after the NMC hearings first started, looking in depth at the circumstances surrounding your rapid decline, within 10 days of arrival in that so-called care home, Lennox House, and your admission to hospital in a diabetic coma.  You died 3 weeks later.

The  final 2 cases, still waiting in the wings, are to be dealt with by the NMC next week.

One case  is that of the care home manager, who is mid-way through an interim 9 months suspension order, placed to allow time for her to seek permission for a Judicial Review in the High Court, of the NMC decisions thus far.  The High Court refused permission to seek a Judicial Review.

The clowns will all be wearing their costumes.  Their faces will all be heavily disguised beneath the cake of their make-up.  They will all have their props to support them.  Their scripts will all have been written, re-written and then written again.  Edited, heavily edited, and then edited again.

You weren’t allowed to write a script of  your own, were you?  Let alone edit it.

The script of your final years, months and weeks of your life was snatched from you.  Grabbed by thugs.  The uncaring, unqualified, untrained, unmonitored, unsupervised, unsuitable thugs who were charged with the most basic and fairly simple duty of looking after you.

Next week, they will still be wearing their masks, their costumes  and their heavy make-up.

As they will continue to do year after year.  Uncaring as always.  Unkind in their presentation thus far.  Unwilling to admit that they failed miserably in their duty of care to you, for you and about you.  They didn’t care enough to care.

The chance to wear your dresses, your gentle make-up and to present your smiling face to the world was taken from you.  By the thugs of care.  The thieves of care.  The robbers of care.

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Care in the UK – 5 years on – Part 4

The next days were spent making arrangements for your funeral. 

I began to follow up some of the questions I’d already asked in mid-December 2007 of the Mental Health Care of Older People Team, part of Camden and Islington NHS / Mental Health and Social Care Trust.  Their social worker wrote to me the day before the funeral to inform me that she’d no longer be the allocated worker, but that her Deputy Manager would be coordinating the “on-going enquiry” into the circumstances leading to your admission to hospital. There was to be a comprehensive investigation under their Adult Protection Procedures.  I asked to be allowed to attend all meetings and to receive a copy of the Report of the Investigation.  The Deputy Manager of the MHCOP team said she didn’t envisage any problems with that request; she knew by then that I’d want and need to stay fully involved.

I’d contacted CSCI (now the CQC) on 20 December 2007, while you were still alive,  to tell them of my concerns about your care, or rather lack of it.  It took them a while to find the right department dealing with Lennox House.  CSCI had not been notified of your sudden admission to hospital on 8 December 2007,  so the inspector I spoke to said they would write to the manager of Lennox House and to me.  I heard nothing back from CSCI, so I phoned them again on 21 January 2008,  to be told that CSCI had indeed written to the manager after my phone call and that they’d received a call back from her to say that she would reply in due course. 

But CSCI  received no response from her, so they contacted her again on 21 January 2008.  That’s when I first discovered that the manager told CSCI, that very day,  that she had ‘arranged’ a meeting with me on 31 December 2007 (as I mentioned here) and that all my ‘concerns had been ironed out’ at that so-called meeting.  That is far from the truth.

Your social worker had a few busy days too, round about 20/21.12.2007, and when I received a copy of your notes (much later in February 2008) I was able to know more.  According to the notes, she’d apparently tried to phone me so many times but had never been able to reach me or to leave a message for me.  Strangely enough, many other people had managed to do just that.  I knew nothing of Adult Protection Procedures or the ‘Form AP2’ that was completed then.  Islington’s Adult Protection Coordinator was busy too, but I did manage to speak with her just the once. 

When I received your notes, sent to me on 12 February 2008, I read that the Adult Protection Coordinator had advised your social worker on 2 January 2008 – well before the funeral – that your family had the right “to request an inquest, though MHCOP would not do this”.    (They are the exact words used in the social worker’s notes.)

Why is it, do you think, that absolutely nobody at all cared enough to pass that vital piece of information to your family?  Not one person told us that we had the right “to request an inquest, though MHCOP would not do this”.  

MHCOP (Mental Health Care of Older People) were well aware that there were serious concerns about the lack of care provided to you by Care UK’s so-called care home Lennox House. 

But nobody cared enough about you or your family to tell us that we had that basic human right.  There were a few other things noted that they could have transmitted to your family too, but nobody cared enough to tell us.  In the best interests of whom was that decision made to withhold vital information from us?

