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.

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?

A feisty band and Chai Patel and Southern Cross

Two appearances -in-word by Chai Patel over the last few days – and both seem fairly innocuous at first reading. 

A piece from Community Care on Friday 29 July 2011 begins:

Operators taking over Southern Cross homes face a long battle to earn the trust of residents and relatives, ex-Priory Group boss Dr Chai Patel has admitted as he prepares to take over one-third of the homes.

Patel told Community Care the firm he will head up to run the homes faces a “long journey” as “reputations are breached in a second and take years to build up”.

He’s referring to the reputation of Southern Cross there.  Perhaps he should remember his own reputation and the way it was sullied by the experiences of residents of Lynde House care home.

An article in the Express on Sunday 31 July 2011 refers back to the year 2000/1 when residents of Lynde House  care home were neglected and mistreated, when Lynde House was owned by Westminster Healthcare, with ….. Chai Patel as its then Chief Executive.  Patel sold Westminster Healthcare soon after the scandal emerged.  Patel was apparently interviewed on Friday 29 July 2011 and  the former government adviser on elderly care, vowed that he would protect pensioners from the kind of ­maltreatment suffered at Lynde House, in Twickenham, Middlesex.

The Express quotes him as saying “The residents felt they could get recourse only by going public which has tarnished my reputation… I have never tolerated poor care and never would ­tolerate poor care.” 

You can’t get away with that one, Chai Patel – otherwise people may be hoodwinked or even deceived by such protest!

Did Patel never bother to read the Report of the Lynde House investigation, dated May 2002 and published on 2 August 2002 – 9 years ago almost to the day? 

If the Chief Executive shoulders no ultimate responsibility for the standards of care provided – or rather the sub-standard care a.k.a. neglect provided – the Chief Executive should not share excessively in the profits made either. 

Let’s look also at 1 October 2002, when the London Evening Standard printed a neat summary of Patel’s career path.  Including these words from Vince Cable talking about the feisty woman who had the courage to stand up to Chai Patel: 

“Without Gillian Ward and her brave group of relatives, none of this would have come to light,” says MP Vincent Cable. “They have done us a major public service. The climate of denial they faced was ferocious.”  “When I first raised the issue with Chai Patel, he totally poohpoohed it. All he had to do was to care enough to acknowledge their complaints, deal with them and apologise. But he chose to deny it and that led to it becoming a national public campaign.” 

I do hope that the residents and relatives of all current Southern Cross care homes don’t have to face the same kind of ferocious denial. I also hope that in his new role, Chai Patel will accept responsibility for the care provided in his name and under his banner.

Where does the buck stop?  If it doesn’t stop with the Chief Executive of a private care provider, then the buck will be in perpetual motion. 

And here’s Gillian Ward again – also known as Deddie Davies.  Still supporting those in care. 

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.

The long and uncaring road to justice for those neglected in care

The latest edition of Private Eye (No 1288) arrived this morning, and a quick read plus a couple of hours spent researching and reading further have proved most revealing. The home stretch (article heading!) may be somewhat encouraging, but then you discover that the wheels of justice have all but ground to a halt.  (Sorry, no link available to the article because it’s subscription only!)  But I hope the Eye won’t object to a brief quote:

“Nine years after formal complaints were first made about neglect and abuse of elderly residents of Lynde House, run at the time by Chai “Diddums” Patel’s Westminster “Care” Homes, the case against two nurses rumbles on – occasionally.

The adjourned disciplinary hearing is not due to resume until the end of July, with other dates listed in November and clearly no chance of reaching a conclusion until  next year.”

According to the Eye – allegedly!

Why has this case caught my attention?  Because I’m only 4 years along a similar road.

A little digging unearthed the Lynde House Independent Investigation Report from May 2002.  Plus a whole host of related information, through each year almost from 2002 to the present.

Jay Rayner from 2002 – A home unfit for heroes in the Guardian.

2005 report on Dr Chai Patel and the GMC disciplinary hearing Care home head denies misconduct – BBC

2008 Lexology allows everyone to see how long and winding is the road to justice, open to manipulation, in the best interests of ….. well, it doesn’t take long to work that one out, but it’s not in the best interests of care home residents who are at risk, their families or their supporters.

If anyone can tell me what has changed since 2002, I would be enormously grateful.

Why am I denied access to a Report produced by an Independent Consultant – commissioned by the Mental Health Care of Older People team but then snatched by the Local Authority as their own property –  into the neglect and subsequent death of my relative at risk in care?

