/ Health

Care homes are failing – but is it too hard to complain?

Portrait of an old man

Our undercover actors living in four care homes discovered many problems with the quality of care. So how can relatives know what’s going on – and how easy is it to complain when you suspect the worst?

Imagine the scene: you believe that the management in your relative’s care home is sub-standard. You decide to complain, but that complaint has to be made to the management.

As someone who writes about healthcare for a living, I know that it’s important to complain when things aren’t right. But as a relative I can totally understand why people might feel uncomfortable doing it.

I’ve had three grandparents in care homes. I saw my parents struggle over a number of years with trying to get numerous problems sorted.

Don’t get me wrong – most staff were brilliant and did their very best – but it’s very stressful when you feel like you’re the only person sticking up for a vulnerable relative. And you may worry that, if you raise any concerns, it’s your relative who will bear the brunt of any staff disquiet when you’re not there.

Which? investigates care homes

Our recent investigation put actors into four care homes to spend a week living as ‘residents’. They raised lots of worrying concerns in the four homes, as well as some good practice.

These included problems of poor nutrition, lack of activity and poor staff communication and skill, and even potential abuse by a staff member in one home. It made me wonder whether relatives knew about what was going on, and felt too inhibited to speak up, or hadn’t been taken seriously when they did?

Here the actors tell us about their experiences during their week undercover:

Where to go for help

The regulator in England, the Care Quality Commission, doesn’t have a remit to investigate individual complaints although it encourages relatives and residents to feed back direct.

If your relative is funded by the council, or if it’s about an abuse or ‘safeguarding’ issue, you can get the council involved. But if you’re paying for your own placement, your complaint will normally have to go direct to the provider.

The good news is that – since October last year – if you’re not satisfied with the home’s investigation, you can go to the Local Government Ombudsman and they can investigate your complaint. But you can normally only do this once you’ve complained to the home.

I’m concerned that the need to go direct to the home may put many relatives off making their views known, fearful of the consequences. I hope that the opportunity to go to the ombudsman if the complaint isn’t handled properly will make relatives feel more secure raising concerns – but what do you think?

What are your experiences – good and bad – of the quality of care in homes? Have you had difficulties making your complaint heard or have staff been open to discussing your concerns?

Comments

A recurring theme here and elsewhere is a lack of effective response to complaints, and to some extent a fear of retribution if making a complaint.
A fundamental change in attitude is perhaps needed. On the basis that most employees in these public and private services are decent individuals, we should encourage them to report wrongdoing to a regulating authority who would protect their identity. We see so many times the number of people who knew of the problem but didn’t come forward. We need to change that mindset. Apart from bringing offending organisations under investigation, the knowledge that the staff have been given a responsibility to report malpractice may encourage less diligent.management to be more watchful and receptive.
This requires two things – effective regulators at local and national level, and deterrent disciplinary action against incompetent or neglectful staff and managers.
As a nation, we are not great at complaining – we should be prepared to if we want change. The last thing we want is a litigation culture.

Gerald says:
8 February 2013

Hi Malcolm,
At last, a fair and unbiased viewpoint .
I agree whole heartily with every word.
The larger the organisation (Public or Private) the less they listen.
I have complained to many Large Entities including Which? and often been ignored .

When one looks at the the Mid Staffs Hospital there appears to be many complainants and whistle blowers and unfortunately even more deaf ears we should also look at the Jimmy Saville fiasco and the Children’ s Home Saga in Wales the scale of the whole problem is enormous.

Many thanks in highlighting the problem the way you have,

To Gerald

There seems to be good and bad in both the private and the public sector care and welfare services. In looking especially closely at private care homes, I do not think Which? is complacent about the NHS provision, but like other directly paid-for services it does require a spotlight to be turned on it from time to time. MP’s, the Patients Association, and the myriad of specialist charities for different conditions seem to be better placed to scrutinise the NHS; they might not do it well enough in some people’s opinion, but they try. And the NHS is an enduring organisation which is not shielded from democratic accountability, community participation, and clinical oversight. Which? cannot tackle everything, its work is paid for by subscribers who want it to cover a wide range of consumer issues and product testing. Nowadays it does include coverage of quite a number of social service and personal health topics, and not all subscribers are happy with that but, speaking personally, I think Which? has got the balance about right. I support Wavechange on this [NB – not “Wavelength” as you refer to him] – and think this Conversation is tuned in to the right wavelength.

Gerald says:
8 February 2013

Dear John,
The service in being discussed is ,I believe, Care of the Elderly,this service has many Providers both Public and Private ,large and small .When carrying out other Surveys in the past on other Services and Products WHICH ? have always done their best to give a balanced view point comparing all services fairly and I have been a supporter of WHICH? for many years because of this .When it comes to comes to Care of the Elderly however these basic principles seemed to have been forgotten, Do you really consider sending 4 Actors (all under retirement age) for a week into 4 Care Homes (all in the Private Sector) constitutes any form of realistic survey from which I or anyone else can get a “Best Value” verdict.
Why has Which? not stuck to its long tried and tested formula for coming up with unbiased reports which all of us can relate to.
This has been my criticism all along, the references I have made to other Providers of Care were only there to emphasize the enormous failings and disparities of this Survey.
On the point you have raised with regards the “Watchdogs” of the NHS I would suggest when one compares the scale of the problem (on going for years) between the two two Sectors it is blatantly obvious that teh Public Sector has a far bigger Problem bu, as Ihave said , this is not the issue which I am discussing and I would be more than happy for this conversation to stick to the point or wavelength as you say.

I can see what you’re saying, Gerald, and in terms of care for the elderly the NHS might well perform poorly, possibly because a lot of elderly people come out of private care homes with medical conditions that those establishments cannot cope with and end their days in a hospital. However, perhaps I was misled by the title of this Conversation, but I thought it was about Private Care Homes, not the general question of care for the elderly. Almost all residential care in this country is now provided by the private sector. The number of local authority-run homes for the retired is negligible and I have not come across any care homes for the elderly provided by the NHS [I’m not saying there aren’t any, it’s just that I am not aware of any]. So the private care home industry is big business and run for profit. The recognition of wrong-doing and the addresssing of complaints might not be part of the culture of this particular part of the commercial sector [as events have eloquently demonstrated recently, it’s difficult enough to get the generally excellent NHS to admit its shortcomings and remedy them]. So this particular exercise by Which? is worth while, provides useful evidence, informs consumers, and raises awareness. I believe that is what it set out to do.