According to the notes, MCHOP were faffing around trying to work out whether there was anybody available in MHCOP with the ‘capacity to conduct an investigation’.  Not wishing to be facetious, but I do wonder whether they meant the ‘mental capacity’ or the ‘physical capacity’ to conduct an investigation.  In the event, an Independent Nurse Consultant was commissioned by MHCOP to carry out the investigation and to write a Report.

The social worker signed off on 8 January 2008 and departed by writing that she would no longer be involved in your case as “the only remaining work is the completion of the POVA enquiry”.  POVA was the Protection of Vulnerable Adults.

You deserved better care.

(To be continued)

 

 

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Care in the UK – 5 years on – Part 3

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

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

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

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

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

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

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

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

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

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

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

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

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

You deserved better care.

(To be continued)

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Care in the UK over two weeks in December 2012

1 December 2012: TENS of thousands of vulnerable people are being physically and mentally abused by the very people meant to be caring for them. Disturbing figures reveal that 130,000 adults were ill treated – usually at the hands of carers or family. Abuse most often took place in their own home or care home.  Read more here.

1 December 2012: Abuse of elderly patients by NHS staff rises by a third in one year with a  shocking 36,000 offences reported last year alone.  Read more here.

1 December 2012: Care home regulation criticised by Norman Lamb.  Regulation of the care sector is not fit for purpose, care minister Norman Lamb has said as he unveiled proposals on English care homes for consultation. He also said there was a “significant lack of corporate accountability for the quality of care”. One suggested measure involves companies having to open up their books to inspectors to ensure they are financially sound. Read more here.

1 December 2012: Care home companies could be forced to open books to prevent another ‘Southern Cross’ collapse.  Read more here.

4 December 2012: Care home job advertisements ‘encouraging’ criminals to apply.  Convicted criminals have been encouraged to apply for jobs in care homes looking after frail, elderly people.  Read more here.

4 December 2012: Ann Clwyd, Labour MP tells of inhumane treatment and says she fears normalisation of cruelty now rife among NHS nurses.  Ann Clwyd has said her biggest regret is that she didn’t “stand in the hospital corridor and scream” in protest at the “almost callous lack of care” with which nurses treated her husband as he lay dying in the University Hospital of Wales in Cardiff.  Read more here.

4 December 2012: Melton Court care home to be closed by Friday. The manager of a South Yorkshire care home, which has been ordered to close by Friday, says she is in talks with two potential new providers. The 21 residents at Melton Court in Maltby have to find new homes, after it emerged the owner is in prison. The Care Quality Commission (CQC) revoked Ishtiaq Zahir’s licence and said the home is operating illegally.  Read more here.

5 December 2012: A PENSIONER with Alzheimer’s died after she plunged down a lift shaft when the door was left unsecured, a court heard yesterday. Annfield Plain company faces health and safety charges after tragedy.   Read more here.

5 December 2012: Wrexham – Concerns over care at mental health hospital.  Read more here.

6 December 2012: Leicester – Dementia sufferer ‘left in agony’ at George Hythe House care home in Beaumont Leys, court hears.  An 89-year-old dementia sufferer was left in agony for four hours with a broken thigh  because a care home supervisor could not be bothered to assess her, a   jury heard. Sarah Bewley was “too busy” doing paperwork to see the woman after she suffered a fall, despite several requests from a care assistant, it was claimed.  Read more here.  See below.

7 December 2012: Regulator moves closer to setting up ‘negative register’ of adult care staff.   If the proposals are approved by government, a national code of conduct would be applied to workforce and the HCPC would consider serious complaints made about individual professionals; any decisions to uphold a complaint would be made public, as would the resulting sanction.

A “negative register” would be maintained of those found unfit to practise.  Read more here.

7 December 2012:  Leicester – Jury clears Leicester care home boss of neglect charge.  After the not guilty verdict was announced, Judge Lynn Tayton QC said: “This case raises very worrying issues, particularly concerning systems that seemed to be in place which created a situation in which no-one took responsibility for the care of this lady.  “She was left in severe and unnecessary pain for a number of hours.”I hope those in charge of the home have looked at the systems and the staff training.” Read more here.

7 December 2012:   Chorley, Lancs – A care-home worker and her husband who subjected  their children to years of horrific abuse were facing jail yesterday after being  convicted of cruelty.  Read more here.
8 December 2012: Wolverhampton – An investigation has been launched into safeguarding at a care home, which helps people with mental health, drugs and alcohol problems.  Read more here.
8 December 2012: Derby – A national health watchdog has issued a damning report on a privately-run Derby care home.  The Care Quality Commission has told the company  that owns Cleeve Villas Nursing Home, in Wilson Street, to do more to protect the safety and welfare of residents – or face legal action.  Among the problems identified were:
  • No organised stock control system of medicines
  • Failure of staff to update crucial medical documents
  • Care plans reviews not completed on time
  • Failure to ensure prescribed medicines were always available
  • Medicine doses not being documented, meaning it was unclear whether medications had been administered
  • No appropriate systems in place for the safe disposal of medicines when they were no longer required.