Why is that report concealed behind the closed doors of the powerful but pathetic Local Authority?  The Lynde House Investigation Report bears such enormous similarities and is available in the public domain.

Why is a local authority able to provide such a barrier to justice, protecting itself and its Care provider in the UK?

Why is a Care provider in the UK able to provide such a barrier to justice?

Do they have more to hide than we know?

Am I likely to be required to spend a further 5 years of my life trying to achieve that thing we call justice?    If anyone reading this has any words of wisdom to offer me, I will be for ever in your debt and you will be for ever on my seasonal greetings list.

Legal nooks of care, whistleblowing, cotton in ears & velvet soles on boots

“Behind the most ancient part of Holborn, London, where certain gabled houses some centuries of age still stand looking on the public way, as if disconsolately looking for the Old Bourne that has long run dry, is a little nook composed of two irregular quadrangles, called Staple Inn. It is one of those nooks, the turning into which out of the clashing street, imparts to the relieved pedestrian the sensation of having put cotton in his ears and velvet soles on his boots.” –  The Mystery of Edwin Drood by Charles Dickens

That was “one of those nooks which are legal nooks”.

I was born and grew up not far away from that ‘legal nook’, long enough ago to have experienced the peace and quiet of the City of London on a Sunday morning (then!).  Little did I realise that I’d be reminded of Dickens’ description when I read the report on whistleblowers from Public Concern at Work – Speaking up for Vulnerable Adults : What the Whistleblowers Say.

There are far too many disturbing quotes from the report – which is very user-friendly so you’ll have to read it yourself – but here’s a few that grabbed me, from the 100 cases looked at:

• Year on year we receive the highest percentage of calls to our helpline from the care sector (15%).
• In care, 55% of all calls were about abuse.
• In 40% of all our care cases, concerns were initially ignored or denied by the organisation.
• Additionally this is a sector with many workers who may be considered vulnerable due to low pay, low awareness of rights and lack of access to or knowledge of support.
• Within the care sector itself, over half of the calls we receive are about abuse. The most common concerns being: physical abuse, lack of dignity, neglect, conduct of staff, verbal abuse and medication administered incorrectly or not at all.
• the vast majority of workers in the care sector (80%) have already raised their concern when they call us and over a third of these concerns are initially ignored, mishandled or denied by organisations
• care workers often do not realise that they are actually “blowing the whistle” until they encounter difficulties when having their concern addressed or are mistreated personally
• whistleblowers struggle with the lack of feedback from organisations regarding how their concern is being handled
• we also receive calls from workers across the adult social care spectrum including: social workers, safeguarding teams, volunteers, students, cleaners, doctors, nurses and other professionals.

And that’s all from the first couple of pages of the report!

The report looks at physical abuse, medication concerns, neglect, financial abuse and so on, and works its way through various case stories, all demonstrating the need for safeguarding vulnerable people in care and also the workforce providing that care.

It has allowed me to understand more of the reasons why I have needed to bang my head against a brick wall in recent years.  It also confirms to me what I sadly had to learn the hard way: that – in my own experience of dementia care – the local authority (all departments from the care commissioning team through to the Safeguarding/Adult Protection unit), the mental health care of older people multi-disciplinary team , the CSCI/CQC regulators and the care providers all colluded to care far more for themselves, to protect their own best interests above all others, than they ever cared for my relative’s best interests, and the best interests of other vulnerable older people in this particular part of the world.

They closed ranks in their own ‘legal nook’ to such an extent that I’m almost in need of care myself, because they have almost managed to transform me into a vulnerable adult, by their own sins of commission and sins of omission.  Almost, but not quite.

Not for the first time, I ask why everything can be hidden behind the word ‘confidentiality’.  We now have the vulnerable being cared for by a vulnerable workforce, according to this report, so it’s hardly surprising that nothing changes for the better.

It’s as if the whole care sector has become anaesthetised, numbed and indifferent to all that is going on under the umbrella of care.  I have been planning to write more about my own experience of dementia care, and this report has sharpened my resolve, so I will go back to the beginning and work my way through it all, chapter by chapter, stage by stage.

“…. the sensation of having put cotton in his ears  and velvet soles on his boots ….”

The cotton may still be in their ears – the velvet soles of my boots will have to be removed.

Whistleblowing in the sphere of Vulnerable Adults

My thanks to Fighting Monsters AMHP for bringing to my attention a Report from Public Concern at Work about whistleblowing in the care sector.

