The Price of Dignity

Letter to the Telegraph 20 January 2012

SIR – Decisions about the future of social care are the heartbeat of our country, touching the lives of every individual and family. The way our society responds to the needs of older people and those with disabilities and mental health needs is an indication of the kind of country we live in.

So decisions about how social care is funded and policies about providing care are not just a matter of how taxes are spent, but of how highly we prize dignity and quality of life for everyone in our communities.

For those of us in local government, there is a great responsibility not only to make the right decisions for our regions, but also to talk to central government about what we think its priorities should be.

As council representatives, we call on the Government to follow the advice of the Dilnot Commission on funding social care. Social care is expensive and, with people living longer, the difficulty of providing quality care should not be underestimated. But concerns about money are not a reason to hesitate; they are a spur to take action. Not only is the current system unfair, it will also be more costly in future.

Changing the system and bringing in reform is crucial and needs to happen soon. Only last week, Dr John Sentamu, the Archbishop of York, called for more to be done to protect the elderly. He said that, while savings were needed, they “must be applied with caution and compassion.” He added: “We all know there are going to be cuts in government expenditure. We dare not cut compassion. Our nation’s humanity is at stake.” It is vital that, in line with Dr Sentamu’s sentiments, we urgently seek a solution to the financial challenge of paying for social care.

Finding an alternative to the current system, as costs climb rapidly each year and become unsustainable, was what Andrew Dilnot was asked to do. His Commission has spent months gathering evidence and considering solutions. While its recommendations are not without cost, they are workable.

The dignity of older people and of adults who need social care should not be at risk because a solution has not been put into place. Indeed, everyone, from the care sector to carers and from local government to older people, needs a solution to be agreed and put into practice as soon as possible. The recent integration report from the NHS Future Forum cites the possibility of using efficiencies from the system to fund social care services as one of the major decisions to be made.

The Dilnot Commission has found a workable solution that balances financial concerns with respect for elderly and vulnerable people. We recognise that the extra cost associated with the Commission’s recommendations prompts questions, and we understand that these are questions for government ministers to consider. On this basis, we can only advise that any limit on costs should be as low as possible to stay affordable, and should not be above about £50,000.

We believe public investment is necessary to protect “our nation’s humanity” and the dignity of older people in Britain.

Graham Gibbens
Cabinet member for Adult Social Care and Public Health, Kent County Council
David Sprason
Cabinet Lead Member for Adults and Communities, Leicestershire County Council
Colin Noble
Cabinet Member for Adult and Community Services, Suffolk County Council

Signed on behalf of the following local authorities: Bedford, Bracknell Forest, Brighton and Hove, Buckinghamshire, Cambridgeshire, Central Bedfordshire, Derby, Derbyshire, East Sussex, Essex, Hampshire, Hertfordshire, Isle of Wight, Kent, Leicester, Leicestershire, Lincolnshire, Luton, Medway, Milton Keynes, Norfolk, North-east Lincolnshire, North Lincolnshire, Northamptonshire, Nottingham, Nottinghamshire, Oxfordshire, Peterborough, Portsmouth, Reading, Rutland, Slough, Southampton, Southend-on-Sea, Suffolk, Surrey, Thurrock, West Berkshire, West Sussex, Windsor and Maidenhead and Wokingham.

'Whistleblowing in Care' conference

Care in the community is coming under particular scrutiny at the moment, and rightly. It is essential that all organisations and individuals have someone to turn to where safeguarding concerns or issues arise. Having an independent body with the experience to advise is even better. Here, the Whistleblowing in Care Conference 2011 examines how to report issues in the care sector and what organisations can do to ensure they have appropriate systems and safeguards in place.

Plans for greater scrutiny of elderly care in England

From BBC News Health 11 December

Plans to "radically drive up" standards of social care in England to protect the elderly have been unveiled by the government.

They include an online "good care guide" to allow family members to rate and review care homes and providers.

Age UK "broadly welcomed" the rating suggestion but called for more funding to improve the independent regulator.

Meanwhile, the Archbishop of York, Dr John Sentamu, has called for reforms in the way care is funded.