Gerald, I must agree that sampling 4 care homes is no way to support a discussion. I have no first-hand knowledge of the world of care, but from what has been reported of private (or subcontracted) care facilities for young or old in recent years I would not draw the conclusion “private good, NHS bad”.
I do not know whether there has been a Which survey of members experiences (both as providers and “customers”) of elderley care homes, but this seems the best route to gain a more representative insight into the quality of care and where it might be deficient. These surveys generally ask for good as well as bad experiences, so hopefully a balanced picture might emerge on which possible action could be recommended.

Gerald says:
8 February 2013

Malcolm, I am glad you agree with the essence of the complaint I have made to Which? I have 30 years of experience in care of the Elderly (no experiences with children,other than my own)
Based upon my experience and memories of reported incidents I have absolutely no problem whatsoever in saying that I believe that the Private Sector is doing a better job of caring for the Elderly. One only has to look at how the Public has voted by taking their custom away from the Public Sector into the Private.When I first started the Public Sector accounted for 75% of the provision , now it is 80% Private, surely this would indicate not all of the Public are as dissatisfied with the Private Sector as the Media and others would have you believe. Even very recent recent events at the Mi8d Staffs Hospital and Welsh Childrens Homes should surely ring bells, just think this has been going on for years, do you think the that any Care Home would have been allowed to keep operating for over 6 years if they had killed someone look at Winterbourne which was closed down(quite correctly in my opinion) for abusing within weeks of the BBC program,I know of instances where the Council and CQC have closed down Care Homes for failing to keep “proper” records etc..
I agree m
with your comments with regards to what would constitute a proper survey but if one is looking at the overall picture I think representatives of ALL providers should be be surveyed, this would give a much more helpful picture to enlighten the Public as to which is BEST BUY
all this has been normal procedure for WHICH? for many years I cannot understand why they have transgressed in this instance, I really do not think they are doing us any favors what so ever.
Thank you for your support.

Robert Thompson says:
8 February 2013

I’ve read with great interest all the remarks above, and I admire the enthusiasm that has been shown in all the replies…………..However, I do feel that many things are misunderstood concerning ‘Private’ and ‘Public’ sector homes. just about every ‘Private’ home takes residents that are funded by a Local Authority, this usually is due to lack of funds by a resident already at the home, or a new resident placed there by a Local Authority. In fact the Local Authority are capable of putting ‘blocks’ on private Care Homes but this seldom occurs in Public care homes. A ‘block’ is when Local Authority (perhaps with the assistance of the CQC) deem the Care Home is not performing to a required standard. Now although this may seem a good thing as it suggests the Care Home will no longer receive further residents paid for by the Local Authority, it also is not available knowledge to a ‘Private’ would be resident. So you put Mother in the Care Home, pay the £3000 a month but without the knowledge that your Local Authority are refusing to fund any of their awaiting residences’ untill they are happy that standards have been raised to the required level! The owner/Manager of the Care Home are not obliged to tell you of the Local Authorities decision at all!…….something wrong there me thinks!
The fees paid by Local Authority to a Private Care home are considerably less than Private fees, infact owners of Private homes have publicly admitted that the Private sector are subsidising the Local Authority residents!
It becomes therefore increasingly difficult to differentiate between Private and Public, as the mix of residents in Private Care but funded by Local Authority is not seen when counting the total residents in ‘Private’ homes…………………
Any comments please?

Gerald says:
8 February 2013

Hi Robert,
Still here I am afraid, Why do you think that the Local Authority seldom if ever puts a block on their own homes? You are correct in saying that with the aid of the CQC they can block public funded placements to homes this has happened recently in my area and the homes closed down very shortly after., every one was rehoused in a matter of days, this is normally the case of such instances when the Local Authority impose a block and therefore private clients would be made aware. All information leading up to this event would be published by the CQC and would also be available under freedom of Information Act in the L/A.The Council also employ Care Managers who are available to help anyone looking for Care.
You are correct in stating the Local Authorities are under funding on a massive scale ,we have advised them over many years and have always been met with the “take it or leave it” attitude we do advised the public of this fact and some respond by “topping up” We believe that this system is totally against the Public’s Interest and have said so on many occasions. It has also come to light that the Local Authorities in some areas are actual subsidizing their own homes because even their own non-profit making homes cannot give the service for the amount they insist that we should.
So to summaries , Any private client looking to go into any home should be made aware of the fees and the service being offered , any blocked home will not generally be taking new clients as they will generally be busy closing down and yes it is a fact that the Local Authorities have been under funding for years , they have recently introduced a scheme with collaboration of the PCT that introduces means testing to Nursing Home placements.
Don,t blame the Care Homes ,blame the Public Authorities, but don’t be surprised if no one listens its been like this for years.
Thank you WHICH? for giving me an opportunity for bringing this out into the open.

