Care UK regrets they weren’t able to care for you, madam

With apologies and thanks to Cole Porter and Ella Fitzgerald, two of your favourites.

Care UK regrets they weren’t able to care for you, madam.

Care UK regrets they weren’t able to care for you.

They can’t even apologise.

Best they can do is  just general regret, madam.

Care UK regrets they weren’t able to care for you.

“Care UK strives to provide appropriate care for all their residents across the various services that they run.”  Allegedly.

“It is always a matter of regret if a service is not provided as they would wish.”   Allegedly.

Apparently I “clearly consider that there were failings in the care provided” to you.  I most certainly do, and I’m not alone in that opinion.

Care UK’s solicitor has been asked “to pass on their regret in respect of this”.

Care UK has been made aware of the fact that Catherine Igbokwe and Sheila Ali have both been struck off the register by the NMC (Nursing and Midwifery Council) for misconduct and for failing you miserably, and that Maria Rholyn Secuya (nee Baquerfo) has received a 3 year caution order for misconduct and for failing you miserably, and that Dahlia Dela Cerna (nee Enriquez) has received a 2 year caution order for misconduct and for failing you miserably.

Care UK can only  come up with an expression of general regret, via a third party at that.  General regret is overworked these days.

Care UK promised to provide a substantial sum in your memory, acknowledging that it failed miserably to provide care to you, and so that we would be able to establish what Care UK’s then Managing Director of Residential Care called “a positive contribution to the world of dementia”. In your memory.   Care UK has now broken that promise.  How foolish we were to place our trust in Care UK.

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.

Registered nurses working as Healthcare Assistants (HCAs)

The NMC (Nursing and Midwifery Council) website contains valuable information for those with an interest in the established fact that many registered nurses (and/or midwives) are working as HCAs (Healthcare Assistants).  The nursing profession is regulated by the NMC.  Healthcare Assistants are not regulated at all.  Problems  emerge when a Registered Nurse is employed by a care provider as a Healthcare Assistant but works outside of that role and still fails to provide the care required of a registered nurse.

A couple of direct quotes from the NMC are essential.  The full text of the NMC information is available .

First quote (my use of red below, not that of the NMC) :

Accountability

If a nurse or midwife is employed to fulfil the role of an HCA, they should only undertake the roles and duties outlined within their job description. However, by virtue of their registration, they would remain accountable for their practice. This means that they would be bound by the code regardless of their HCA status and their fitness to practise could be called into question if they were found to be in breach of any of the terms. The code states that nurses and midwives are required to “provide a high standard of practice and care at all times”

The code states:

“you are personally accountable for actions and omissions in your practice and must always be able to justify your decisions”

“you must be able to demonstrate that you have acted in someone’s best interests if you have provided care in an emergency”

Therefore, in an emergency situation, there may be occasions, where a nurse or midwife could be required to work outside the scope of the HCA role parameters. As a registered nurse or midwife they would be expected to use their professional knowledge, judgement and skills to determine occasions where it would be appropriate to work outside their HCA role parameters and should be prepared to account for their actions should they make the decision to do so.

Second quote:

Vicarious liability

Vicarious liability means that the employer is accountable for the standard of care delivered and is responsible for employees working within agreed limits of competence appropriate to the abilities of that employee. To remain covered by an employer’s vicarious liability clause, an employee must only work within this area of assessed competence and within the responsibilities of their role and job description.

Nurses or midwives who undertake HCA roles should therefore, inform their employer that they are on the NMC register as a nurse or midwife and that in exercising their professional accountability, they may be required to step outside their contract of employment as an HCA. They should also seek to ensure that their contract recognises the extent of their role and that the job description is clear as to what would be expected of them in this role.

End of quotes.

It’s well-known that HCAs are not regulated.  A system of voluntary registration will not be good enough.

Dr Peter Carter, head of the RCN (Royal College of Nursing), said recently that the NHS is too reliant on  HCAs who are asked to pick up nursing skills as they go along.  Untrained, unregulated, cheap labour.

“Many hospitals employ healthcare assistants as opposed to registered nurses, and many of them don’t give them as much as an hour’s training.

“This happens in some care homes and domiciliary care too.”

“It is wholly unacceptable that the elderly should be cared for by people who are not given the rudimentary training.”

He also said “Cheap care is poor care.  Poor care ends up being more expensive.”

The RCN refers to itself as ‘the voice of nursing across the UK and the largest professional union of nursing staff in the world with more than 400,000 members’.  It also invites Nurses qualified outside of the UK working as health care assistants, ‘who are not and have never been registered with the Nursing and Midwifery Council (NMC)’,  to join the RCN at a concessionary rate for the first year.

The RCN offers advice to registered nurses and midwives who do not meet NMC requirements, providing information for overseas nurses who cannot register to work as a registered nurse or midwife but who are currently living in the UK.