Care Services Minister Paul Burstow said the government's new plans would help to tackle "quality and mistreatment".

The ideas - proposed during workshops of care users and their relatives - will form plans for a new patients' rights group, Healthwatch.

They will go on to form the basis of a white paper in the spring.

As part of the plans, ratings for care and dignity standards for residential homes and home care providers would be published online, similar to the way websites used for booking holidays do.

It would include the latest information from inspections, plus any record of mistreatment or abuse by staff, as well as feedback from care users and relatives.

Under the proposals, local Healthwatch scrutiny teams would visit and speak to residents about their experiences. Committees featuring relatives of care users will also be formed to scrutinise services that do not meet standards.

However any formal inspection would still rest with the Care Quality Commission (CQC), the independent regulator of health and social care services in England.

Ministers hope it will provide a "more qualitative assessment" from the point of view of residents and their loved-ones of local care standards and would "empower people as never before" to choose the right care.

Healthwatch will, by law, be able to use duties placed on care homes which contain state-funded residents to let representatives into their premises for visits.

Ministers say they will look into options for allowing Healthwatch onto the premises of the minority of care homes with private-only residents.

"It can't be right that you can find out exactly what a hotel or restaurant is like, in just a short time searching the web, but people have so much trouble working out the standards of different care homes and home care providers - when that choice is so much more important. Mr Burstow said: "Measures like publishing social care comparison sites and opening care services up to greater scrutiny will revolutionise the way people and their loved-ones choose their social care.

He said as well as highlighting good quality care providers, "we're intent on doing absolutely all we can to shine a light on bad treatment and raise quality for everyone".

National standard

In an open letter to the prime minister, the Archbishop of York said the report by the Dilnot Commission, which recommended a £35,000 cap on individual contributions to social care costs, "had shown us the way forward".

The Dilnot Commission was a government-backed review into the long-term funding of care in the elderly.

It recommended that social care costs in England should be capped so people do not face losing large chunks of their assets but ruled out calling for care to be free.

The report also argued there should be a national standard so everyone had the same access no matter where they lived.

Dr Sentamu said: "The current adult care funding system in England is widely acknowledged to be unfit for purpose and to need urgent and lasting reform.

"What is needed is a system for funding care which enables the risk to any one individual to be pooled, through taxation or insurance or, preferably, a mix of them both," he added.

On Sunday morning Dr Sentamu tweeted: "I am calling on the Prime Minister, and taxpayers in England, to help reform funding of care for older people."

Age UK, the older people's charity, said it did not want to see the proposals detract from the work the CQC already does.

"Age UK broadly welcomes the care home rating suggestion as a potentially useful addition to the existing system of care quality commission inspections and we have been calling for elements of the proposals for a while," a spokesman said.

"But most important is radical and urgent reform to ensure a fair and sustainable care system for the future, which is why we are calling for a white paper in the spring which embraces the recommendations of the Dilnot Commission."

EHRC Report

Report highlights home care failures

by http://www.nhs.uk

Wednesday November 23 2011

Lapses in home care 'may breach human rights'

A number of elderly people are being let down by home care services, an inquiry by the Equality and Human Rights Commission has found. The commission reported that around half of the older people and relatives interviewed were highly satisfied with their standard of care. However, in a minority of cases there were significant lapses in the care some received.

Among the problems reported were older people being left unwashed, denied assistance with eating and without a say in the way they were treated. In a few isolated cases, elderly patients reported physical abuse and having money systematically stolen.

The report is one of a series of damning examinations into elderly care to be published in recent months. Investigations by the Patients’ Association and Care Quality Commission (CQC) both found major lapses in medical care for the elderly.

It is important to stress that this report, like other recent investigations, found that the overall standard of care was good and that these types of incidents are not necessarily widespread. However, the CQC has said people have a right to expect a certain standard of care and that it wants to ensure that all elderly people are being treated with dignity and respect. Earlier this week the regulator launched a major inspection programme to monitor home care services for the elderly.

Why was the inquiry performed?

The Equality and Human Rights (EHRC) says that a great deal of attention has been paid to the human rights of older people in institutional settings such as hospitals, and residential and nursing care, but that there is a significant risk that older people could have their human rights infringed while receiving care at home.