Gerald says:
8 February 2013

Dear John,
The service which I am referring to is Care of the Elderly which encompasses Nursing Care Nursing and Residential Care and since the new Care Act and the formation of the CQC this service is provided in Care Homes (Private and Public) , in Hospices and in Hospitals. The CQC is responsible for inspection in all these establishments Since the role of inspection has been taken over by the CQC from the Local Authorities and the Area Health Authorities there has been a dramatic reduction in Local Authority provision as you indicate. The reasons for this are many and varied but one not small factor has been the Public have a choice and it appears that the Public has favored the Private Sector.
With regards to your point about the Hospitals you have a short memory it was the Care Homes (with Nursing ) that were used to relieve the Bed blocking scandal not the other way around.
You obviously can not remember the Geriatric wards which were prevalent in the NHS for Caring for the Elderly, they STILL exist in some areas. I would also refer you to the latest fiasco coming out of the NHS at mid staffs hospital and others at this very moment no where no how would this situation been left unattended if this appalling situation was to have happened in the Private Sector.
I refer to the overall situation as i do not believe that the Survey on which this conversation is based has been carried out up to the normally excellent standards of WHICH?, I have followed which for many years and always believed in their Best Buy recommendations .Please forgive me if I feel let down but I really do not believe this report which should look at ALL the providers gives anyone any basis to make an informed choice. When I first started to get involved in this and other similar conversations My intentions were not to get into the sort of discussion which you accuse me of,it was to highlight the injustice that this report was giving to thousands of small businesses (25000) and many more thousands of people working in this Sector (approx.400,000) ALL doing a good job (according to the Vast Majority of the clients. When you mention the dirty word called Profit you must remember that if we do not make a Profit we would be closed down fairly quickly. We are not allowed to make a massive loss and be then be baled out by the General Public (Tax Payer) If you are really interested in getting Best Value use the Freedom of Information Act and obtain real figures from your Council and Health Authority and you will then maybe understand how sick the situation is. No one wants to believe !

carolef says:
15 February 2013

Hi Gerald

Back on the 21st Jan 2013 you asked if anyone had used Age Uk for help or assistance, and yes it took me a while to contact them, which I did on the 30th Jan 2013, well I am just letting you know that, apart from a computer generated response acknowledging the email sent, I have not heard anything at all from them as of 15th February 2013. Whilst I appreciate that they must have hundreds, if not thousands, of queries to deal with, I had hoped that I would have had some form of communication from them by now, if only to say they were busy and would get in touch sometime soon…..

regards Carole

Gerald says:
23 February 2013

Dear Carole,
Please do not hold your breath , I can count on one hand the number of times I have seen anyone from these sort of Organisations actually in a Care Home and even then it was only to raise money.
You and yours are doing more good with the visiting you have started please consider setting up a “friends and relatives group” as I have always found them very helpful if run the right way and working with the Staff in a constructive manner.
An outsiders view point should always be welcome as long as it is well meant and it is realistic and put in an informed manner. What really upsets me is when people with no knowledge of what it is like to be in the situation which Care Home Residents are in and have the audacity to decide what is or isn’t, good for them. Please refer to the survey method s employed by WHICH? And explain to me how anyone could have understood the magnitude of the problems ,even after 30yrs I am still learning.
You have seen from this conversation how few “Critics” really have a clue, in most cases they are so self opinionated they can’t be bothered to ask the people in the care homes themselves, making the excuse that everyone of the 400000 residents is suffering from Dementia etc.
In my view that is blatant Ageism with a large dose of patronisation thrown in.

gerald says:
25 February 2013

Dear Carole ,
Lovely to hear from you again, everyone seems to gone
rather quite recently.
Disappointed with your response from Age
Concern,you would have thought that a large concern such as Age Concern
would have designated a special helpline to assist people such as you
it does rather make you wonder where their priorities lie. Hopefully
they do not give the same lack of attention to all the Elderly
suffering in the NHS at the moment. My wife and I have been caring
for my wife,s mother for over 20 years now, (she will be 100 next year)
and do you know what? We have had no contact whatsoever from anyone at
Age Concern or Help the Aged at any time . maybe they might appear with
the Queen,s Telegram, you can but hope.
Keep up the good work there are
numerous people who have no-one to visit the and really do appreciate
people such as you and your hubby taking the time and trouble going to
see them, personal moments such as these mean more than anything .
All
best Wishes,
Gerald

Gerald says:
17 March 2013

Dear Carole
I have located the following site http://www.relres.org/ which looks ideal for you and any other relative wanting to complain about Care Homes. I have dealt with these people in the past and have found them very helpful

Gerald

Carole says:
18 March 2013

Hi Gerald

Long time inbetween us communicating but still nice to hear from you. Thank you for the link to that particular site, but I fear that it is more for people currently in care and for others concerned with their care……anyway, I will have anothert look at it on a different day to see if I can read differently into it. On a previous note: I was, unbelievably, sent mum`s notes from Holly House Psychiatric Unit, where she was placed after the time spent at the Care Home, and reading it has made me so so mad and brought up all the old emotions and feelings that I had towards the Care Home….In one of your messages you asked me why I seemed to defend Holly House…well I did believe that mum was being better cared for there… adn why didn`t they raise concerns regards mum`s treatment and so on??? Well, I suppose I needed to believe that someone was treating her properly….One mum`s first day of admittance it logs her condition physically and, I am NOW of the same opinion as you, why didn`t they raise concerns??? There is a full report but also a computerised drawing of the human outline and they hace marked all the bruises that her body was covered in., hgihlighting where they were darker on her shoulders, biceps, wrists, calves and lower leg into the ankle (on the right leg alone this bruise)and these are marked on both left and right sides!!!!! They do also comment and make a reference to her “panda” eyes which is what started me off on this campaign in the beginning, A couple of times, also, during the notes there are reference to ? fracture which makes me wonder why nobody reported any of this. Was Holly House trying to cover the backs of Welland House Care Home???? Home come, having read this (i assume they did) did the CQC and Worcs Council not go anyf ruther and investigate all her bruises and so on. Another thing that is so so upsetting…is the medication that she was on when she left AH and the continuing meds that were given to her….having got a friend of mine (who is a GP) to look over the list she was prescribed, I cannot understand how anyone could place so much into a human being and then still expect them to perform….My mum must have been in the devil`s hole and my tears, guilt, anger (any other emotions I have) have caused me so much upset and annoyance over this. By the way….Age Uk only sent me an email listing other places that may be of help to me!!!!! More sites to trawl through, but without success.
Thank you Gerald for letting me at least have the chance to tell someone about the latest instalment…I haven`t been able to go any further with this and still the clock ticks down towards May and my 3year deadline!!!!!

Gerald says:
18 March 2013

Dear Carole ,
I would now be inclined to agree with you that there has been a cover up .

The question is who is being protected and why?

I do not believe it is the Care Home as it is in the Private Sector and I cannot believe that All these Public Sector people would rally around it at a time such as this , my experience tells me this would NOT happen.

