Tag Archives: Pulse

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.

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Seven Ps for the Vision for Adult Social Care

A while ago, I mentioned the The Seven Ages of Man, and continued the theme with The Seven Stages of Dementia .  Then came the Seven Steps to end the scandal of malnutrition.  I did consider then that the number 7 might be powerful, magnificent even and so would emerge again.

Then, along came The Seven Ps, all listed within The Seven Principles of the Vision for Adult Social Care: Capable Communities and Active Citizens.

Prevention – Personalisation – Partnership – Plurality – Protection – Productivity – People

I now have a vision of the brainstorming session that must have accompanied the conception of The Seven Ps.  A kiss (Keep It Simple, Stupid!) was passed round the room, attracting and enticing members not to overstretch themselves.  The Dictionary of Management-speak was lifted from the bookcase; it fell open to reveal the page of Ps.  The Seven Ps were conceived immaculately, provided with perfect pre-natal care and delivered without pain relief.

The Dalai Lama said that if one’s life is simple, contentment has to come.

It’s somewhat strange to see People at the end of the list of principles, but I’m sure our Coalition writers have their reasons.  Shouldn’t People come first?

There are a few missing Ps, as far as I can see, the first being the paradox.  Is it possible to strip and slash local authority funding and budgets while demanding that local authorities assume responsibility for certain functions that were previously the responsibility of National Government?  It does not make sense.

Creating capable communities is a great idea, but the word capable appears just once in the full text – apart from the title and as a heading on every page – on page 32 Delivering the vision demands a capable and well-trained workforce.

This capable and well-trained workforce has yet to emerge, and may struggle to emerge with all the cuts being in place overnight and without much in the way of consultation by our Con Dem Coalition.  I almost resisted the temptation to mention the lack of mandate given by the Great British Voting Public (the real Big Society – the fictional Big Society remains a mystery to me) to this minority-marriage-of-convenience Government – but that really is another story, another irresistible temptation.

New career pathways will be developed, including more apprenticeships and a new care worker role in home and residential care, as well as more PAs.

Is this yet-to-be-trained capable workforce going to create the capable communities?  Will there be a flurry of independent (for-profit private) providers emerging to provide the training?  Will there be a move to create a genuine career for care workers?  Will there be a decision to pay more than the basic minimum hourly rate of pay so as to attract care workers to care about the work they do?  Or will the private profit preferences prevent progress?  (Sorry, that’s only five Ps.)

Is the capable community to comprise family, friends and neighbours only, with the capable and yet-to-be-trained workforce retreating into the background?   An ever receding professional workforce?  The emphasis throughout the whole Vision is on informal support via kind and caring neighbours, willing and able to provide sufficient support to those in need; a Timebank reminiscent of the bartering of old (not much use to those who are already too frail/old/incapacitated to be able to give the little they can now in return for what they need now!).  Active citizens?

The Royal Borough of Windsor and Maidenhead, one of the four ‘Vanguard Communities’ for Big Society, will test a web-based complementary currency approach for care and support, to assess the potential benefits both in reduced demand for formal care and in people’s quality of life. That might work in Windsor and Maidenhead, but it won’t work where I live!  It may work in many places where an existing community spirit and involvement already exists – but it won’t work in areas where there is no community spirit.  Recent decades have demolished communities in some areas; it could take as many decades to create flourishingly caring communities again.  What happens to the people living with needs who happen to live in those decimated communities?

Personalisation and choice sound great, and both are long overdue.  But I’m not convinced by the plan to increase rapidly the availability of Personal Budgets ‘preferably as Direct Payments’.  Personal Budgets ‘preferably as Direct Payments’ won’t suit everyone in need of care.  They will undoubtedly suit some recipients who have the physical and mental abilities and energies (or the family/friend/neighbourhood support) to become an employer, to research and search for a PA if that’s their wish, to hire and fire (if need be) a care worker/PA, to manage the financial aspects  – and good luck to them.   The Vision might be less rosy for someone with mental capacity problems, such as dementia, and who may not have family/friends to support them.  Can the Vision envisage vulnerable elderly people coping comfortably to set up their own care package?