Read more here.

Read the CQC report on Cleeve Villas here.

That list of failures is just the kind of thing most people don’t know about, so  awareness raised to the top is what we need in the world of care.

When it comes to the comment made by the spokeswoman for Cleeve Villas Care Services : “As a dedicated provider of care services, we at Cleeve Villas have taken on board the suggestions from CQC as to how to enhance our overall performance and have already taken steps working with a specialist healthcare consultancy to address these.”Our aim as always is to ensure the individual and complex needs of our residents are met.”

I don’t believe you.  Yet.  This is not the first CQC detailing same/similar problems.   What has taken you so long to show that you care enough to provide good quality care?

9 December 2012: Vulnerable care home residents are treated like “brutes or malfunctioning machines”, said Hilary Mantel, the author, as she spoke of the “utterly depressing” search to find accommodation for a disabled friend.  Read more here.

10 December 2012:  We haven’t a clue how much a care home will cost us.  The vexed question of how we pay for the care needs of Britain’s ageing population rears its ugly head so often that it is no wonder everyone thinks it is a pain in the neck.  Read more here.

10 December 2012: Star ratings: Families need reliable information on care home performance.  Read more here.

10 December 2012: Preventative care for elderly under threat.  Services have been cut or frozen by two-thirds of local councils since coalition came to power, according to ComRes study.  Read more here.

10 December 2012: A Birmingham care home is being investigated by council and health bosses amid  allegations of neglect.  Bramley Court Care Home, in School Road, Yardley Wood, is facing the probe  after a complaint was made about the standard of care given to elderly  residents. New admissions have been suspended while a joint investigation is carried out  by the city council and NHS Birmingham and Solihull.  It is not the first time the home has been in the spotlight over its  treatment of residents. In August a report by watchdog, the Care Quality Commission, found residents  were being put at risk of not receiving adequate food and drink.  Read more here.

10 December 2012: Winterbourne View scandal prompts new care guidelinesReport warns that care sector risks slipping back into institutional culture typified by Victorian asylum system.

The report warns that, elsewhere, staffing cuts caused by reduced fees paid to care providers are causing residents to be left alone for hours at a time and are fostering excessive reliance on use of drugs and on physical restraint, “often for minor perceived misdemeanours”.

Brendan Sarsfield, Family Mosaic’s chief executive, said: “We would argue that if providers don’t believe this has ever happened in their services, it just may be that they haven’t looked hard enough.  Read more here.

10 December 2012: Care home provider Family Mosaic has warned that the care sector is in danger of slipping back into the institutional ways of the past and is urging care providers “not to be complacent” and be vigilant for danger signs of abuse.  Read more here.

10 December 2012: Winterbourne View scandal: Government rethinks use of hospitals.  Norman Lamb said “”We need to have a situation where people who run care organisations – public or private sector or voluntary – know that they are accountable for the services they provide and there are consequences if they don’t.”  You can’t argue with that so let’s home he brings about accountability.  Read more here.

12 December 2012: Copthorne, Sussex – Care home boss suspended over death of patient.  A care home manager has been suspended by the Nursing and Midwifery Council over allegations she shredded a document to cover up a mistake which led to the death of a resident. The resident of  Orchid View care home in Copthorne was given three times the prescribed dosage of Warfarin, a drug used to prevent blood clots, over 17 days in 2010. Read more here.

12 December 2012: Stockton care home boss denies a catalogue of failures.  Meal times at the home were “appallingly organised” and 15 out of 17 patients  lost weight over a one-month period, the Nursing and Midwifery Council heard.  Read more here.

12 December 2012: York care home warned to make urgent improvements.  The Care Quality Commission has issued a formal warning to Mimosa Healthcare (No 4) Limited, which is the registered provider of Birchlands Care Home, that they are failing to protect the safety and welfare of the people using the service.  Read more here.

12 December 2012: Wall Heath care home told to shape up or face enforcement action.  The Care Quality Commision (CQC) is demanding an improvement in the standards of care at Holbeche House after inspectors found failings during an unannounced visit in October.  The Wolverhampton Road home, which is run by Four Seasons (Bamford) Limited, was found to be below standards for the care and welfare of service users and assessing and monitoring the quality of services.  Andrea Gordon, deputy director of operations (central region) for CQC, said: “The law says these are the standards that everyone should be able to expect. Providers have a duty to ensure they are compliant.  Read more here.