You mention that you have a friend who is a Doctor, perhaps you could have a word with him/ her for and explanation.

This situation is far more complicated than is at first apparent one just needs to look at the scale of the cover ups at the Mid Staffs Hospital where hundreds of people died before their time over many years and numerous people were ignored, even now no one has been penalised and no action has been taken against the Trust running the place. If you look at the Winterbourne case you will see the proper way it could have been handled.

One set of Rules for some and another set of rules for others .

All the best

Gerald

P.S. keep open minded, you will need to be to fully understand

Friends and Relatives do actual help after the event , I should have thought of them earlier.

gerald says:
25 February 2013

Dear Joanne Pearl,

A very recent “MORI” survey differs condiderably from yours, this survey carried out in a cross section of 850 homes (compared to your survey of 4 Homes) and looking at responces from 14000 residents( compare to 4 part time actors) showed that 96% of participants were satisfied with the overall standard ( 62 % were very satisfied). 92 % are happy living at their care home (3% not happy) As you have not surveyed any Residents at all it is dificult to get a true and realistic balanced view
Please respond to the findings of this survey, which was carried out by a Nationaly respected poll .

I hope the silence findicates Which? and others are now concentrating thei efforts on the much larger problem in the NHS as clearly indicated by the Mid Staffs Hospital debarcle.

A cheap suggestion. Ask your MP to makes it compulsary for every Care Home to have a panel of volunteers from visitors to the home in a panel. The panel’s terms of reference would be to report to the relevant minister any malpractices. The minister would then be under pressure to act. The panelists, being visitors, would realize the pressures in a Care Home and should thus be realistic in their views.
Tony Baker

Dear Tony,
Talk about OTT , I really do not think that anything that has been dealt with in this conversation warants the his extreeme Big Brother approach, now if we were to relate to the crisis of care in the Staffs hospital situation then I could understand your approach and imposing your drastic solution, but as far as I know nothing anywhere resembling this solution has been even suggested .
Just out of interest do you not realise that Care Home Visitors are adised ,by law, how and where to make complaints and anyone of them can jointly or independantly obtain the help of their local M.P.
I personally think their G.P. would be more responsive.
Most Care Homes already have Residents and Visitor Committees which are more than able to deal with most complaints. (Yes believe it or not this system does work)

I can assure you that out of 450,000 approx residents in care homes there will be some who are not satisfied with the service but when you look at the numbers reflected in this conversation I really do not think your suggestion is warranted

Carole says:
22 June 2013

Hi Gerald…Isnt it amazing how the CQC keep being brought up in all things wrong with their so called investigations in ensuring that vulnerable people -of all ages – havnt been getting the treatment and honesty they deserved??? I had to give up my fight against these and the care home on the 7th May 13 due to the three year rule and I cant help wondering if it was these self same people who were in charge at the time of my original complaint and seeing what they are being accused of now…no wonder my request was dismissed so readily…. Let’s hope that these people are now made to understand the suffering that those of us who have worries/fears about these places that they are supposed to moitor….

Gerald says:
24 June 2013

Hi Carole,
Lovely to hear from you again.
The instances you refer to relate to the CQC cover up arranged with the NHS with regards to the 100s of deaths which happened at Mid Staffs Hospital etc.to suggest that the CQC would have the same attitude towards the Private Sector Care Homes is not born out by the facts.ie there are numerous cases where the CQC has closed down Care Homes for transgressing their rules and regs to a much smaller degree than that which this coverup involved, plaease show me any facilities which the CQC have closed whatsoever in the NHS. I would remind you that I have referd to to this imbalance of approach between the Public and private Sector critics in the past (WHICH?) included.
Why does everyone ignore the terrible goings on in the NHS even the BBC (public sector) did another Panorama report on a small 20 bed care home and failed to balance it with a report on any Hospitals in the NHS.
Why can’t people look at the larger picture and see that the Care Homes are being used as a smoke screen for the NHS to hide behind, fortunately the general public, when given the chance , support the Private Sector.
Just out of interest, did you know that the majority of staff employed by the CQC are ex Public Officials is it any wonder that they have always shown this biased attitude against small family owned businesses.

Jane Lee says:
27 July 2013

I have visited several care homes where relatives have been staying and I am very concerned about the increasing trend of using non-regulated footcare providers for residents instead of chiropodists. What is also worrying is that staff at these homes are promoting these practitioners as chiropodists, which is misleading. It is breaking to law to claim to provide “Chiropody Services” when not registered see http://www.hpc-uk.org/aboutregistration/protectedtitles/ I would urge everyone who has an elderly resident in a care home to check that their relative is having chiropody treatment from a regulated practitioner. You can check if they are registered here ;- http://www.hcpc-uk.org/check/ In all the care homes I visited there was no chiropodist visiting so I made sure that my relative had their own chiropodist. When I complained about there being no resident chiropodist this i was told by staff that “they do the same things” which is incorrect as Chiropodists have to do a 3 years degree course whereas these other practitioners train by distnace learning. Some unregulated footcare persons have as little as 5 days practical training! So please check what level of footcare service your relative is getting. If you/they are paying to have Chiropody, then that is what they should have. Incidentally, some Chiropodists have changed their title to “Podiatrists” but the Titles are interchangeable and are both Protected Titles in law.

Gerald says:
27 July 2013

Dear Jane,

You make a very interesting point, one which I have spent many hours trying to sort out.
I believe chiropody is supposed to be “Free of Charge” to all pensioners and provided by the NHS can you tell me why anyone in a Care home for the Elderly should have to pay in the first place .
Surely if the NHS chiropody were to fulfill this duty then your point would be dealt with as assume that all NHS practitioners would be registered etc.

Just a point, when we took it up in our area it took us over 2 years to get anyone from the NHS to attend to any residents, their excuse was shortage of staff. Are there any Chiropodists registered the same as Dentists and Opticians?