According to Pulse: patients shun personal health budgets

As for Demos: Personal budgets will revolutionise social care delivery, but only if local authorities are fully prepared

The Charities are changing rapidly, too – so if the reliance on charities increases just when some charities are crumbling, what then?

File on 4 programme on Charity funding and fraud  – grassroots rebellion is underway

Transcript available  if the programme is no longer.

The Oxford Student – ‘tax the rich minority and give to the poor majority’ – is on the right track.  ‘The electorate have sleep-walked into a cannibalisation of public services and welfare that will push Britain back seventy or so years, as £8.1 billion of public spending has been cut.

To the people who voted for the Tories in May, think about this: who paid for the Conservative election campaign? Who bankrolled the triumphalist swagger of these men into Whitehall? Tax evader Lord Ashcroft donated £5.3 million to the Tory campaign. That’s a lot of money, and it doesn’t come without strings attached. Nor does the £1 million donated by hedge fund manager Michael Hintze, whose finance group CQS is based in the Cayman Islands tax haven. Nor still does the £500,000 donated by John Wood, boss of SRM Global, which also has 7 hedge funds registered in the Caymans. These donations makes it difficult to believe that the Tory promise to crack down on tax evasion is anything other than shallow rhetoric. And the fact that the chairman of Care UK, one of Britain’s largest private healthcare providers, donated £21,000 to Health Secretary Andrew Lansley also makes it difficult to believe that the (real term) cuts to the NHS were made in good faith.

Is the Vision the first step towards the privatisation of social care?  The LibConDemolition of the Welfare State, of the NHS, of Social Care?  Who gave permission for that?  Not me.

So, Seven Ps from me to the ConDem Coalition:

Properly procured popular permission prevents public protest.

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GPs should review care home medication every six months

Question: Who’s keeping a finger on the pulse of care in care homes for the elderly? was a question I asked recently.

Answer: Older People’s Specialists’ Forum (OPSF) and the British Geriatrics Society

The Older People’s Specialists’ Forum (OPSF) is a group of healthcare professionals specialising in the care of older people. Its members include representatives from: The British Geriatrics Society, the Royal College of Speech and Language Therapists (RCSLT), the Department of Health, the National Association of Primary Care, the Society and College of Radiographers, the College of Occupational Therapists, the British Association of Art Therapists, the Chartered Society of Physiotherapists, the Royal College of Nursing, the Royal College of General Practitioners, the Royal College of Psychiatrists (Faculty of Old Age Psychiatry).

Nearly seven out of ten (68%) care home residents do not get a regular planned medical review by their GP and 44% are not getting a regular planned review of their medication a survey said today.

The survey was launched by the Older People’s Specialists’ Forum (OPSF) and asked care homes across the UK about their experiences of accessing healthcare services for their residents.

The survey also found that 59% could access specialist dementia services such as memory clinics and community mental health teams. Most care homes could request input from specialist nurses when a problem had arisen but very few homes appeared to have access to input from specialists to prevent problems arising.

According to PULSE, the British Geriatric Society will publish GP guidance next April to improve care in nursing and residential homes by tightening up medicines-management arrangements, following disturbing findings uncovered by Pulse’s recent special investigation.

The guidance will highlight the importance of six-monthly medication reviews by GPs or pharmacists, and the need for a medical and nursing care plan within one month of admission to a care home.

About time too, would be the reaction of every single person who has experienced sloppy, slapdash, uncaring medication control in a residential care home with nursing, specialising in dementia.  About time too.

CHUMS  Care Homes Use of Medicines Study looked at Medication errors in nursing & residential care homes, studying 256 patients in 55 homes. Patients were on a mean of 7.2 medicines each and 69.5% of patients had at least one error.  The field work was carried out in 2006‐7 .