12 December 2012: Nurse at Rodborough care home slept with vulnerable female patient and invited another to swingers’ parties. Trevor Rice, a senior triage mental health nurse at Park House Mental Health Resource Centre, was formally removed from his post by a Nursing and Midwifery Council disciplinary committee on November 23.   Read more here.

12 December 2012: A bungling nurse who was cleared to work in Sussex despite making a number of shocking errors is being investigated for a second time.   Nicanor Sindanum made national headlines after he was allowed to continue to work as a nurse despite being found guilty of 17 serious errors by a nursing panel while working in Scotland.   In June this year a nine-month banning order imposed by the Nursing and Midwifery Council (NMC) in September 2011 was revoked and replaced with conditions of practice order.  This meant that, despite his failings, Sindanum was allowed to start work for an Eastbourne care home so long as he told bosses that he had restrictions placed on him. But now it has emerged that Sindanum faces a second investigation for alleged failings dating from 2009.  Read more here.

13 December 2012: Slyne-with-Hest, Lancashire – Four people have been charged with offences under the Mental Capacity Act 2005 following a police investigation into the mistreatment of residents at a care home in Slyne.  Read more here.

13 December 2012: Wales – More should be done to reduce Wales’ reliance on using care homes as a way to look after older people, says a group of Assembly Members.  The assembly’s health committee has backed moves to help people keep their independence for as long as possible. Families need simple and accessible information about the options available for elderly relatives, it said. It pointed out that many elderly people who pay for their own care were unaware of the help available to them.  Read more here.

13 December 202: Panshanger, Welwyn, Herts -Massive arrogance’ jibe as ‘out of scale’ care home plans thrown out.  Read more here.

13 December 2012: Morpeth, Northumberland – Coroner hits out at care of woman in Morpeth home.  Mr Brown, recording a narrative verdict, yesterday concluded the fall “did  play a part” in Mrs McEwan’s death as the fractured femur caused immobility  which made her more susceptible to the fatal complaint. The coroner also found three serious failures in the care of Mrs McEwan.

He ruled senior carer Stephanie Wilson had left Mrs McEwan’s bed in an  elevated position, moments before she fell while trying to get into it.

Furthermore, Mr Brown said staff had failed by phoning a doctor’s surgery  instead of an ambulance after the fall, even though Mrs McEwan was in obvious  pain and in need of such care immediately.

Finally, the coroner said workers had been wrong to lift Mrs McEwan back on  the bed, saying they should have left her where she was comfortable until the  ambulance arrived.

Mr Brown nevertheless accepted that staff had been misguided and in need of  better training rather than motivated by malice.  Read more here.

13 December 2012: Croydon  – Are Croydon care homes up to the job of looking after borough’s most vulnerable?  Nearly a third of care homes in the south of the borough are failing patients and residents in one or more key standard, an Advertiser investigation has found.

Campaigners for better care say the findings paint a “dire” picture for sick and elderly people at a time when savings in care provision are set to be enforced.

Among those that are failing in one or more key standard are homes which charge elderly people up to £800 a week.

Stuart Routledge, chief executive of Age UK Croydon, said: “It is appalling that any nursing home should fail to protect the dignity and respect of their patients and residents.

“This survey underpins the urgency for social care funding reform so that those older people who struggle daily with chronic ill health, frailty and disability have the peace of mind that they will be well cared for at their time of need.

“In particular, this shows the dire consequences of a social care system that has been under increasing financial pressure over the last eight years and in many areas is now financially stripped to the bone.

“Staff across health and care services have a professional and moral duty to make sure the dignity of their patients and residents is enshrined in every action. This means involving people in decisions about their care, providing care that treats people with respect and helping people to be as independent possible.”

Read more here.

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Neglect and abuse in care in the UK in November 2012

Some people try to convince me that cases of neglect and abuse of vulnerable people in care in the UK are extremely rare.  Some people also try to convince me that those who talk of such cases are scaremongering.

Below is just a selection of cases of neglect and abuse of vulnerable people in care in the UK over the month of November 2012.  It is a selection and by no means all of the cases I came across.  The dates are the publication dates.

5 November 2012:   Britain’s biggest care home owners ‘have £5 billion debts’.      Read more here.

5 November 2012: Nottingham – Police are investigating an elderly care home in Nottingham which closed after  having its council contract suspended.  Read more here.