Jane Lee says:
27 July 2013

Unfortunately, Gerald, owing to cost issues Chiropody/Podiatry is now longer free at the point of delivery for all pensioners. All NHS Trusts have their own criteria to determine eligibility.
Chiropodists/Podiatrists need to be registered in order to use the Title see:- http://www.hpc-uk.org/aboutregistration/protectedtitles/ and, as you say it is mandatory for all NHS Chiropodists to be Registered
Very few NHS Trusts provide a mobile Chiropody/Podiatry Service now and require patients to attend central clinics.

Gerald says:
28 July 2013

Dear Jane,
This is exactly the same response I originally got from our NH/PCT and only after contacting the Department of health did I get any joy for our Residents.
If you are really interested in getting the best service for the Elderly in care homes, perhaps you could take the trouble of clarifying this issue on a National Scale .By the way I am not surprised with the response you have got from your local people, it appears that when an Elderly person goes into many people in the NHS treats them as second class citizens I wonder why?
The Health Department’s instructions continuing healthcare for the Elderly was published around 1996 and as far as I am aware it has not been changed and it is NOT up to reinterpretation by the Trusts as you suggest.

Jane Lee says:
28 July 2013

Hello again Gerald,
You mention “The Health Department’s instructions continuing healthcare for the Elderly ” where can I see a copy of this document, it might be useful?. Thanks.

Gerald says:
28 July 2013

Dear Jane,

Dept.of Health
Publications Department

Please also check out why the PCT & the Local Authorities have got together and are now making Nursing Home Placements “Means tested” this is something else which they have introduced by stealth and subterfuge.

Jane has made the important point that some care homes are using unregulated providers of foot care. Care homes should be using registered chiropodists, whether or not NHS services are available. Let us focus on the service provided by care homes rather than attacking the NHS.

Gerald says:
29 July 2013

Hi Wavechange

Lets knock the the Private Sector once again its easier than dealing with the real villain isn’t it.
My point is really simple that if the NHS was to carry out its duties then people in care homes would automatically get chiropody FREE and delivered by qualified practitioners which is surely the best of both worlds.
Why is it OK to knock Care Homes and not at the sametime compare it to the lousy treatment of the Elderly by the NHS, the Elderly have paid their National Insurance all their lives haven’t they, surely there is an injustice in this somewhere?

The subject of this Conversation is the deficiencies of care homes, and Jane has made a valid criticism.

If we had been invited to discuss the failings of the NHS, we should focus on that. I recently have expressed my concern that the NHS is spending money on worthless homeopathic ‘treatment’.

Gerald says:
29 July 2013

Wavechange

If one concentrates on the essence of Jane’s comments, surely it is the duty of the qualified chiropodists to sort out their unqualified colleagues not the care homes .Care Homes are not responsible or qualified for dealing with this sort of of professional matter.
Helping the Residents to obtain their treatments “free of charge “, under the NHS, or from any other source on the other hand is surely something they should be encouraged to be involved with isn’t it?

The residents are having to pay for a service just because the Local Health Authorities are not meeting their responsibilities.surely dealing with this sort of matter is more useful than getting involved with matters of professional etiquette.

If this conversation only deals with the deficiencies of care homes it then denigrates into a “”Knocking Shop” , surely a more balanced discussion should be welcomed?

Gerald

I believe that care homes have a duty of care to select qualified people to deliver foot care. If they can help their residents obtain treatment free-of-charge, that’s great.

Using unregistered footcare providers for reasons of economy (as suggested recently by John Ward) might be appropriate for residents capable of making informed decisions and no significant problem with their feet. I don’t see this as an option for anyone with diabetes, where loss of feeling is common.

I very much support John’s recent comments about this Conversation.

Gerald says:
29 July 2013

Dear Wavelength

During earlier discussions you actually stated that you had no experience of Care Homes whatsoever, what has changed? you also accused me of trying to influence you , at least I have 30 years of experience what gives you the right to decide what care Homes can or cannot do, surely you must understand that they have their Guidelines (Many laid out, quite clearly, by the CQC Standards)
If you check out the legal implications of what you are suggesting you might also find that your believes are also not practical.
The client decides whom they employ to provide external services NOT the Care Home you might find that they would be severely criticized if they tried to curtail the freedom of choice of the clients.

I suggest you totally ignore my comments, Gerald. 🙂

Can we please be polite and respect one another when making comments. Thanks.

Jane Lee says:
30 July 2013

Thank you Gerald for that but the wbsite has a huge number of documents on it. Could you point me to the link for the one you mention?
Many thanks.

Gerald says:
30 July 2013

Please remember this was around 1996 and I was on a committee specially set up by the Area Health Authorities I am sorry I cannot be more exact .Try google “continuing health care for the elderly”
The main points I remember is that it made it very clear that services detailed were mandatory, I also remember at the time that only one out of three we attended accepted without reservation and so it does not surprise me that other Authorities have procrastinated .
As you will note people in general appear to have difficulties in understanding Local Health Authorities do not always comply with The Health Departments directives, but I am sure you have a wider understanding
Good Luck ,be patient it took us over 2 years for our nurse manager to get residents on their list

I am coming late to this debate, but as an HCPC Registered Podiatrist(Chiropodist) I would like to respond.
It is not the duty of the practitioners who are Regulated under Statute to “sort out” the unregulated footcare providers. They are not our “colleagues” as they are outwith the Profession of Podiatry.
Care homes have a choice as to which type of practitioner they choose to use and at the end of the day must take responsibility for that.
This is a different argument to the one about whether or not resident should have to pay for podiatry treatment.
We now live in a world where demand for all types of healthcare is infinite and resources are still finite. The NHS is a victim of its own success in that the health of the nation has improved and people are living longer. This however, brings it’s own set of challenges for the ever-beleaguered NHS.

Having said that, care homes must still take responsibility for what goes on within their establishments and what staff they engage.