On 11 January 2012 the Guardian featured an article about ‘Healthcare Assistants working out of their depth’ and mentioned several respondents to a survey conducted by Nursing Standard magazine who said that HCAs monitored patients’ vital signs but did not understand the results.

‘ One nurse in the survey said: “There is sometimes an attitude from unregistered staff that it doesn’t matter what they do because ultimately it is the registered nurse looking after the patient who will take responsibility.’

Are some care home providers in the UK employing NMC Registered Nurses ‘on the cheap’ by contracting them to work as HCAs and thus by-passing regulatory requirements?  Are some care home providers in the UK doing so because they are fully aware that the registered nurse is not ‘fit for purpose’ as a nurse?  Are some care home providers in the UK employing staff  as HCAs but still allowing them to perform the functions of a registered nurse even though the care provider is aware of the inadequacy of the registered nurse in question?

Vulnerable care home residents are placed at risk.

“Cheap care is poor care.  Poor care ends up being more expensive.”

NMC hearings schedules – aka close to Care in the UK

I omitted to post this :  NMC Hearings Schedule – 6th to 17th February 2012 – at Euston House, London.

All in the best interests of Care in the UK.

More later, but click here for the charges.  Same as above link – but I wouldn’t want anyone to miss it.

A care home or a disaster waiting to happen?

This is not something I’d planned to write just yet, but the shocking abuse of people with learning disabilities at Winterbourne View shown in the recent BBC Panorama programme, and the reasons behind the demise of private care provider Southern Cross have troubled me enormously,  so I’ve revised my plan.  I will do all I can personally to raise awareness of the crisis in care that is slowly being revealed.  With help from everyone involved and interested enough to care, we will bring about a change for the better.

I had intended to work my way slowly through the failings of the so-called care system that have affected my own family and my own life before reaching this chapter, but the world has changed, so I will start at the end.

The horrors of the torture of adults with learning difficulties at Winterbourne View long-stay/residential hospital have caused many people to ask questions.  The regulator CQC has so far not come up with answers but has promised an internal investigation.  Paul Burstow, care minister, promises action to safeguard vulnerable people in care.  Andrew Lansley, health secretary, managed to use the scandal to plug his questionable Health and Social Care reforms in his statement on Winterbourne View, and he talks of a ‘serious care review’ (sic).

John Healey, shadow health secretary, can manage only this empty comment on Southern Cross: “Thousands of very vulnerable people and their families will be worried sick by what’s being reported about Southern Cross.”  Ed Miliband is turning into the invisible man, so I can’t find anything of interest that he’s said over the last week – but he did get married recently so the honeymoon may be reason for the sound of silence.

It’s almost as if this bunch of ‘representatives of the people’ have only just arrived on the scene from another planet – but, no, they’ve all been on one side or other of the political washing line for years now.  Wearing blinkers, and all turning a blind eye to what so many real people have had to put up with.  Yes, I’ve written long and clearly worded letters to all of them over recent years, but – just like the CQC did to Terry Bryan, the senior nurse with the big whistle that nobody bothered to listen to when he blew it loudly in their ears – they all stick their heads in the sand, delegate matters downwards to someone who has a high qualification in the ‘copy & paste department’, who then creates a meaningless letter of reply quoting platitudes.  Pointless exercise – and a waste of an opportunity to ‘represent the people’ which is what they’re all paid to do.

I listened to BBC Radio 4’s Any Questions at the weekend.  Some of the panel don’t even know the difference between NHS care and social care, but they are the ones with the power to influence the audience, to make decisions about our lives.  Power is dangerous; power corrupts …. but that’s something I’ll leave for another day, and I will try to return to the abuse of power.

For far too long, the sound of silence has done its best to try to deafen and silence those of us who have not turned a blind eye.

Those responsible for the neglect and abuse of vulnerable adults in need of decent care have managed to create a system that arrogantly dismisses each and every major concern that is brought their way.  People ask how a care home could possibly exist that doesn’t provide decent care.  People ask who is responsible.  People wonder who is to blame when things go so badly wrong.   I’m not alone in knowing how these things come about – read on!!

They’re all in it together.  The care providers, the local authority care commissioning departments, the so-called regulator CQC, the formal complaints procedures that take away the will to live from those who dare to complain, the social services departments, the safeguarding of vulnerable adults units, the MPs who can’t be bothered to care, the Ombudspersons, the police who can’t find a way to help, the GMC, the NMC, the PCTs, the ICO – to name but a few.

After the scandal of Winterbourne View, someone asked “Is this the tip of an iceberg?”.  It is one hell of an iceberg.

Is what follows the description of a care home fit for purpose?  Or was it a disaster waiting to happen?

Please share any answers you may have, because I’ve almost lost the will to live too, but only almost.