6 November 2012: Suffolk – The great care home giveaway: Tory council calls in the private sector.   Suffolk County Council has agreed a multimillion pound deal with the private sector to take over its care homes amid fresh calls for financial regulation to protect elderly residents and the taxpayer.

The council’s 16 aging homes will be closed by 2015 and 10 new homes (and wellbeing centres) built – giving the county 104 extra beds to help meet growing demand.

The first five will be built and owned by Schroders UK Property Fund – who will lease the homes back to Care UK. The land is being given to Schroders for free by the council with unrestricted freeholds.   Read more here.

9 November 2012: Dementia patient found wandering in the freezing night ten miles from home after carer ‘forgot’ about him – Read more here.

9 November 2012: – Devon -Council breached equality duty in setting care home fees.  Authority to review care home fees after High Court found it failed to consider impact of possible home closures on vulnerable residents.  Read more here.

19 November 2012: Hayling Island – three women arrested as police investigate claims of neglect at a care home – Read more here.

19 November 2012: Olney, Northamptonshire – two women charged in connection with neglect at a residential home – Read more here.

19 November 2012: Luton – woman denies neglect after an elderly woman with dementia was left on a bus in Luton overnight – Read more here.

19 November 2012: St Saviour, Jersey – A care home nurse threatened to teach a  colleague a lesson by beating her up ‘in the African way’ during an aggressive  outburst, a tribunal heard. Read more here.

20 November 2012: Buckinghamshire – two care home workers charged with neglecting patients at care home for dementia sufferers – each charged with 19 counts  of wilfully neglecting a person without capacity between August 18 and 19, 2011 – Read more here.

23 November 2012: Archway, London – Whittington Hospital – two senior nurses ignored plight of epileptic 17 year old who suffered 5 epileptic fits in the space of 24 hours and died four days later – Read more here.

26 November 2012: Swindon, Wiltshire – Selena House Care Home, Stratton St Margaret to close in December “over safety fears” – The CQC report said the home had failed to meet 11 government standards,  including care and welfare, dignity, cleanliness and infection control. Read more here.

27 November 2012: Goole, Yorkshire – Three Women Arrested after elderly woman is injured ‘while unattended’, allegedly, in care home . Read more here.

27 November 2012: Chingford, Essex – Chingford rehab unit so understaffed patients were left to wet the bed, watchdog finds.  Vulnerable patients’ dignity was compromised by poorly trained staff at a rehab unit where dementia was mistaken for a learning difficulty, according to a damning watchdog report. Read more here.

27 November 2012: Cambridgeshire – Abacus Care Cambridgeshire  has been issued with a formal warning by a health watchdog after failing to meet standards for a second time. Read more here.

27 November 2012: Great Wyrley, Staffs –  care home worker stole cash and personal belongings from residents and staff to help fund her drug habit.  Read more here.

28 November 2012: What can be done to ensure care home residents get quality healthcare? Reports suggest the availability of doctors in care homes has fallen short of what residents are entitled to. So what can be done to ensure these patients get the care they deserve?  Read more here.

30 November 2012: Maltby, Sth Yorks – Melton Court care home residents face pre-Christmas move after it emerged the home’s owner is in prison serving a sentence for causing grievous bodily harm.  Read more here.

And finally, as December 2012 arrives we find:

1 December 2012: Care home regulation not fit for purpose, says care minister Norman LambRead more here.

Better late than never, I guess, but what took you so long to work that one out?

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Joined up care?

It’s nigh on impossible to keep up with the volume of reports produced about care, so blogs by others are a valuable source of information, because they’ve often done the homework – especially if they’re salaried professionals working in the care industry in some form or other.   I read blogs and articles in the press by doctors, social workers, mental health professionals, carers, friends and families.  Alongside a few by politicians – seldom  rewarding.

Community Care is on my little list, and that’s how I came by this article by Mithran Samuel about a ‘Surveillance’ system to identify failing care providers.  ‘Efforts to identify and tackle failing care providers are being stepped up through the creation of “surveillance” groups in which commissioners and monitoring bodies will share intelligence on organisations.’ 

My first thoughts, on reading the headline, turned to some kind of CCTV system being in place, in each and every care providing facility, be it hospital or care home.  At each and every meeting between ‘human beings’ and those ‘professionals’ who are charged already with providing good quality care.  At each and every meeting when the provision of care has seen to have failed.  Not a bad first thought, but CCTV would only be valuable if those on the receiving end of sub-standard care were allowed access to it too.