A number of points occur to me after reviewing recent contributions to this Conversation:

a. There have been serious mismanagement and abuse issues affecting institutions in both the private and public sectors where the elderly or vulnerable are in occupation on a residential basis rather than as patients requiring treatment.
b. There have also been examples of bad nursing and lack of care in hospitals, most of which are under the NHS.
c. Generally nowadays, the residential care of the elderly is managed by private care home operators. Some of it involves nursing and treatment which is provided directly by, or supplied under contract to, the care home operator.
d. The care home manager organises the provision of chiropody/podiatry treatments. In my view a free NHS service should be provided where this is possible and in other cases it should be done by a registered practitioner. If for economy reasons, there is an intention to use an unregistered footcare provider this should be made clear to the residents or to their responsible relatives who might wish to make alternative arrangements.
e. Every time this Conversation gets back on track to looking at the deficiencies of the private care home sector, the treatment of NHS hospital patients is brought into the discussion as a deflection from the real issue [which is about complaints about the failings of care homes]. The Which? investigation might have its drawbacks relative to other surveys but it has met its stated objectives and shone more light into hidden corners of the care system for the elderly.
f. Perhaps a more thorough examination by Which? would reveal many more serious concerns on a wider scale in the private residential care business [or perhaps not – we just don’t know]. However, I would contend that the resources and expertise needed to do such a study go way beyond what Which? subscribers like me want it to do as a voluntary-funded consumer organisation with a thousand other product performance, legal, safety and protection issues to deal with.
g. Personally I find the frequent references to the appalling circumstances at the Mid Staffs NHS Hospital [which have been the subject of full-scale inquiries] irrelevant to this topic and do nothing to bring about closure for those affected.
h. Overall the entire system is over-reliant on the input of relatives and volunteers to ensure that residents experience the kind of care and support they should have, and on goodwill, watchdogs, and whistleblowers to alert society to the problems. It is apparent that some of the charitable and voluntary organisations that we expect to engage with these problems are themselves either overwhelmed, under-resourced and ill-equipped, or have other priorities.
i. To redress the situation, society either needs to lower its expectatons or find a very large pot of money.

Your last point disturbs me. Much of the criticism is levelled at lack of “compassionate” care – that is staff not being caring towards patients, not lack of resource; this applies to criticisms made in both the public and private sector. Staff who behave unnacceptably in this regard should be weeded out and either properly trained or removed quickly – an attitude that “this is the way it is” simply encourages this sort of poor behaviour. We seem too tolerant of underperformance – perhaps frightened by litigation – but until we get to grips with it we will suffer. “Whistleblowers” – people who care about this – should be protected from intimidation and not subjected to gagging clauses – calling it bribery might be better – and Local Authorities should be more prepared to respond to relatives complaints.

I wholly agree Malcolm. I think my final point was over-simplified and too cryptic. Proper care should cost no more than improper care. Training and supervision are the keys to quality. It is the “inspection and protection” regime that needs beefing-up and it would be money well spent. Bad care is the real waste of resources.

Keeble says:
29 July 2013

Re Malcolm R’s comment regarding lack of compassionate care – my father died in a Care Home last year and every day I feel sad about the lack of compassion he went through from the staff of the care home in his last years. He was bedridden and mostly ignored except for when staff brought him his food which was often unedible – when I called at meal times I often had to complain. The only other times he saw any of the staff was when they had to “change” him as they would not hoist him to the toilet using “safety issues” as the excuse. He was a large man and the way the staff treated him was not as a human being but more like “a resident they could do without”. They were ok dealing with the little old ladies, they were easy to handle, but I complained so often, including to their Head Office, that the Manager told me to find somewhere else. The Head Office said they would look into it – they did not. At this home their was a member of staff that treated my father with respect – however this member left after my father died as I have seen her since and she told me she could not handle the lack of care at the home any more and it had made his ill. Please Gerald no comments from you.

I agree Malcolm, though I think John is right that we need to find money to help ensure that our elderly receive good care. I have little experience of care homes but in the past few months I have heard some rather distressing tales from friends. The worst was a 95 year old having to wait for half an hour for help after having an accident.

Gerald says:
29 July 2013

Dear John
In general I agree with your summary ,the main reason for me referring to “other providers” of care for the elderly is to give a balancing viewpoint to the equation which surely should be available in any reasonable discussion .
yes there has been public investigation into the NHS but has there been any action taken, I do not think so.There has also been investigations into Care Homes and numerous people have lost their lively hood for far more minor transgressions than happened at the Mid Staffs Hospital.
I have always looked to WHICH ? for balanced reporting in the like of Cars etc. often dealing with complex issues I welcome such a report into the care of the Elderly .

Gerald says:
30 July 2013

Dear Keeble

My only question is why did you put up with this situation so long, why did you not move your father immeadeately you were aware there were problems???

Please reply as I really cannot understand why people dot not use this obvious option,Managers of Care Homes need to understand this dilemma so that they can respond to their clients better.

Please be assured I will deal with this matter compassionately .

Finding a suitable alternative care home in a convenient location, and with a current vacancy, is not so easy. Transferring a resident is not just a logistical exercise. It is the inadequacy of the complaint process, and the lack of effective resolution within it, that adds so much distress to the situation, to the extent that people really do not know what to do for the best.

Gerald says:
30 July 2013

Dear John,
To assume that any service is not dependant on the amount people are prepared to pay is surely unpractical . Even at the Savoy in London which can charge as much as £6900 Per Night they would not offer some of the services which people take for granted in aCare Home
When one considers the number of people residing in care home (approx 450000) you surely don,t expect one model for all, and that definitely would not be either a ford or a Rolls Royce.
The problem is that everyone seems to have there own ideas on the matter, to come to any common workable example is impossible.

Gerald says:
30 August 2013

Please check out cash and resources WHICH put into Cars, washing machines tvs, ec etc and then tell me that these products are more important than Caring for our families older generation?
I donthink so

I was addressing the problem of a resident being mistreated, or treated with insufficient care, and the practicalities of just removing them immediately to another home. My point was that it is not a simple matter of ringing around a few establishments and seeing who can take the elderly relative in for a few nights. As you appreciate, this involves serious long-term considerations that affect the life and well-being not just of the resident but of other members of the family. I sensed – perhaps incorrectly – that there was some criticism of Keeble [above] for not having arranged an immediate transfer for her father. There should be a procedure in place that deals with concerns over care and treatment and resolves them within the chosen environment. The degradation and indignities to which some residents have been subjected should not be experienced at even the most basic place.