The title of the report – Speaking up for vulnerable adults: What the whistleblowers say – speaks for itself, almost, and is available here for anyone interested.

I’ve read it twice now; it’s only 21-pages long and it’s very well written indeed.  I’m going to read it a third time before I comment any further, but I just wanted to say a quick thank you to Fighting Monsters and to Public Concern at Work for allowing me to see, in part, the reasons why I was beginning to think that the pea had been stolen from my whistle, over the recent years of my own attempts to blow it in the ears of those charged with providing decent standards of care in the UK.

“Public Concern at Work is the leading independent authority on whistleblowing in the UK. We run a free advice line for those who have witnessed crime, danger or wrongdoing at work.”  I wish I’d heard of Public Concern at Work  before now – because I could have pointed a few people in the right direction.

It’s not just my pea that’s been stolen.

If I forget to return to this report, I’ll be surprised – or it may mean that I’ve been abducted.

Save the Cleveland Street Workhouse – we’re going to need it

What a depressing week last week was when considering care in the UK, and this week is heading in the same direction.

A short week ago, I was about to return to my obsession with the number 7 in the world of care, dementia care, political manipulation (aka demoliton) of the welfare state – and I had planned to start blogging my own personal ‘Seven Story’ of the lack of care in the UK as my family has experienced it.  I’ve decided to put that personal account on hold for now, because I have no wish to divert my attention away from the latest evolution of care in the UK.

1.  First, I came across a ‘seven’ :  Seven steps to driving down prescribing costs via Pulse and via the National Audit Office, but not necessarily in that order.  A saving of at least £200million is the estimate.  It’s not rocket science – so I’m somewhat amazed to discover that it needs a National Audit Office report to make seven ‘common sense’ suggestions.

2.  Then, I came across a variety of written answers to questions in Hansard – 10 February 2011 Written Answers detailing  meetings that  Ministers and senior officials in Andrew Lansley’s department  have had, since Lansley’s appointment, with independent sector organisations where Care UK representatives were in attendance.  There are only 5 listed, and there are more to come – but the latest written answers haven’t appeared yet.   But Grahame Morris did get a half-hearted answer from Simon Burns to his question as to how many health contracts had been awarded to Care UK in each month since May 2010 :

“We do not hold information centrally about local national health services and social care contracts. Primary care trusts and local authorities are responsible for their own contracting arrangements and decisions.

We can confirm that, as at the close of the last accounting period on 31 December 2010, the Department has not entered into any new contracts with Care UK since May 2010.”

John Trickett asked about the monetary value of the contract given to Care UK for the treatment of prisoners; and what assessment had been made of the compatibility of the award of that contract with  procedures and guidance on tendering – another non-answer followed from Paul Burstow.  It was the Hansard heading of Care UK: Prisoners that caught my eye.  But more on that one another day, and I’m sure I’ll come up with more than seven!!!  You can do the mathematics for yourself!  I’ve done my sums already.

There are still more written answers to come – eventually – so we will just have to hope that they are answered, rather than fudged.

3.  A serious case review found that residents of Summer Vale Care Centre, a Leicester care home for 26 people with dementia and mental illness had been “badly failed”.

“The report commissioned by Leicester City Council found patients were subjected to physical and sexual abuse from fellow residents. Summer Vale Care Centre in Mowmacre Hill closed in October 2009 after a whistle-blower alerted the authorities.  A police probe uncovered 65 “sexual or concerning” incidents at the home. The force said just seven incidents had been reported to them prior to their 2009 investigation, three of which had sexual connotations.  It is very clear to everyone involved with this review that all agencies badly failed the residents and their families.”

“There were lots of incidents and concerns and even though there were around 60 professionals involved in making sense of this information, all of whom agreed that something should be done, no-one asked searching questions and no-one assumed the lead role“, added Dr Margaret Flynn, the report’s author.

No prosecutions so far due to insufficient evidence, but one still pending involving a senior member of staff.

26 vulnerable people with dementia and mental illness v. 60 professionals who failed them, but not one single prosecution thus far.

And the best that Minster Care can offer is “It is regrettable that the quality of care at Summer Vale Care Centre did not meet the high standards expected by ourselves and the local authority partners, and deserved by our residents.”  Note that the residents come last in that Minster Care statement.