My next reaction was one of amazement that commissioners and monitoring bodies aren’t already ‘sharing intelligence’ on what could be failing care providers.  You mean they’re not sharing intelligence?   Shows how naive you can be when you don’t work in the care industry.

So I had to read Quality in the new health system – Maintaining and improving quality from April 2013 by the National Quality Board.  (A draft report at present)  The report focuses on the health system, but with a view that the model described will also be central to the provision of social care, whenever/if ever our caring coalition government gets round to doing a full-time job and speeding along the reforms and changes to the social care system.  So my comments are, in the main, about the way a similar model might impact on care in general.  I don’t really mind whether it’s called ‘health care’ or ‘social care’ – I just mind about ‘care’.

  • We are clear in this report that quality is everyone’s responsibility.
  • Successful implementation will depend on the ethos, values and actions of people working across the system and at every level.

Good starting point.  I read  about ‘outcomes’  and ‘The domains of the NHS Outcomes Framework’:

  1. Preventing people from dying prematurely
  2. Enhancing quality of life for people with long-term conditions
  3. Helping people to recover from episodes of ill health or following injury
  4. Ensuring people have a positive experience of care
  5. Treating and caring for people in a safe environment and protecting them from avoidable harm

Can’t argue with that at all.  That’s what care should be all about, but I would have thought that was fairly obvious from the start.

I take issue with the report where it says  ‘Like many other bodies, CQC drives improvement in the quality of health and social care services’.  The driving seat of improvement has been empty for far too long, and the CQC, local authorities, social services, care providers, care managers and care workers have reneged on that responsibility.  The focus has all been on money.  Nobody has bothered to focus on the quality of care, or if they have, they haven’t voiced their concerns with sufficient vigour.

In theory – and on paper – these bodies and individuals, including social workers, nurses and other care professionals have been charged with all the 5 points listed above, according to their professional codes of conduct handed down by their individual regulators.   If each and every one of them had opened their eyes, their ears and their mouths many of the tragedies of care would not have happened.  But they all failed.

  • Across the system, we must be united in our responsibilities for preventing serious failure and for taking action to put it right where it does occur.

But, hang on a minute,  Joe and Josephine  Public always thought you were united in such responsibilities.  There are so many of us mere humans out here who, through no fault of our own, have had to bang our heads against the slammed doors of ‘this body’ and ‘that body’ with each in turn telling us to ‘go elsewhere’ but without providing any support or guidance, or even care and consideration.  What fools we were.  Nobody listened to us – so will a Report from the NQB open their ears, eyes and hearts?

  • The quality of care provided by an organisation is dependent on the people it employs.
    How on earth can care providers justify paying little more than the minimum wage to staff who are too afraid to speak out?
  • Where health and care professionals do have concerns about the quality of care in their employer organisation, or any provider organisation with which they have contact, they should raise these with the leaders in their team, or the clinical leaders in their organisation. If they feel they cannot raise concerns with a particular individual, or where they have raised concerns which have not been acted upon, individuals should follow their organisation’s published whistleblowing procedures.
    Will the arrival of a new quango-equivalent make that a reality?  It should be happening already – so will anything change?
  • The provider leadership should recognise that quality is equally as important as stewardship of public resources.
    Quality is more important than anything and certainly more important than financial considerations.
  • The provider leadership should be able to raise concerns it may have with its commissioners, and the commissioners should work with the provider to address any quality problems as far as possible.
    True – it should be happening already, but it isn’t.  It must happen.
  • Local Authorities are responsible for commissioning social care services, managing the contracts they hold with providers of care services.
    Are they not aware of the implications of that responsibility?
  • Responsibility for the quality of care being provided should be recognised by the governance within the local authority. The local authority commissioners should use their interactions with providers to seek to drive continuous improvement as well as to identify any actual or potential quality problems or failings.
    Why have they not been doing so?
  • Local Authorities also have a particular role to play in safeguarding adults in vulnerable circumstances who are abused or at risk of abuse. Information about abuse or potential abuse should be shared with local authority safeguarding teams and, depending on the circumstances, may also require involvement of the police.
    It does not need a new ‘architecture’ for that to happen.  It should have been happening for years now.  They all failed.
  • Local Authorities will be part of the new local Quality Surveillance Groups … where they should share information and intelligence. If they have concerns about whether providers are meeting the ‘essential standards of quality and safety’ they should raise these with the CQC and with any other parts of the system with an interest through that Group.
    Why not use the word ‘must’ rather than ‘should’?
  • CQC ensures that only providers who have made a legal declaration that they meet the essential standards of quality and safety and satisfy the registration process are allowed to enter the market and provide care.
    But legal action is rarely taken against those who failed to obey that legal declaration.  That must change.
  • All regulated healthcare professionals must meet the standards set by their professional regulator and are required to ensure that they stay up to date in terms of their clinical skills by participating in continuing professional development.
    Where are the checks?  Where is the system for that which should have been happening?
  • Across the health and care system, we know that there are excellent examples of where local health and care economies have built strong working relationships between their organisations, where there is an active dialogue about quality and where concerns or risks are raised promptly and dealt with collectively in a coordinated way. But this is not the picture everywhere.
  • Different parts of the health and care economy should come together to share information and intelligence about quality as part of new Quality Surveillance Groups (QSGs).
    ‘Must’ not ‘should’.
  • These QSGs will provide a forum for local health and care economies to realise the cultures and values of open and honest cooperation.
  • The creation of QSGs should not add a level of bureaucracy to the system.
  • Any statutory organisation – local, regional or national – who has concerns about the quality of care of a provider should alert other QSG members to their concerns by triggering a Risk Summit.
  • The NHSCB (NHS Commissioning Board)  will lead the establishment of QSGs so that by 1 April 2013, there  is a comprehensive network in place across the country.   (With monthly meetings.)
  • Where the concerns in question involve a potential adult safeguarding issue, the chair of the discussion must ensure that the relevant local authority safeguarding adults protocol is followed. This will help ensure that adult safeguarding processes are not compromised.
    At last a ‘must’!  That should have been happening – will anything really change?
  • However, they (i.e. the mechanisms described to encourage different parts of the system to work together) do not provide a silver bullet. Maintaining quality requires commitment, endorsement and leadership from every part of the system, from national to local levels. It must be seen as the business as usual of organisations individually and collectively.
    Another ‘must’ – more please!
  • The model we describe will not take away the risk of there being another serious failure in the NHS.

