Thoughts on diabetics’ access to blood glucose strips being restricted

A timely reminder appeared on the BBC website today in the form of this piece bearing the title Diabetics’ access to blood glucose test strips ‘restricted’, which led me to the Diabetes UK report Access to test strips – A postcode lottery? (Aug 2013) .  The Daily Record from your short time in Care UK’s Lennox House care home featured heavily at the NMC hearings that started in February 2012 and concluded in April 2013.

One entry in the Daily Records was a strange entry, written almost as a post-script afterthought once you’d been admitted to hospital in a diabetic coma.

That entry (unsigned, by the way) gives the results of a urine test, and alongside is bracketed the following: “There was no available glucose strip since the GP does not prescribe according to Deputy Manager & Home Manager”.

Does that not appear to be a peculiar entry in a record of care?  It almost looks like an attempt to validate the absence of care.  The full urine test results were indeed alarming.  I’m not a medic but it didn’t take me long to work out which parts of the results should have rung bells.  But the care home didn’t find them sufficiently alarming to call an ambulance, because they waited  another 15 hours before doing so, by which time you were in a desperate state, with spasms lasting nearly half an hour noted hours before an ambulance was called.

When I arrived in A&E, soon after your arrival there, I was asked to explain how your diabetes had come to be ‘so out of control’.  I didn’t know that it was out of control, of course, but the hospital for some reason thought that you lived with me and that I was responsible for your care.  Not so.

When I asked the manager to explain to me what that entry in the Daily Record meant, she said that the GP refused to prescribe test strips for the care home, and that Care UK also refused to supply them.  That’s the point at which I offered to pay for a full year’s supply for the care home so that no other person would suffer the way you did.

During the investigation into what happened with your care, the investigators were told that test strips had been bought from a well-known chain of chemists – but no evidence could be found to support that.  Not even a petty cash record.

However, at the hearings at the NMC, there were other and different rationales put forward.  One proposed by the manager was that your diabetes was ‘diet controlled’ and not medication-controlled.  Not so.  When she saw you, allegedly just before she left the building, you were “warm and pink” and you gave no indication of distress, pain or suffering.  What a shame she didn’t have the time to act on your urine test result, that she was surely informed of before leaving the building.

You were not in a position to monitor your own glucose levels.  Vascular dementia made that impossible for you, and in any case your previous GP (not the one providing services to Lennox House) had monitored you regularly, as had your clinic appointment regime.  You never missed an appointment.  It was the responsibility of the care home to monitor your diabetes – that’s what care homes are supposed to do.  Care.

Another memory has been brought forward by today’s reports.  The GMC (General Medical Council) was informed by the GP involved that she had no knowledge that you had diabetes, and that had she known she would have carried out the required test and had you admitted to hospital.  The NMC was told a very different story by the nurses involved, namely that the GP had indeed been informed of your diabetes when she visited you (and prescribed an antibiotic for a suspected UTI).  They can’t all be right, can they?

Again at the NMC hearings, mention was made by the manager and other nurses and their representatives  that there had been no training in diabetes at Lennox House, before your arrival there.  It was even said that there was no specific training in diabetes given for a couple of years after your death.  Not so.  Would nurses never have heard of  Hyperosmolar Hyperglycaemic State (HHS)  (previously called  Hyperglycaemic Hyperosmolar Non-ketotic Coma (HONK) or  Diabetic Ketoacidosis  (DKA) ?

Diabetes UK calls the restricting of access to test strips a lottery.  You definitely did not win the lottery in Care UK’s Lennox House care home where your diabetes was neither monitored nor tested, whether by strip or by other means.

Barbara Young, Diabetes UK Chief Executive,  said “Rationing test strips to save money does not make any sense, because  it is putting people at increased risk of complications that are hugely expensive to treat.”

You’d be a fool to argue with that.

I sincerely hope that Home Secretary Theresa May, recently diagnosed with diabetes, will not find her access restricted.  If she does have that experience, she will no doubt take steps to ensure the restrictions are lifted.

Care in the UK makes progress

Last week saw the final stage of the hearings, at one of numerous NMC locations that have hosted the fitness-to-practise procedures, into the lack of nursing care provided to you during the time you were in Lennox House care home, Holloway/Islington, in 2007, and just before your death.  Appropriately enough, we were directly opposite the Old Bailey for the finale.