4.  The Report of Ann Abraham, Health Service Ombudsman on ten investigations into NHS care of older people is incredibly hard to read – not because of its language but because of the distressing content.  It  carries the title ‘Care and Compassion?‘ – and if you get to the end of it, you will certainly be wondering where the care and compassion were, and whether the NHS still knows the meaning of either word.  The use of a question mark says it all.  Just ten stories of neglect – ten desperately sad stories – and probably just a brief snapshot of the way our so-called civilised society has decided to neglect a whole section of the population.

5.  Then, when you are trying to work out what the heck is going on, you read that “A Conservative MP and former GP who claims coalition Government whips attempted to gag her and prevent her from speaking out against the NHS reforms has warned health secretary Andrew Lansley he is ‘losing the profession’.

Dr Sarah Wollaston, the MP for Totnes in Devon, said she refused to sit on the committee of MPs considering the health bill after being told she could only take part if she agreed not to table any amendments and always voted with the Government.”

Gradually, it all becomes clearer.  They’ve all lost the plot!  And the only ones who will suffer are the older, vulnerable people in need of care.  There’s no sign that Cameron and Clegg care much about the real world; they just won’t listen to any comment or criticism.  I hope they open their eyes and ears and, more importantly, their hearts soon.  This destruction is not necessary.

6.  Today brings a report in the Daily Mail claiming that ‘Trespassing laws are to be used to evict elderly patients who ‘block’ hospital beds.   Pensioners reluctant to go home – often because they are too frail or confused to cope on their own – will be given 48 hours to leave. If they refuse, NHS trusts will seek a court order for possession of their bed.

The ‘bed-blockers’ could even be forced to pay the legal fees incurred.’

Not being a natural Daily Mail reader, I hesitated before mentioning this report – but I know for a fact that this kind of ugly threat is being carried out.

Frail and confused?  That normally means older people with dementia.  And that is precisely the situation that I have in mind: someone who has been in hospital now, waiting for the NHS and the PCT and the Local Authority to get their act together and carry out the required assessments so that one 87-year old can leave hospital.  The 87-year old can’t carry out those assessments himself, and neither can his family.  The 87-year old can’t care for himself, and neither can his family provide that care.  But that is precisely what the NHS and the PCT and the Local Authority are wanting.  Meanwhile, they are threatening eviction.  Well, bring it on!! Let it happen – and then we’ll name and shame you all.  Meanwhile, his family are complying with every single request that comes their way – but every question they ask is being ignored.  So perhaps we have arrived at a One-Way-Street of Care in the UK.

7.  Meanwhile, the Cleveland Street Workhouse – originally built in 1775 and the likely inspiration for Charles Dickens’ Oliver Twist – is under threat.    ‘Complete redevelopment of the workhouse site has been proposed. If these plans go ahead, this important historical building will be totally demolished.  A very large-scale private residential development, quite out of character with the street and its historical surroundings, will take its place.‘

But if the thugs in the ConDemOlition Coalition get their way and demolish everything in sight, we may well see a return to the Workhouse.  So perhaps The Cleveland Street Workhouse needs to be preserved and renovated for future use.

Well, that was an unplanned Seven and certainly not a Magnificent Seven.

Johann Hari’s plan to solve our care home crisis

Johann Hari, journalist and columnist at The Independent, has come up with a 10-point  manifesto to transform the shabby system of care of the elderly in place at present.

Very recently, he wrote an extremely moving account of the last ten years of his grandmother’s life in care, as she suffered atrocious treatment in various care homes.  His article – My grandmother deserved a better ending than this – was apparently the catalyst for the tsunami of emails he received from relatives of people in care homes and from care workers, all sharing their own experiences.

Today Hari cries out again in The Independent, with a list of proposals that some people may think are unnecessary, judging by some of the fatuous comments on his previous article.  But sadly, some of us know only too well how essential this manifesto is – and how long we have been waiting for it.

I do so hope that he will attract more attention than those of us who have been pleading for years now, begging the ‘authorities’ to take positive action to improve the care system.  But our cries were bootless.

Please listen, world, please listen now.  Trust us, believe us, listen to us, hear what we have to say and improve the system once and for all.

It’s not necessary for me to comment on the ten ‘Acts’ of Johann Hari’s plan.   But I applaud each and every one of them.  If I could add just one further point to your plan, Johann, it would be one single acronym for the care system to acknowledge and to live by:

HOT as in HONEST OPEN TRUTHFUL

Be honest – be open – be truthful. Because so far, our so-called care system has been far from HOT.  It has been frozen into inactivity.  Heartless, uncaring, and deaf.

