Care in the UK – 5 years on – Part 5

The day of your funeral arrived.   It took place late on a cold and dark January afternoon.  It was always destined to be a quiet occasion because you had outlived most of your relatives and friends, so it was to be just a small family affair.  The Service was elegant and personal, with a sprinkling of your good humour and more than a dash of our family history.

Your unexpected and sudden admission to hospital and death there had caused us enormous pain.  We knew by now that there would be a full investigation into the circumstances surrounding your admission to hospital within 10 days of arriving in the care home.  We had hoped to have the time and space for our last farewells to you at the funeral.  We were not even allowed that.  Care UK chose to intrude again in death as it had done in your life.

The Service ended and we followed the Minister out of the Chapel, only to see two people sat right at the back.  The care home manager and another person had chosen to invite themselves to your funeral.  Representing the care home Lennox House and the care provider Care UK  that had failed to care for you.

One of your family had already told the manager that she would not receive a warm welcome at the funeral, so it was disturbing to see that she chose to ignore that advice and that request not to attend.  The Minister spent quite some time talking with us all before he departed, as we stood outside, almost in the darkness, looking at the floral tributes.  Strange though it seemed at the time and strange though it still seems to us, the care home manager went to her car to get her mobile phone and took photographs of some of the flowers that had been designed to reflect part of  your origins.  You’ll know the images I’m talking about here.

Little did we realise though that her motivation for attending your funeral went far beyond the usual reasons for attending a funeral, albeit uninvited and unwelcome.

You remember that ‘Complaints Form’ that I mentioned here before?  The one that allegedly came into being on 31.12.2007 when we chanced to bump into the manager at Lennox House.  Well, after the funeral service  the manager must have driven at speed back to the office, where she signed off the Complaints Form at 18:00 hours, with the words “Resolved” and making references to things that were allegedly said at the funeral.  The form indicates that no further investigation would be required by Care UK as the complaint had been ‘resolved’.  Wrong, wrong and wrong again.

The same Complaints Form made reference to things that she could not possibly have known then, because even we didn’t know then some of the things mentioned on this form and we were the first to know them, later.  Nobody else knew these facts then when the Complaints Form is supposed to have been created and completed.  Contemporaneous?  I doubt it.

But we didn’t know about all of this until July 2008.

Almost her parting words as she left the cemetery, the manager said again “We’ve taken steps to ensure that this kind of thing never happens to anybody else”.  The same words she’d used twice before and said to me on 31.12.2007.    They resemble those oft-used but empty words “lessons have been learned”.  Except that the lessons are never learned well enough to ensure that this never happens again.

I wanted to say to her that – while I could appreciate the benefits others would undoubtedly derive from those steps – they  are steps that should have been taken long before you arrived in that care home.  They’re the most basic elements of care, fundamental to a place that calls itself a ‘care home’.   The elementary fundamentals of care.  Without them being firmly in place, nobody has the right to use the words ‘care home’.

The Investigation would take its course, I said, so we should wait for that before making any comments on it all.  It was a funeral, after all, so everyone was polite, as you would expect of us.  We didn’t know then that there would be two Investigations, both of which revealed much of the same, but with one revealing far more than the other,  including many of the most basic lessons that needed still to be learned.

You only had one chance in that care home.

You deserved better care.

(To be continued)

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)

 

 

Care in the UK – 5 years on – Part 2

This day, 5 years ago, was obviously a day of quiet reflection for us, as will be today.  It’ll give me a chance to update this blog over events while you were in intensive care.

All we could do when you arrived in hospital, on Saturday 8 December 2007, was sit with you in ITU, where you were transferred once you had been stabilised in A&E, and once we had discussed with the Consultants.  Questions were beginning to formulate in our minds, caused by the very questions we were asked by the Consultants, but it was a weekend so there was no chance of contacting the social worker or the care home manager.  We left messages on the social worker’s answering system.

The first question we were asked was to explain how your diabetes had come to be so out of control.  Our answer: we never knew it was out of control.  It was as if we were being held responsible.  Only later did we discover that, for some unexplained reason, the paperwork indicated that you lived with us, rather than that you lived in Lennox House in London.  That was our first realisation that the paperwork needed to be looked at with a close eye.  We were asked many more questions, of course, and we were told much about your condition on arrival.  Shocking was your condition.

On the Monday, still in ITU, I had a sudden thought.  The social worker had declared herself “the decision maker” when it came to deciding where you should live.  We were not even invited to the ward round meeting where this important decision about you was made.  She was “the appointed decision maker”, she said.

So, I wondered why she had not responded to my phone message.  After all, surely she should be making decisions now too, shouldn’t she, if she had taken so much power away from us, and from you.   But the social worker was conspicuous by her absence and by her silence.

Then, you were moved into isolation because it was decided you had C-Diff (Clostridium Difficile).   So you spent the next few days in isolation, with us as close as we could get to you.

Still no contact from the social worker.

We had to leave you to go to the funeral of a dear friend, and we were away for a couple of days.  I managed to speak with the social worker and with the care home manager.  I was polite but firm when I asked the care home manager to explain to me exactly what had happened in the days that I hadn’t been with you.  The social worker told me that she had asked for a report from the care home, so I asked to see a copy of it when it emerged.  I never did get to see it.   I also asked the Lennox House care home manager for a copy of every single page of the care home notes, records, paperwork that arrived with you, paperwork that went with you when Lennox House care home sent you by ambulance to A&E.

When I mentioned that you had C-Diff, the care home manager told me that you had had an episode of C-Diff when you were in Highgate Mental Health Unit’s assessment ward, just before discharge from there. That was news to me.  I said I found it surprising the care home had accepted you, and I asked why it hadn’t been mentioned before.  Her words will never leave me.  She said that it often happened that people arrived in the care home with C-Diff, but it wasn’t necessarily mentioned on the paperwork.  She said the same applied to MRSA.

To say that I was stunned would be an understatement.  I was beginning to get used to shock.

I learned that you had been seen by  a GP  – the manager said you’d been seen the Wednesday before admission to hospital.  Not true.  A GP had only been summoned  by the sending of two faxes – yes, faxes – two hours apart on Friday 7 December 2007.  But nobody declared that when the first investigation was carried out.  (More about that another day.)

You were moved out of isolation and ITU to a general ward.  You regained consciousness only briefly, and one day they managed to get you from bed to chair.  Just the once.

You spoke only two words.  “Thank you.”  The last words you ever spoke.

Tomorrow is another day – and it certainly was, 5 years ago.

You deserved better care.

(To be continued)

Why I despise the so-called system of care for vulnerable people

I’ve been fairly controlled over recent weeks, months or even years.  I suppose I’ve been waiting and hoping for a chink of light to emerge, for a culture change to emerge, for a way forward to emerge in the so-called system of care that we have allowed to be in place.

However, I am reaching screaming point.  Hardly surprising.  When someone is destroyed because of absent systems of protection, and when it then takes almost 5 years to work your way through to a full understanding of why the so-callled system of care for vulnerable people fails to provide decent care so very often – that’s when you reach screaming point.

Time and time again, the CQC comes up with yet another report as it did today, with a report into the ‘care’ afforded to people with learning disabilities.  Or rather the lack of  care.  I’ve read it all, but there’s not much hope for real change.

Week and month after week and month, our government comes up with …… not one single plan to improve things.

Year after year, the same old same old same old gets published in the press, reported on radio, featured on TV.

Still nothing changes, so I need to scream now.  It won’t change anything – but it may just help me to scream.

[Next section of this particular blog post: Deleted temporarily pending the return of sense to the world of care.]

Therewith, I will leave this one for today.  But not for long.

…. 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.