To assess the situation the EHRC examined a broad evidence base gathered from 1,254 individuals, local authorities, care providers and other organisations across England. As is the case with all surveys of this type and size, there is the potential that the results do not accurately reflect what is happening across the wider population.

 What experiences does the report highlight?

The EHRC says many older people reported being highly satisfied with their home care and that good quality home care has undoubtedly had a hugely positive impact on their lives.

The report noted though that while they may not be typical of the standard of care on offer, several people reported concerning lapses in home care, including those that may breach their human rights. Below is a selection of these comments and experiences.

Support with food and drink

In one particularly bad example a 76-year-old woman with advanced cancer had to struggle across the room to heat her own food, as her care worker said she could not use the microwave due to ‘health and safety reasons’. The EHRC contacted the Health and Safety Executive, which said that it could see no reason why workers could not heat meals in a microwave.

There were also a number of reports where older people had experienced severe weight loss and dehydration because they did not get the support needed for them to eat.

Physical abuse

A small number of people surveyed highlighted instances of intentional physical abuse, most often rough handling or unnecessary physical force.

One 78-year-old woman said: “Rather than say ‘sit in the chair’, they’d push me back into the chair, that sort of thing, and I didn’t like that… It was only on one occasion – I recognised it as a push. She wasn’t nice at all… I couldn’t do anything about it. I can’t even walk and I think they know this you see; they know you’re vulnerable.”

Neglect of personal care

In a number of instances care workers did not perform the tasks set out in people’s care plans, which often feature just the basic tasks needed to ensure physical wellbeing.

The daughter of a woman in her 80s said: "One time carers decided not to do any of her washing any more, even though [it was included] on [her] care plan, leading to my mum being left in filthy nightwear and clothes and bedding.”

Another woman described how care workers often rush their work or leave early, leaving her mother “in distress, dirty and without water and food”.

Patronising or ignoring older people

At times, the way care workers addressed people was condescending, patronising or ignorant of elderly people as individuals: “Some staff ‘talk down or shout’ at my mother thinking they will ‘get through’ to her by doing so. She is an intelligent woman and isn’t hard of hearing.”

Financial abuse and theft

Groups assisting with the report, such as Action on Elder Abuse, said they had seen a number of examples where care workers had systematically stolen from elderly people, particularly those with dementia.

However, on a positive note there were instances where care workers had protected vulnerable people from being financially exploited, such as a case where an older man was having two friends take money from his pension while pretending to assist him with banking and shopping.

Lack of control and flexibility

At times people receiving care said they felt they were treated like a task rather than as a person, or not given assistance with tasks of true priority. For example, some reported being put to bed in the afternoon due to a lack of evening care slots, and in one case, a woman was refused help getting off the toilet by a worker who had instead used her appointment time to prepare the woman a sandwich.

Lack of personal sensitivity and privacy

At times people found care workers lacked awareness of people’s cultural or personal backgrounds. For example, one older gay man with dementia said he decided to stop receiving care “because of the homophobic reaction of care staff”, and many Muslim people felt they could not be sure that the prepared meals they received were genuinely Halal.

What solutions have been recommended?

The EHRC’s extensive report looks at a range of measures that could ensure better care for the elderly. Among the suggestions made by the CQC:

The introduction of improved legal protection for older people, particularly the closure of a loophole that means that home care is not subject to the Human Rights Act in the same way residential care is.

Greater consideration of the impact services will have on people’s human rights when they are being designed and commissioned. The EHRC points out that even though budgets are shrinking, many local authorities have already redesigned the way home care is delivered to make the most of the money they have and ultimately improve the standard of care elderly patients receive.

Better guidance for older people and their families to ensure they know their rights and how these should be protected.

Having recently examined standards of hospital care for the elderly the CQC announced a major programme of inspections to assess the standard of home care for the elderly. In its role as an independent regulator of health and social care, it will start its inspections in April next year, and will scrutinise the support administered by around 250 care agencies across England.

What can I do if I am unhappy with my care?