The prevalence of errors was: prescribing 8.3%, monitoring 14.7% (for relevant medicines), dispensing 9.8% and administration 8.4%; these figures represent the likelihood that each act (prescribing a medicine, for example) will be an error. In terms of patients receiving errors: 39.1% received a prescribing error, 18.4% (of those who needed it) a monitoring error, 36.7% a dispensing error and 22.3% observed to receive an administration error.

The great majority of monitoring errors (91%) resulted from a failure to request monitoring. There was considerable variation between areas, with three‐quarters of monitoring errors occurring in London.

Conclusions: There is an unacceptable prevalence of medication errors in care homes, affecting some of the most vulnerable members of society.   Action is required from all concerned.

Questions:

Why should it take so long for caring care to be provided?

Why should it take so long for ‘required action’ to take place?

Why should it take so long for sensible measures to be seen to be in place to protect vulnerable elderly people?

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Who’s keeping a finger on the pulse of care in care homes for the elderly?

The results of a ‘care homes survey’ carried out by PULSE make for interesting reading.  Interesting, but also shocking for anyone who has ever questioned the standards of care in a care home with nursing.

A significant minority of the 100 PCOs responding to Freedom of Information Act requests do not provide even basic care-home services, with 14% providing no access to tissue viability nursing, and 10% have no access to continence advisers.

The investigation, which involved submitting three separate FOI requests to each PCO, reveals the patchy nature of services across the NHS, as well as the headline findings of soaring numbers of serious incidents and sharp funding cuts.

Of the GP practices that responded to the survey:

67% say that the funding they receive for the care of patients in care homes is not adequate for them to provide a safe and effective service.  14% say it is adequate; 19% don’t know.

61% say that the arrangements for the medical and nursing care of patients in care homes is not organised satisfactorily in their area.  26% say it is satisfactory; 13% don’t know.

41% say that on unscheduled call-outs, they ‘sometimes’ receive the information and nursing back-up they need.  9% say they always receive it; 28% often; 19% occasionally; 3% never.

40% provide once a year medication reviews for patients in care homes.  33% once every six months; 17% once every three months.

60% said they were ‘sometimes’ left with no option but to prescribe antipsychotics to patients with dementiathat is unacceptable, a totally unacceptable way to treat patients with dementia, if ‘treat’ is the right word.

42% rated the nursing care of patients in their local care homes for the elderly as acceptable.  5% ‘very good’; 23% ‘good’; 23% rated the care ‘poor’;  6% rated the care ‘very poor’.

44% rated the nursing care of patients in their local nursing homes as acceptable

48% had observed Staff sloppy or unprofessional in their local care homes.

40% found Staff lacking in compassion

72% found Poor quality of staff training

47% found Patients denied their dignity or sufficient stimulus

6% found Evidence or suggestion of abuse by staff

And yet:

65 & of those GP practices had not complained in the last year about the quality of care for residents in care homes;

23% had complained;

12% don’t know.

Astonishingly:

58% of those GP practices who had complained did not know whether the complaint was satisfactorily investigated by their primary care organisation

24% felt it was not satisfactorily investigated

17% felt it was.

Many more staggering statistics in the full survey report, but it is distressing to read that 53% of those who responded found that Mental Health Care services and 34% that Continence Support were being savagely cut for care home residents.

Dr Krishna Chaturvedi, a GP in Westcliff-on-Sea in Essex, said: ‘Our practice has served more than 10 residential homes for 20 years but due to the increasing stress, we decided to take all homes off the list after making several pleas to the SHA and PCT for extra support, none of which was forthcoming.’

Is this really what we mean by “CARE”?

The vast majority of people in need of residential care, with or without nursing, come from  a generation of stalwarts that grew accustomed to the understanding that if you want a job done properly, you should “do it yourself”.  And they did just that, for as long as they possibly could.   There are some things they no longer can do for themselves.  If Cameron and Clegg and Co. continue with their vicious cuts campaign, they will force that generation to suffer the consequences.

Is it time for the words care home to be erased from our vocabulary?

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