Gerald says:
30 July 2013

Dear John,
My question to Keeble was a genuine attempt to try to understand why, after several attempts both with the Home,s Manager and Head Office to improve her fathers care she still her father in this establishment. It is not intended as a criticism and I am obviously aware of the other factors you mention having placed both my parents and my wife’s.
I would be interested to know of the involvement of the Local Authority Social Services, the Area Health Authority and the CQC
It would be also interesting what sort of Contract (with or without care planning ) was involved.
Was there any care assessments made before admittance , was there any reference taken up by Keeble etc. etc.
The objective of my queries is to ascertain what actually happened and to give other readers the benefit of Keeble,s experience ,as they say prewarned is prearmed .
Please refer to my previous mail to understand , my whole objective is to help the Public to understand the complexatives and pitfalls involved in this procedure .
I am in total agreement with your summary and in fact would go even further, my only criticism is that you view point is rather narrow, you are only looking at the tip of the iceberg .
All I can say is that Care Homes and Nursing Homes have all been under the very strict control of Local Authorities an Health Authorities for at least 40years ,it is only in the last couple of years that there has been a reasonably independent Authority involved .Things have improved considerably according to a number of recent reports (always room for improvement as they say) The same NOT being the case for the NHS Geriatric Wards and the Local Authority Care Homes (yes they still exist) according to CQC reports

Gerald questions the allocation of Which?’s investigation and campaigning resources [see reply above] and feels that “caring for the elderly” should have higher priority.

I believe the resources that Which? puts into its product testing and research are directly related to the feedback it gets from its subscribers who pay for the magazines, books, and other services. The time and effort put into various other campaigns and the consumer issues that it deals with pro bono publico are in broad response – and probably proportionate to – the concerns expressed by the public at large on a wide range of subjects. I expect “care for the elderly” has earned its rightful place in that hierarchy. Perhaps the membership should want less on kettles and cars and more on care homes but the evidence must be that they don’t. In my view, it is the role of the Care Quality Commission to protect people in care through setting standards, inspecting, remedying deficiencies, and enforcing as and when required. There are 18,000 registered care homes. I cannot see that it is either fair or appropriate for Which? to divert any more of its resources in this direction – indeed it is sometimes claimed in these Conversations that when Which? does shine its light on other services, commercial activities,and controversial issues that it should stick to what it knows and leave these troublesome topics to fester in the dark. I am glad it doesn’t heed these calls, and I am also pleased it has kept its focus on the private care industry and not deflected its beam into the public hospital sector on this occasion as suggested in some quarters. I am hoping that it will shortly pick-up on the Competition Commission’s recent report on regional monopolies in the private hospital sector which is obviously concerned more with the costs rather than the quality of service.

Gerald says:
30 August 2013

So John ,lets forget any form of fairness, lets forget the fact that generally the Public (over 450000) are generally satisfied with the Private Sector lets just try and discredit ALL the Private Sector now including the Private Hospitals,
Good and fair competition is good for everyone including the NHS why are you turning a blind eye to the Biggest monopoly in the World ? which according to the CQC is failing dramatically or don’t you read the news papers or the CQC reports either.
Whyhave you such a downer on the Poor Struggling Private Sector??

I am aware of the failings of the NHS, and I know that a number of hospitals are doing badly on essential functions, especialy in East Anglia where I live. Fortunately, the CQC is on their case, the local MP’s and GP’s are trying to get improvements, managements are being changed, and the health minister is on the rack in Parliament. I am not complacent that all will shortly be fixed but I think there is a democratic process and a complaint mechanism [which is what this article is about] in place. Which? is basically a service for consumers who spend their after-tax money buying goods and services and want research on these products to help them get satisfactory results and good value for money. It also looks at various state-run services as and when it can but its priority is the commercial sector since that is the area its members want to know more about and which costs money at the point of consumption. Much of the private sector providing both medical and residential care services is in the hands of some very large corporations that need to be held to account, as does the NHS but as I’ve said before the NHS is not generally providing long-term residential care where clinical treatment is not an element.

The NHS is failing because of the unreasonable demands put upon it by “benefit migrants” and immigrants who have never contributed a penny into it, yet still get all the advantages of our system. There is an increasing problem in inner cities of children born to immigrant families where 1st cousin marriages is the norm, This causes babies with deformities who need care over and above the usual postnatal care.http://www.theguardian.com/science/2013/jul/04/marriage-first-cousins-birth-defects when will this government clamp down on the abuse of our NHS and restrict care to those who have paid into the system? Shouldn’t those of us who have paid into the system for years demand that the balance is redressed?

Gerald says:
2 September 2013

Dear John,

I thought the “Product” was in fact Caring for the Elderly at the end of their lives which in my mind should involve ALL places of domicile as laid down by the Department of Health’s Directive : Continueing Healthcare for the Elderly .
When Which? do other product surveys on services such as Banking, Insurance, Builders, Plumbers etc etc.they try to include a broad cross section of Providers, large and small, Public and Private and Corporate. Why haven’t they approached this particular, highly emotive , subject with the same attitude.
Please note I have asked the People at Which this question and I have failed to obtain any reasonable answer.
Instead of making excuses for Which or trying to second guess them perhaps you could ask them to put their point of view, maybe you could get an answer from them .

Gerald says:
2 September 2013

Dear John,
I have been a member of Which for many years and as I understand it their objectives have always been to give a “balanced perspective ” of services or products which they survey.
My point is very simple, in this particular survey, dealing with Care of the Elderly , they have dramatically failed to meet their usual high standards by concentrating solely on a very small cross section (four) of the Private Sector and totally ignoring the Public and Voluntary Sectors.
To understand where people are being “Cared for” one has only to look at to the records at the Registry Office, you would be suprised to find the number of people dying in Hospitals and in their own homes,if one then compares the level of service given one might understand my point.