 Then, after 53 pages, comes:

  • The patient comes first – not the needs of any organisation.
  • Quality is everybody’s business.
  • If we have concerns we speak out and raise questions without hesitation.
  • We listen in a systematic way to what our patients and our staff tell us about the quality of care.
  • If concerns are raised, we listen and ‘go and look’.

 There’s talk of ‘rewards’ for those providing the standard of care we all expect, with a statement I don’t quite see the need for: ‘payments and incentives must be structured to encourage quality improvement’.  How about serious penalties for those who fail to provide the required standard, rather than financial rewards for those who are doing what they’re already being paid to provide?

There’s much talk of being ‘open and honest’, and I agree wholeheartedly with that as a major innovation that needs to be introduced to  the culture of care.   It is immoral for anything other than open and honest communication from a care professional.

It is the arrogance of the so-called professionals that has taken more than my breath away over the last 7 years,  since I first had to involve myself on behalf of a vulnerable person in need of care.  The arrogance of every single part of the system that I had to deal with.   The arrogance that made them all untouchable.   It protected them all along the way, as they delivered shabby shoddy sub-standard care, knowingly and complicitly.

The social workers, the multidisciplinary team, the heads of mental healthcare of older people team, the NHS assessment unit, the commissioning department, the local authority, the CSCI/CQC, the Adult Protection Unit and so on.  Arrogant, challenged in the optical department, challenged in the hearing department, challenged in the protection department.   They were all challenged as caring human beings.

And finally,

This report is meant as a guide to support the system in exercising judgement and applying common sense to what will be complex situations, where the impact of the decisions made will be profound for individuals, families and communities.

That’s the bit I like most – the application of common sense would prevent many situations becoming complex.  It’s not rocket science.  A modicum of common sense would suffice in many cases.

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Do we care more about dogs than we care about our senior citizens?

A man has been charged with causing suffering to a Metropolitan Police dog after a door was slammed on its head.

The short story is here for all to read.

Apparently, Lukasz Sklepkowski, 28, of no fixed address, has been charged with causing unnecessary suffering under the Animal Welfare Act.

You know what’s coming next …

We’ve had a week of CQC reports on hospital neglect of our mature citizens, followed hotly by another CQC report on the starvation of same mature citizens in our so-called care homes.

Can someone explain to me why one dog should be more precious than thousands of vulnerable people in need of care?

At least the dog had several police officers to protect it during its activities.

There is allegedly the Animal Welfare Act.

Where is the Human Welfare Act?  I’ve searched but haven’t found it so far.