Over the main entrance to the Old Bailey, which opened in 1907, figures were placed representing fortitude, the recording angel, and truth, along with the inscription

“DEFEND THE CHILDREN OF THE POOR & PUNISH THE WRONGDOER”

As I sat in the hearing room on the 5th floor of the building,  those words were directly in front of my eyes all week.

On 17th April 2013, Sheila Ali the former care home manager / nurse  was struck off; her name is removed from the register of nurses allowed to provide nursing care to people.   She wasn’t present to hear the decision because, overnight, she decided suddenly to withdraw from the proceedings, and to remove her instructions from the barrister who had represented her.  When he announced this to the hearing, he was invited to leave.  He left.  So neither of them was present to hear the decision.

On 19th April 2013, Dahlia Dela Cerna/Enriquez wept as she received a 2-year caution order, having been found guilty of misconduct and with current impairment.  That’s the first time she’s shown anything that resembled human emotion.  They have all shown callous disregard for you – and for me.

On 21st December 2012, Catherine Igbokwe was struck off,  having been found guilty of misconduct and with current impairment, so her name was removed from the register.

On 21st December 2012, Maria Rholyn Secuya/Baquerfo received a 3-year caution order, having been found guilty of misconduct and with current impairment.

The documents in the above links are very long but very detailed.  Words I’ve heard used to describe the hearings include ‘complex’, ‘extremely involved’, ‘complicated’ and ‘very difficult’.  The decision documents are just that too.  Presumably to deter people from reading them in full, and in detail.

After you died, over 5 years ago in December 2007, there were lots of investigations and reports written, some of which I have never been allowed to see.   No matter how hard I’ve tried, the words written have all been kept behind closed doors, far away from the eyes of those who cared about you.  We, your family, have never been granted access to the full reports of the investigations by Islington local authority.

It was on 1st October 2008 that I first referred these nurses to the NMC.  The hearings at the NMC began on 6th February 2012 and concluded almost 15 months later  on 19th April 2013.  Once I had been called as a witness and had given my evidence, I attended every single day as an Observer.  So I observed and heard every single word spoken in public.

Needless to say, I’ve heard things said that I have never known about.  I never knew before now, for example, that the care home manager Sheila Ali had been in Lennox House all day on 7 December 2007 without bothering to come to see you or to dial 999, even though she had apparently been alerted to the fact that you were in spasm for long periods, unable to speak, unable to swallow, unable to move.   She didn’t care.

She didn’t care much for those residents mentioned in this article in the Daily Mail in August 2008, bearing the gruesome title ‘Care home boss suspended after dead bodies of two pensioners ‘are left for days’.  That was 8 months after you’d died.

It goes without saying that there were many other revelations at the hearings too.  No wonder we have never been allowed the full knowledge of your last days.

It’s been extremely difficult for me to sit through those sessions, but I owed that to you and I had to represent you.  It was the only thing I could do on your behalf and in in your absence.  Your voice was taken from you by  Care UK and its so-called care home, Lennox House.

I’ve found it hard to be told, by the legal representatives of the nurses involved, “You have no need to be here” – “These proceedings are nothing to do with you” – “You are not involved in these proceedings”, and so on.  I had every need to be there; the proceedings had much to do with me and with you; I will always remain involved.  There’s more I have to tell, and tell it I will.  Honestly, openly and transparently.

They took away your voice.  Nobody took away my presence.

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.

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)

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)

Care in the UK – 5 years on – Part 1

Five years to the day after you died, I am now able to tell the world of the circumstances surrounding your sad death.  I’ve had to keep it fairly close to my heart for reasons that will become obvious.

You arrived at Lennox House, a so-called care home provided by so-called care provider Care UK, in Islington/Holloway, London on 28 November 2007, having spent the previous 4 months incarcerated (against my will, and against your will too) in a hellhole of an assessment unit.  Your vascular dementia was too challenging for all but you.  The extra-care sheltered housing recommended as eminently suitable for you was eminently unsuitable for everyone, with or without dementia.  Thanks to the Notting Hill Housing Group, and thanks also to Islington Council’s commissioning department who didn’t seem to know what they’d commissioned.