Make sure you know your rights. The EHRC says that most older people have little or no understanding of how home care works or what their options are. If you are a carer you can find more about home care on Carers Direct or by calling Carers Direct on 0808 802 0202.

Make an informed choice. Many older people feel that they have had no choice over their home care provider, especially if it has been changed. Not only can older people make choices of who their home care is provided by, they can also choose to take local authority funding to hire their own home help (for example, through a direct payment). For more information, see Choosing your own support on Carers Direct.

Make sure you know who to complain to and how. The EHRC says that older people commonly endure distressing treatment that in some cases breaches human rights legislation. Complaints about care can be made directly to the home care provider or to the local authority. These can then be taken on to the Local Government Ombudsman. People who pay for their own care (self-funders) can complain directly to the ombudsman. You can find out more about local authority complaints on Carers Direct.

Home Care Inspections by CQC

Home care services in England are to be subject to a fresh inspection by the Care Quality Commission from April.

BBC News Health 22 November 

The CQC has announced it will report on 250 companies who help people in their own homes with tasks such as eating, washing, dressing or taking medication.

Its reports will be produced before the health watchdog publishes its verdict on the state of home care nationally.

An Equality and Human Rights Commission report due out on Wednesday is expected to be critical of home care services.

An EHRC spokesman said the care watchdog’s pledge could be an “important first step” in addressing concerns raised by its own inquiry.

CQC inspectors will carry out the reviews alongside professionals and those who have personal experience of using home care services.

‘Behind closed doors’

CQC chief executive Cynthia Bower said: “The operation of home care is not as transparent as care in hospitals and other sectors because the interactions happen behind closed doors.

“That is why we want to focus on this sector of social care in this way.”

The CQC already runs routine spot checks, but this will be an extra inspection.

An advisory group is to be set up to assist the inspection process, with members from organisations including the EHRC, Age UK and the United Kingdom Homecare Association.

Ms Bower said it would focus on areas such as dignity and respect, safeguarding of people in vulnerable circumstances, and inspections would also look at how well supported and trained staff were.

Checks will include speaking to those who receive home care, as well as to their families, and home visits, she said.

The inspections follow a pilot scheme run by the CQC in which 30 home care services were reviewed.

Protecting the Elderly from their Carers

Stephanie Rose reviews the recent Government statistics concerning risks to the elderly, and details how risks can be reduced.

Tim Ross, Political Correspondent of the Telegraph, in his spine-chilling article this week, draws our attention to the first-time-publishe


d government figures concerning abuse of the elderly.

Of 96,000 adults who had suffered alleged abuse between April 2010 and March 2011, more than 34,000 vulnerable adults were alleged to have been hit, slapped, kicked or suffered another type of physical abuse while almost 27,000 allegations of neglect were recorded. Almost one in four cases, some 23,000, involved ‘financial abuse’, including theft, fraud, exploitation, pressure related to wills, or the misappropriation of benefits or possessions. In the majority of these cases, the alleged victims were elderly. Most of the allegations were reported to social workers by health or care nurses but 42% of incidents were alleged to have taken place in the victim’s own home.

The figures make frightening and depressing reading. An occasional case of abuse is a case too many, but these figures suggest that failures in care are not occasional. Of course, they do not reveal the huge numbers of vulnerable adults who receive high levels of care and attention from their carers, nor contrast with those whose carers go beyond expectation in the way that they provide for their relatives, patients and clients.

What as a society can we do to protect the vulnerable and the elderly?

A first observation is that care should not be left as the sole responsibility of one carer. Initially, care may be excellent, but as time progresses (or a relative, patient or client becomes more challenging) care can deteriorate. Without the support and oversight of others – extended family, relatives, visiting nurses, supervisors – the risks increase. Every vulnerable person should have the support of both a carer and 'a confidant' –someone who they can confide in, and who has the capacity to take responsibility and alert other services where necessary.

Secondly, we as a society should focus greater care and support on the care providers.   There are thousands of home carers who go unassisted and unmonitored, battling daily against difficult conditions and behaviours, and no doubt succumbing to the short-cut, the drop of standards or the reaction backlash. Frequently, the sheer stress of providing care without respite may give rise to risk.