 

 

 

 

 

 

 

 

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NMC to review ‘serious cases’ before the employer does so

There’s an old saying, with many variations on the same theme:  ‘everything comes to him who waits’, and my favourite variation is  ‘all things come to him who waits – provided he knows what he’s waiting for’.  I’m not absolutely sure that this next revelation is something I knew I was waiting for – but after years of waiting for the NMC to get its act together, there’s a small chink of light appearing.

The NMC (Nursing and Midwifery Council) is to review serious cases before internal investigations are conducted by the employer of the nurse(s) in question.  According to Nursing Times

Nurses and midwives involved in “very serious cases” that pose a risk to patients should be referred to the Nursing and Midwifery Council prior to an internal investigation, the regulator has stated.

In updated guidance on referrals, the NMC has called on employers to make referrals as quickly as possible in order for it to consider issuing an interim suspension until the case has been fully investigated.

The regulator said it had “clarified its advice as a result of cases in which employers have misunderstood their responsibility to refer quickly if patient safety is at risk”.

It states: “The revised advice specifically encourages employers to refer a nurse or midwife at an early stage in very serious cases, even before they conduct their own internal investigation.”

NMC director of fitness to practise Jackie Smith said: “We would like to remind employers that if they believe the public’s health and wellbeing is at immediate and serious risk, they should contact us straight away.

“This will give us the opportunity to issue an interim suspension or restrict the person’s practice while the case is investigated,” she added.

The revised advice and information also notes that in less serious instances cases may be referred back from the NMC to the employer to be dealt with locally.

The guidance also includes more detailed information about the existing responsibilities of employers to check references, identity and competence.”

This news is of such importance, that I’ve just given you the full content of the Nursing Times article, and I trust that will be acceptable.   It’s not so easy to find the updated guidance on the NMC website, but this is the nearest I’ve found – Urgent referrals and interim orders.

As an employer you have the power to suspend or dismiss a member of staff, but this will not prevent them from working elsewhere. Even suspensions by a local supervising authority midwifery officer (LSAMO), which would prevent a midwife from practising in that region, will not prevent a midwife from practising in other regions, or practising as a nurse if registered accordingly.

We are the only organisation with the powers to prevent nurses and midwives from practising if they present a risk to patient safety. In very serious cases it will therefore be appropriate to refer a nurse or midwife to us at an early stage, even before you conduct your own internal investigation. This allows for the possibility of issuing an interim suspension or restricting the practice of the nurse or midwife concerned until the case has been thoroughly investigated.

I am shocked to discover that this has only just been ‘clarified’ by the NMC, but it goes a long way to explain to me why I’ve had such a fight on my hands for the last 4 years now. 

Perhaps I was naive and took it for granted that the onus was already there on the employer, in my case one of the big care home providers, and that the NMC would be contacted by any employer who has serious concerns about the standards of care being provided by a registered nurse or midwife.  I didn’t know then how easy it was for the employer to allow several registered nurses to resign from their employment. 

Perhaps I was equally naive to expect that the Local Authority would have a duty to follow through with all the sensible procedures, in order to protect other people who could be at risk if those same registered nurses who were allowed to resign were then ’employed’ elsewhere.  But when a care provider has several 25-year contracts with the same local authority, you begin to learn how to whistle in the wind! 

Perhaps I was even more naive to expect that the local authority’s Safeguarding/Protection of Vulnerable Adults unit would be equally responsible for ….. safeguarding others.

The NMC is a Regulator.  The GMC is a Regulator.  The CQC is a Regulator.

What is being a regulator all about if it fails to regulate in the way that most of us, mere mortals that we be,  would want and expect a regulator to regulate?

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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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Who guards the guardians? Oh yes! Good question.

So, Lord Justice Leveson has one simple question at the heart of the public inquiry he is to oversee.

Who guards the guardians?

If only that same question could be asked about those who are charged with guarding our mature relatives in need of care at the most vulnerable stage of their lives.

It would require Lord Justice Leveson to ensure that his inquiry would encompass not only the toothless Care Quality Commission, but also the care providers, the local authority commissioning departments,  local authority facilitators (for want of a better word), the whole network of careless care that so often destroys the lives of those who deserve better care.

The ethics and culture of the care system need a thorough examination also.

“The terms of reference raise complex and wide-ranging legal and ethical issues  of enormous public concern,” said Justice Leveson in a statement released this afternoon.”

The same should be said about the way in which we have allowed a care system to develop that raises equally complex and wide-ranging legal and ethical issues of enormous public concern.

I’m not talking about phone-hacking.  I’m talking about the preservation of life.

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