So, within a year of what they called ‘independent living’ but which was, in reality, ‘independent dying’, we were persuaded to agree to you and all your needs being assessed.  How wrong we were.  But we had no way of knowing, of course, that the social worker was not being HOT – honest, open and transparent.  Your needs weren’t assessed at all.  You were merely drugged up to the eyeballs, to keep you controlled.  Within 3 months – when even a couple of the staff asked us why you were there, when you were so lively, cheerful and chatty, even though you quite rightly wanted to get out of the place – you became a gibbering idiot.  We were given the big refusal when we asked what medications you were being given that could have had such a dramatic impact on you, in just a few weeks.  We persevered and discovered that you were on Buprenorphine, an opioid painkiller.  That was one hell of a kick in the teeth, for you; you’d only ever taken paracetamol before to deal with your back pain.  But your back pain turned out to be osteoporosis.  So I extend my thanks to your GPs who never bothered to look further than their noses, until we insisted on further investigation.  Not that it was severe enough for that kind of painkiller.

Then along came Amitryptiline, alongside the Buprenorphine,  and they worked their evil on you.   There was nothing we could do.  Nobody would listen to us.

We wanted to move you away from that assessment unit.  I told the social worker in August 2007 that if they kept you there for long, you would die. I wasn’t far wrong, was I? But the social worker knew best, even though she’d only known you for months of your 83 years. Aided and abetted by her superiors, kept you there, until such time as the Mental Capacity Act came into full force on 1 October 2007.  We were told that if we didn’t like the decision made – by a show of hands at a ward meeting to which we were not even invited, but people who’d met you only once were able to show their vote – we could do the other: take it to the Court of Protection.  Thanks here to Doug Wilson, Phoebe Masso and a few others who were all involved in this strange kind of decision-making in their best interests, but not in your best interests..   We started to fill in all the appropriate forms for the Court of Protection.

We couldn’t bear to see you suffer.  So we agreed to your move to Lennox House so-called care home, so called state-of-the-art ‘flagship’ care home, the way forward for dementia care.  You arrived there, in the nursing section, on 28 November 2007, awaiting a bed in the residential section.  Your needs were then not for nursing care.  Still upstanding, still able to ask us questions, still able to say that you wanted to go home.  But it was clear to us that we would never be able to achieve that for you.  We spent the first few days with you, hoping that you’d settle and be able to regain your strength, and the fighting spirit you’d shown all your life.  83 years and a bit of a great life.

We phoned daily and were told you were settling in well; walking the corridors – that was your normal, as someone who could never sit still for long.  Always doing something, always on the move, always active.

Ten days later, at 0915 on Saturday 8 December 2007, we received a phone call telling us that you’d been admitted to the Whittington Hospital’s A&E department, as you were in spasm, had a possible seizure, and that you were needing oxygen “and we can’t give her oxygen here”.  That’s what Lennox House told us.  Before we left home to head for London, I took another phone call.  This time from the Whittington doctor, telling me that we would have to make serious decisions about the degree of intervention they should take.  The A&E Consultant told me that you were unlikely to live beyond that day.

He didn’t know you, though.  You managed to cling to life for another 3 weeks, before giving up your fight.  Before you lost your fight, I began asking questions as to what on earth could have happened in the 7 days since I saw you last.

I first asked the Alzheimer’s Society for help when I first realised that something had gone seriously wrong.  They refused me any assistance at all, saying that they didn’t get involved in this “kind of thing”.  I explained that I wasn’t asking them to get involved, just to point me in the direction of help and support.  That’s what I understood the Alzheimer’s Society to be all about.  But I didn’t know then as much as I know now about the Alzheimer’s Society’s  close connections to local authorities, and to care providers.  Nor had I then been told by a couple of the Alzheimer’s Society’s representatives that they thought I was what they called a troll, who had never had any connections with dementia, with social services, with care homes, and so on.  They have continued with that kind of unkind care too.  So I extend my thanks to the Alzheimer’s Society for showing me that they don’t really care.

I decided to go it alone from then on, expecting no support from anyone, but accepting any support that came my way.  For the support that came, I will be forever grateful.  As for the support refused or contorted by lies, I will be forever perplexed.

It’s taken me 5 years to get answers to some but by no means all of my questions.  Many will never be answered because people in positions of power seem not to understand those little HOT words: honest, open and transparent.  I’ve never heard so many untruths told.  And still being told too, after all this time.  So it’s not over yet.

Two separate investigations have taken place into the circumstances surrounding your neglect in care, with 2 very different reports emerging from them.

Last week, the NMC made some decisions, about the staff employed by Care UK and working then at Lennox House.

Catherine Igbokwe was struck off by the NMC.   She will never do to others what she did to you.

Maria Rholyn Secuya (nee Baquerfo) was given a 3 year caution order by the NMC.  She will have to be on her best behaviour.