I’ve tried to do my bit to improve some of the Acts too, as have so many people before and since.  I failed miserably in part, because the might of the local authority is great.  As is the might of the mental health care of older people team, able to engage and pay for massive amounts of legal advice when I challenged the shoddy standards of that particular mental health care of older people team, and their ‘convenient’ interpretation, use and abuse of the Mental Capacity Act.  (I’m still working on ‘others’ involved.)

That legal advice was all paid for from the public purse, of course.  The tax payer and the Council tax payer paid the price of that.  All to preserve the dignity and reputation of the local authority, the care home provider, the CQC/CSCI, and the reputation of all the other weasels involved.

My relative paid the ultimate price.

I would have preferred the ‘authorities’ to have spent that money on care, rather than on legal advice to protect their puffed-up selves – and to protect the puffed-up care provider.

Where were you then, Paul Burstow?  Neither you nor your predecessor was willing to listen then.  You are all there when it comes to talking about money and funding, but you’re strangely absent when it comes to the discussion of care standards and quality of care.

The CQC/CSCI is blind, deaf and toothless.

The policy in place to protect vulnerable adults from abuse carried the name ‘No secrets’ – but secrets is precisely what the authorities operate, preserve and protect.  In their own best interests – but not in the best interests of the vulnerable adults.

We should be ashamed that such a manifesto is necessary – but it is absolutely essential.  We are supposed to be civilised – but we are not.

Reflections on Mimosa Healthcare Ltd and connected matters

The CQC recently introduced a new system of monitoring the quality of care provided in residential care homes, relying more on paper-based self-assessments by the care providers, and also relying heavily on whistleblowers to alert the CQC of the need for its involvement, all with the hope that the CQC will inspect and act promptly to deal with suspected neglect or slipping standards.

26 November 2010 – This is Bristol article: The owners of Sunnymead Manor, Southmead, Bristol a ‘care’ home where vulnerable residents were left to fend for themselves in dirty and unhealthy conditions have been warned they face prosecution unless they take immediate steps to improve the situation.

Mimosa Healthcare, whose slogan is Where People Matter, has been given seven days to draw up an action plan and has agreed not to take on any more patients until a string of problems are dealt with.

Sunnymead, which specialises in looking after people with dementia and “high care needs”, has been in trouble with the authorities in the past but appeared to have cleaned up its act last year.

Mimosa has since apologised to residents and their relatives and has promised to clean up its act.

So that’s more than once that Mimosa Healthcare Ltd has promised to clean up its act.  It hasn’t managed to do so for yet in spite of new management being in situ.

CQC’s Review of Compliance – published today.

May 2006 : CSCI inspected Sunnymead Manor ‘care’ home in May 2006 (the first inspection under the ownership of Mimosa Healthcare Ltd): Cost ~£456 – £508 per week plus additional charges.  All 5 requirements (under the previous owner) were seen to have been complied with.  However, 9 statutory requirements were made, plus 5 recommendations.

The company are clearly striving to improve standards; however the significant shortfalls in two main areas must be addressed as a matter of urgency to ensure that residents get the care they need and new staff are equipped with the skills they need to meet those needs.
A number of requirements have been issued in respect of: –
• Pre-admission assessment processes
• Assessment and Care Planning processes
• Identification and meeting changing care needs
• Meeting care needs in a respectful and dignified manner
• Effective communication between staff and residents
• Induction programme for all new staff
• Staff training records be kept for all staff
• Home Manager must make application to register
• Safe working practices must be followed in respect of moving and handling of residents and in infection control procedures.

They are serious failings in care, already highlighted in 2006.

June 2007 : CSCI inspected Sunnymead Manor in June 2007:  8 statutory requirements were made, plus 4 recommendations.  Cost £471- £600 per week plus additional charges.  “…. the home must always ensure that residents do not come to any harm, and get the help they need” – so the Regulator was aware then that staff were not ensuring that residents did not come to harm, and that residents were not getting the help they needed.

“A stable staff team and improvements in the induction process for new staff and ongoing training, will benefit residents by ensuring they are looked after by staff who are better trained.”  That speaks for itself – the Regulator was aware of staff and training inadequacies resulting in sub-standard care to residents.

April 2008 : CSCI inspected Sunnymead Manor ‘care’ home in April 2008:  3 statutory requirements are made, no recommendations.  CSCI rating 2 star = “good”; Cost £498- £560 per week plus additional charges . “The care plan reviewing process is satisfactory in the nursing unit however needs to be more effective in the dementia care unit.”