A residential care home for 90 frail and vulnerable older people, many with dementia, described as a flagship, state-of-the-art care home, showing ‘the way forward for the future care of older people’, but where:

• there were no systems in place for appropriate staff selection, staff induction, training, and on-going supervision
• communication with GPs and other health services was seriously, dangerously and sadly lacking
• new staff received no induction programme
• pre-admission assessments, risk assessments did not reflect residents’ needs, follow-up assessments were not undertaken
• care plans were not written up in a meaningful way, let alone looked at by the staff
• the staff did not understand their roles
• there were no systems in place to monitor hydration and nutrition
• the nursing records did not reflect patients’ needs
• the care plans did not identify needs
• the record-keeping was seriously challenged and challenging
• no charts available for the monitoring of decline in a resident
• there was no system in place for clinical supervision and performance appraisal
• nursing staff without chronic disease management training
• no records kept of any training that was provided, if any was provided
• no knowledge of or training for diabetes management in place
• no system in place for routine monitoring of diabetes, swallowing or breathing difficulties,
• unsigned and undated and often illegible records kept, with entries that were meaningless
• a total lack of understanding of the need for and reasons for accurate medical/clinical records to be kept
• MAR (medication administration records) with entries unsigned or countersigned, and changes made without signature or date
• no records available to give details of the suitability of the staff to be employed in their positions
• no records available to give details of the employment status of the staff.

I can’t list any more now – but I trust you get the gist of this particular disaster waiting to happen.

Was that a care home fit for purpose?  Or was it a disaster waiting to happen?

But nobody noticed.  Until it was too late.

And yet, the care provider provided the care home with nursing and many others; the local authority commissioning department commissioned it and allowed it to open – so delighted was the local authority that it gave several 25-year contracts to the care provider to provide such services; the CQC/CSCI inspected and found all to be in order – before the ship sank, that is; the social services department found it suitable for vulnerable elderly people to be placed there – but placing them at even greater risk.

Unsurprisingly, the ship hit the rocks.

Then, and only then, did they all go behind closed doors, into a huddle, impose a massive action plan, close it for a full year to new residents – that’s the best that could have been done, although there were calls in the area for it to be closed in its entirety.  But, hey, the local authority had entered into a 25 year contract.  The care provider was in splendid ignorance – at first, but is no longer so innocent.  The care provider is not a novice to this business.  That is one of the most distressing and most depressing aspects of it all.  How many other care homes are there, being run in a similarly shoddy fashion, with careless care being provided to some who because of age, disability or illness are at their most vulnerable and who deserve good care.

My patience has been tried and tested, almost to the point of exhaustion, as I worked my way through each and every stage of the complaints procedure, before being allowed to progress to the next stage, and I haven’t yet reached the end of it all.  It is obscene, offensive, corrupt, squalid and unworthy of the word ‘care’ for this system to be allowed to exist, with absolutely no accountability, nobody prepared or willing to accept personal responsibility, and all behind closed doors, so that the wider world remains unaware of what is being perpetrated and perpetuated.

Over the weekend, I decided to look back over quite a few years.  From just a couple of years:

published 13 June 1998 : ‘In the short term, decentralisation shifts responsibility for funding care to individuals. In the long term, the combination of decentralisation and privatisation may make the costs of care higher than they need be to government and society. In the USA, the loss of control over the finance and delivery of long-term care seems to have increased the cost to government and decreased quality and access for individuals. The effects of these policies have not been adequately studied and understood in either country.’  (Allyson Pollock and Charlene Harrington.  I do wish we would learn to listen to Prof Allyson Pollock!)

published 4 April 1999 : ‘Local authorities have to get as many placements as possible with insufficient money,” he says. “If care is going to be determined by people undercutting each other, we’re going to be in an appalling situation.

published 8 September 1999 : ‘Care homes may be forced to close due to government quality measures.  Care home owners are demanding urgent talks with the government because of fears measures designed to improve quality will lead to home closures. ‘

published 11 November 1999 :  ‘Training has been the Achilles heel of social care with about 80 per cent of the workforce unqualified and an absence of clear employer responsibilities and targets. But a five-year training strategy by national training organisation TOPSS England aims to change this.’

‘It sets training standards and new qualifications for local authorities and the private sector covering a social care workforce of approximately one million. It draws together NVQs and post qualification training, spanning care workers in nursing homes and social services directors. As well as setting targets for training and qualifications, the five-year action plan aims to predict what future skills will be most in demand and how the government, employers, and employees should pay for the training.’

‘And the picture of training to emerge in other areas is little better. Only 19 per cent of staff in homes for people with learning difficulties were qualified and only 23 per cent of staff in homes for older people.’

‘Andrea Rowe, manager of TOPSS England, says the new regulatory regime will be judging care homes on the quality of their training as well as service standards being developed by the government. “They will lean on homes and close them down if they don’t meet the new service standards,” she says.’

‘Private residential and nursing homes claim they face a financial crisis, pointing to a mounting number of receiverships.’

It appears that we have made no progress.  We being the real Big Society ‘we’ – each and every person involved in the decision-making process.   The ones to suffer are the ones in care.  They suffer neglect and abuse because of society’s inability to show that it cares. .