Sheila Ali, the care home manager/nurse, is challenging the decision made thus far by the NMC, so her barrister has decided to seek approval for a Judicial Review. In the interim, she has a 9 month suspension order – but that may change.

The case of Dahlia Dela  Cerna (nee Enriquez) has been adjourned until next year.

This is all available on the NMC website of Hearings/Outcomes for 17 to 21 December 2012.  Available here in the public domain.

As are these two articles that appeared in the press:

8 August 2008 – Daily Mail article here.  “Care home boss suspended after dead bodies of two pensioners ‘are left for days’.”

Yesterday, 28 December 2012 – Islington Gazette article by Meyrem Hussein here.  “Pensioner ‘is left in agony for days’ at Holloway care home”.

So, that’s where I’ve got to, five years to the day after your departure from this world.

You deserved better care.

(To be continued)

To care or not to care?

Imagine the 83-year old person in the following story was your own relative.

The article is here : Islington Gazette – dated 10 February 2012 – a few extracts below:

‘The Nursing and Midwifery Council’s (NMC) Conduct and Competence Panel is investigating five nurses’ care and treatment of an 83-year-old woman who died after spending around 10 days 
at Lennox House Nursing Home in Durham Road, Islington.

The panel heard this week that the elderly woman was taken to Accident and Emergency at Whittington Hospital in a diabetic coma on December 8, 2007. She died on December 27.

It is alleged that several serious signs of deterioration in the two days leading up to her hospital admission weren’t acted on.

These included agitation and a tendency to lay on the floor – symptoms which retired nurse Sue Bradell-Smith, who carried out the investigation of Lennox House in 2008, said were abnormal and would have made her “very worried”.

Other allegations include a failure to monitor the patient’s condition and diabetes, failing to create a pain management plan and feeding the patient fluids orally although her swallowing difficulties were known.

According to the home’s records, by the evening of December 8 she was suffering with continuous muscle spasms and had dysphasia, an inability to speak – yet it is claimed that the emergency services weren’t called straight away.

NMC’s solicitor John Lucarotti said the treatment provided fell far below what is expected of a nurse.’

How would you feel if you are now being required to understand alleged facts that are totally new to you – almost four-and-a-half years after the death of your relative?

You are now being given to understand that the care home manager was in the building all day long, right through from 8.30 am to 8 pm in the evening – but couldn’t be bothered to get off her backside to attend to one 83- year old in desperate need of care and attention.

You are now being given to understand that a nurse came to see the manager and told her that the 83-year old was not well.  Still the manager did nothing.

You are now being given to understand that nobody involved considers that the care they provided was poor.

You are now being given to understand that the manager didn’t react or even care much when the nurse told her the 83-year old was in spasm, unable to speak, unable to swallow.

Can you imagine how you would be feeling now?

 

Fine words butter no parsnips in residential care

Andrew Lansley has come up with the revolutionary concept that there will be a code of conduct and minimum training standards for all care workers operating in the field of adult social care.  Or is it perhaps a slow evolution of care?

He said, allegedly: “Good local supervision offers support every day. Distant national regulation can often only react after the event.  Employers must always take responsibility and be accountable for the staff they employ. But, we recognise that more can be done to support employers in this and a code of conduct and clear minimum training standards will provide important clarity in this area.  These measures will help employers to better consider the skills profile of potential employees and ensure that patients and service users get the care and support they need.”

Somewhat late in the day, for some of us, so forgive me for shouting ABOUT TIME TOO!!

But, it’s the response from Care UK and its  Managing Director of Residential Care, Toby Siddall, that has caused me great discomfort :

 “Directors at Care UK see codes of conduct as only part of the solution.   Matters of technical competence and behaviour are already an important part of the employment contract for Care UK employees. Whether or not a member of a care home team treats people with dignity is about the leadership, training and recruitment of people with the right personal values – not about a line in a contract.”

Well, well, well!!!  Perhaps, Mr Siddall, you would care to explain just how long it is that ‘matters of technical competence and behaviour’ have been an important part of the employment contract for Care UK employees.  Since when?  Tell me the date! 

They certainly weren’t in place in Care UK and at Lennox House care home at the end of 2007 and in 2008, when Lennox House was ‘investigated’ twice within 8 months   and not allowed to accept new residents for a year while a whole host of measures enabled Care UK to  drag itself from the gutter to an acceptable standard of care provision. 