November & December 2008 : CSCI inspected Sunnymead Manor ‘care’ home in November 2008 (2-star rating = good) and again in December 2008 (zero star rating = poor) after concerns were raised about the quality of care.

In November 2008 there were still 3 outstanding statutory requirements from the previous inspection; a further 4 immediate requirements following the November inspection; a further 4 statutory requirements following the November inspection; plus 1 recommendation.

In December 2008 (zero star rating = poor) there are now 5 outstanding statutory requirements; a further 18 statutory requirements from the December 2008 inspection; plus 4 recommendations.  “The Registered Person must ensure that the home is conducted so as to promote and make proper provision for the health and welfare of people who live at the home. “ When you read that  December 2008 inspection report in full, it is clear that December 2008 was the point at which CSCI should have heard enormously loud alarm bells ringing.

And yet, a mere 5 months later, all is apparently well and seen to be well by CSCI.

May 2009 : CSCI inspected Sunnymead Manor ‘care’ home on 6 May 2009; all 18 requirements and 4 recommendations were seen to have been met; following this inspection there is one statutory requirement made (concerning residents’ valuables) plus 2 recommendations (concerning the placement of non-flattering photographs of residents, and the use of the term ‘wandering’ in records giving a negative image of individuals).    CSCI rating:  two-star – “good”.  Cost: £498 – £560 per week plus additional charges.

The CQC dates are as confused and as confusing as some of CQC’s inspectors.

Step back to April 2009 and a Nurse from Sunnymead Manor – who was suspended from the care home in August 2006 – is before the NMC:  The work of Nonhlanhla Nkomo at a Bristol care home showed severe shortcomings, a hearing of the Nursing and Midwifery Council in London heard.

The 52-year-old allegedly left an elderly man at the Sunnymead Manor care home with a “hugely swollen” face by not treating a tooth infection.

She also did not know another patient was a diabetic, it was claimed. The hearing continues.

Ms Nkomo, known as Ivy, was suspended from the care home in the Southmead area of Bristol in August 2006.

Ms Nkomo, who began working at the home as a registered nurse in April 2006, is also accused of failing to record whether she had administered medication to a further eight patients.

February 2009

Kingsmead Lodge, Shirehampton, Bristol –  Mimosa Healthcare

A care worker who allegedly witnessed abuse at a Bristol care home has been suspended.

The 18-year-old is one of five care workers who have given statements about incidents at Kingsmead Lodge in Shirehampton at which are being investigated by police, social services and watchdog organisation, the Commission for Social Care Inspection.

None of the care workers allegedly involved in abuse has been suspended.

But the teenager, who looked after dementia patients at the nursing home, has been suspended on full pay after speaking out.

The care worker said she had not been given adult protection or whistle-blowing training.

And the CQC is about to rely on whistleblowers????

December 2009 : Honeymead ‘care’ home and Bishopsmead Lodge ‘care’ home – Mimosa Healthcare Ltd

New evidence of failings by a major care home provider in Bristol has been uncovered by a BBC investigation. The findings come after concerns were raised about Mimosa’s other two Bristol homes, Kingsmead Lodge and Sunnymead Manor, earlier this year.

November 2010 and Mimosa Healthcare Ltd still has the effrontery to boast on its website with the following words: Where People Matter; We know all about caring – and so do the people who live with us; Mimosa is passionate about Dignity in Care; Experience a very special place where people matter.

I beg to differ, Mimosa Healthcare Ltd.  It does not appear to me that you care enough about the standard of care in some of your care homes.

Has the time has come for the Advertising Standards Authority to find a way to regulate the misleading content of marketing messages on companies’ own websites?  The ASA does not currently have any remit over marketing messages on companies’ own websites.  Trading Standards don’t care either, nor does the CQC.

In fact the CQC inspection reports could do with regulating too.  That is where most people looking for decent care for their relative, or even for themselves, turn to first of all – the CQC website.  But it is all fudge.  We are becoming an internet-governed world.  We are being encouraged to rely on internet connections for numerous sources of information.

If the CQC really cared it would have found a way by now to put maximum pressure on care providers to provide care rather than neglect.

If our governments really cared they too would have found a way.

Mimosa Healthcare is not alone – read up on Compassion in Care’s analysis of care.  Read a few of the inspection reports that Compassion in Care has put under the microscope.

My heart goes out to every single resident of every single Mimosa Healthcare ‘care’ home.  How many of you have been neglected when you should have been cared for?  

You all deserve better care.