Managing risks to clients is one of ‘Stephanie’s Bespoke Care Services’ top priorities. It was for this reason that we originally introduced the relative’s video log. Clearly, over time, it has developed a plethora of uses over and above risk management, but this still remains a core purpose of the video recording. We also ensure, whilst providing continuity of care, that each client is cared for by more than one carer; and each client is seen and cared for on a regular basis by supervision. This way, the corners are identified and reinforced. Poor practices are picked up at an early stage. Carers who are not coping are supported. Most importantly, the little tell-tale signs of concern are spotted.

No system can be perfect, and any care is going to be only as good as the carer can manage; but with the right level of experienced observation and scrutiny, risks can be reduced.


The ideas here are the personal ideas of the author and may not be reproduced without permission and attribution to Stephanie's Bespoke Care Services.

Abuse of the Elderly

100,000 elderly and disabled victims of suspected abuse

Almost 100,000 elderly and disabled people were feared to have suffered abuse at the hands of their carers last year in what ministers described as “an absolute scandal”.

By Tim Ross, Political Correspondent

4:02PM GMT 03 Nov 2011

A landmark inquiry into the scale of mistreatment disclosed that a quarter of cases involved relatives or carers putting alleged victims under pressure to change their wills, stealing property, or fraud.

More than 34,000 vulnerable adults were alleged to have been hit, slapped, kicked or suffered another type of physical abuse while almost 27,000 allegations of neglect were recorded.

Ministers and elderly rights campaigners condemned the picture of care home staff and relatives who exploit society’s most vulnerable citizens.

It is the first time that comprehensive government figures have been published showing the number of cases of alleged abuse in care homes and in the private residences of vulnerable adults in England.

The figures follow warnings from the Care Quality Commission over the “alarming” failure of hospitals to care for elderly patients.

The watchdog has also severely criticised the company that owned the now closed Winterbourne View care home for disabled adults in Bristol, where alleged abuse, including slapping and taunting of residents, was uncovered in a BBC documentary earlier this year.

Details from 151 councils showed 96,000 adults had suffered alleged abuse between April 2010 and March this year.

Almost 14,000 victims were suspected of having been abused or neglected repeatedly during the year, according to the report from the NHS Information Centre.

Most of the allegations were reported to social workers by health or care nurses but 42% of incidents were alleged to have taken place in the victim’s own home.

Almost one in four cases, some 23,000, involved “financial abuse”, including theft, fraud, exploitation, pressure related to wills, or the misappropriation of benefits or possessions. In the majority of these cases, the alleged victims were elderly.

Paul Burstow, the health minister, said the figures were “an absolute scandal” and promised more snap inspections of care services to stamp out abuse.

“No-one should have to put up with abuse,” he said. “This is the first publication of mandatory data of this kind. It demonstrates our total commitment to shining a light on poor care.

“Hundreds more unannounced inspections of adult care will be taking place, and we will also be making it mandatory to have local boards, involving police and other professionals, in place to tackle abuse.”

Social or healthcare workers were the alleged perpetrators in 29% of cases while family members, including the victim’s partner, were suspected of being the abusers in 25% of cases.

There were more than 18,000 cases of alleged emotional or psychological abuse, and almost 7,000 cases of sexual abuse.

Four in 10 investigations that were completed during the year were found to have been fully or partly substantiated, while 30% were not, and more than a quarter were inconclusive.

Michelle Mitchell, Charity Director of Age UK, said: "These figures show shocking mistreatment of the most vulnerable in our society.

"It is extremely worrying to see such high levels of neglect and abuse in residential home settings. The figures also raise further concerns about the quality of domiciliary care, which is delivered in a person's home behind closed doors and so problems are likely to be under reported.

"Safeguarding measures are clearly still failing far too frequently and urgent attention needs to be paid as to why 96,000 cases of abuse were allowed to happen last year."

Adrian McAllister, chief executive of the Independent Safeguarding Authority, which is responsible for banning abusers from working with vulnerable people, said the figures were "appalling".

"Behind these statistics are stories of real pain, lives that have been damaged and trust that has been broken by those who job was to improve the lives of vulnerable adults, not abuse them," he said.