As for treating people with dignity – that was absent too when those residents were left dead in their beds for days, as the Islington Tribune reported. 

Of course, the Reports of three (or more?) investigations are all held behind closed doors – far away from daylight, so as to protect the best interests of Care UK.  The best interests of the Leadership of Care UK including Mike Parish, Chief Executive, and the then MD of Residential Care Tony Hosking, and the Managers and Deputy Managers of the whole not-fit-for-purpose care providers, of those in Islington who commissioned and allowed Lennox House to function when it was not fit for purpose, the then CSCI (now CQC) to name but a few.  Their best interests are forever preserved by the hiding of those reports.   

 If leadership can be held responsible, as Care UK now seems to understand, how come heads never roll when people die as a result of sloppy leadership and sub-standard care? 

Unless and until it is a requirement for all those Reports, and others too of similar investigations, to be published and available in the public domain so that everyone can see what went on behind closed doors – nothing will ever change.

Or could it be that too many Directorships spoil the concentration?  9  for Toby Siddall alone.  And for Michael Robert Parish …….

 

Care home secrecy slammed

It is with some considerable personal pleasure that I have just read  in the East Anglian Daily Times that POLITICIANS have hit out over secrecy surrounding an Essex care home which was shut down amid abuse allegations.

If any politicians would like to ‘hit out’ over the secrecy surrounding Lennox House care home in Islington, they only have to ask me, and I will provide as much detail as has so far been available in the public domain – and I can provide far far more than has ever been made available in the public domain, if that’s what would help you, Politicians, to achieve honest, decent, caring systems of care for our honest, decent, caring vulnerable elderly citizens.  The rest is still shrouded in secrecy.

They have slammed a decision to bar the public from a meeting next week where lessons learned from the saga at Greenways Care Home, Colchester, will be discussed.

Well, in Islington family were barred from meetings too – let alone the public.

Why does this all interest me enormously?  Because my own relative was the person who suffered neglect, which is a form of abuse, in that Islington care home, Lennox House.  Nobody from our family was allowed to attend any one of the ‘meetings’ held.  We have never been allowed to see the full report either.

But the care home management, the care home provider, the healthcare professionals, the social care professionals were all invited to attend those meetings.  The care home management, the care home provider, the healthcare professionals and the social care professionals were all provided with a copy of the full report of the investigation carried out into the neglect of my relative.  So that they could all comment on  it and have any ‘amendments/alterations’ made before it was finalised.  That is one aspect of the whole mess that I will never understand.

The family of the person who was the vicitim of abuse in care, neglect in care,  was not allowed that same privilege.  No ability to attend meetings; no ability to contribute significantly to the final report; no ability to inisist on changes to that final report – other than simple factual inaccuracies, that is.

Our family member was no longer in a position to ask to attend meetings, to see the report before it was finalised – she died within 3 weeks of suffering that abuse/neglect in care.

The Safeguarding Adults team ‘chose not to inform the police’; they chose not to inform the Coroner either; they chose not to inform family that they had the right to ask the Coroner to conduct an inquest.

And yet, the whole situation was considered sufficiently serious for the then CSCI  to impose ‘enforcement action’ and to refuse new admissions for a year to Lennox House.  The CSCI inspection reports are all still available on the CQC website.

The perpetrators  are the ones to have been protected.  The care home provider that couldn’t provide care has been protected.

What was that policy called?  I remember –

NO SECRETS

No secrets: guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse

Our relative wasn’t protected.  She was dead before anybody thought about massive ‘action plans’ and ‘enforcement action’, all of which the Care Provider willingly complied with of course, and all of which will have been of benefit to the other residents and future residents.  Too late for our relative.

My thanks to Vern Pitt at  Community Care for bringing to my attention the fact that politicians seem to have opened their eyes.  Long may they stay open.

Open up please also the hearings/meetings/serious  case reviews/adult protection procedures to public scrutiny.  Otherwise we will never believe that you really care.  And then we too can see whether lessons have been learned.

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

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

Both of them had denied all 16 charges.

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

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

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

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

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

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

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

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

The Basingstoke Gazette yesterday has several items of interest.

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

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

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

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

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

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

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

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

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

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

Why have I been following the story of Briars?

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

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

The  CSCI/CQC inspection reports for Lennox House:

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

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

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

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

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

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

The gaping holes of care in the UK.

And that will be the subject of the next instalment.

No secrets.

These are not isolated incidents.

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