I appreciate the points you are making but I think Which? are entitled to narrow down the scope of their enquiry. Private care homes cost people an enormous amount of money and a number of them are not well-run; relatives have complained that the system fails the residents and that they find it hard to get answers to questions or to get things put right. I am not sure that mortality ratios and locations have any bearing on the specific issue. I fully expect people who are looked after in residential homes to receive bettter care than people who are trying to survive on their own or even with a relative, and obviously the eldery patients in hospitals are usually there because they have serious illnesses or conditions some of which are mortal; the numbers for hospices would be worse. I cannot see why the private care home sector seems so concerned over being the focus of Which?’s coverage; if everything is satisfactory there should be nothing to worry about and a lot to be gained from it.

Gerald says:
2 September 2013

Everything you apply to Care Homes is actually 10 times worse in the NHS including the costs.

Just what sort of residents do you think are now going into Care Homes if you think that only the Hospitals deal with End of Life Care .Things have moved on since the “good Old Days ” at least 90% of Residents now require Palliative .The new NHS commisioning boards are offering placements at less than a quarter of the price they give to Hospices and Hospitals for exactly the same Care Requirements, why would you think that is such a dissparity ?

Gerald says:
2 September 2013

Dear Jane,

The NHS has been in trouble way before immigration, the basic problem is Bad Management at all levels any organisation which deals with the massive problems which the NHS has by promoting Bad Managements (such as the Chief Exec. of the Mid Staffs Hospital) or paying them off massively (as in the case of the BBC) needs a massive wake up call.
Where is this going to come from I ask? it is obviously not coming from the share holders (in this case the Public) or any Politition as they seemk to be totally ignored by these Monoliths.
I being a lowly Care Worker have no simple answers but I humbly suggest that answers will not be forthcoming from Beurocrats, Politicians or their like, we have to approach people with a proven track record of running very large enterprises and give them our full backing over many years.
As long as the NHS is used as a Political Football it does not stand a chance of becoming the superb institution which it deserves to be.

Jane has raised an issue which many people sympathise with, especially in these straitened times, about the impact of “non-contributors” on the service provided by the NHS. I do not share this view myself because I think that in the vast scale of the NHS the impact of these demands is marginal and tolerable. The NHS is funded out of curent revenues, in the form of income and other taxes [like CGT and IHT], National Insurance, VAT, and other customs & excise duties. The multiplicity of sources of these revenues means that it is impossible to say that immigrants are not making any contribution to our public services and I doubt if there is any competent evidence that their uptake of public services exceeds that of the rest of the population. If all non-UK nationals left the country and all UK-citizens abroad returned I am not sure it would be possible to spot much difference in health service uptake and the nett revenues accruing to the state might even be lower. Returning to the topic of this Conversation, I suppose the point is that a better NHS – potentially increasing survival rates and life-expectancy – would put even more pressure on the private care home sector and it is questionable whether it could cope.

I am afraid you are misinformed John Ward. Children from Moslem families are over-represented on the Paediatric Specialist Wards of inner city hospitals – http://www.theguardian.com/science/2013/jul/04/marriage-first-cousins-birth-defects

see also ; http://www.dailymail.co.uk/health/article-185768/Sickly-immigrants-add-1bn-NHS-bill.html

So there is the “competant evidence” you allude to.

in addition, when we open our doors to Romanians and Bulgarians in 2014 we will have yet more problems :http://www.thesun.co.uk/sol/homepage/features/4861619/Time-Bomb-immigrants-to-bring-drug-resistant-TB-superbug-to-UK.html

To say the demands are “margimal & tolerable” is, IMO, unrealistic and naiive.

Gerald says:
3 September 2013

The Private Sector could definately cope, due to blocking actions by the Local Authorities changing eligability criteriers there are now empty beds in most areas.There is still bed blocking going on in the NHS

Gerald says:
7 September 2013

Dear Jane,
The really sick thing is that , the NHS has colluded with the Local Authorities and has introduced means testing for Elderly People to fund Nursing Home fees (which used to be a free alternative to a bed in a Hospital ward).
Check this out on another WHICH conversation, certain people do not seem to want to reconcile this fact. but it is true, it has just been very cleverly hidden.

Gerald says:
13 September 2013

Dear Jane,
To make your point relative to this particular conversation you also need to point out that the Elderly of this Country ,the people who have paid all their lives for the NHS are now having to sell their homes etc. to fund for Care in Nursing Homes because the NHS has withdrawn funding.

This Conversation is to discuss care homes and their failings.

The subject is not funding of care. The subject is not deficiencies of the NHS, so please don’t bring this up again, Gerald.

We’ll have a Convo about funding for care next week – stay tuned…

Gerald says:
13 September 2013

Hi wavechange,
I did not bring this up,it was Jane with John responding.

A fair comparison of Providers of any service being scrutinised by WHICH ? should be the objective, not this one sided, bigoted approach which you and others are advocating.

Gerald says:
13 September 2013

Not before time !

I’d like us to be polite to one another in the new debate when it’s published please (and here in the meantime!) Thanks

As Jane has pointed out, the NHS faces many major problems and is stretched both finanically and in capacity. The Guardian article she referenced was about UK nationals and it put the issue of birth defects arising from first-cousin marriages among the muslim community in context. Certain places will obviously experience a greater impact than the country generally and in those places it will be staistically disproportionate but overall it is not especially significant.

The pieces quoted from the Daily Mail and The Sun seemed to be highlighting one of the implications of immigration and contained a fair amount of speculation. Nevertheless, there is no doubting that many people are deeply concerned, if not to say somewhat frightened, by the perceived consequent change in priority for NHS treatment across the population.

Looking at the demands on the NHS, and thinking about the medical conditions that affect the cost of specialist services and the availability of treatment, we could also consider the incidence of alcohol abuse, tobacco addiction, over-consumption of unhealthy food, narcotic substance dependency, malicious behaviour, sexual promiscuity, dangerous driving, and several others no doubt. I think the muslim community would figure low in an ethnicity analysis across most of those issues. The injuries and harms are generally self-inflicted but the costs of healing [and treating victims] falls on us all. The great bulk of NHS resources is still expended on ordinary illnesses, sufferings and conditions, deficiencies and defects, bodily weaknesses and malfunctions, maternity, childbirth and age-related degeneration that are virtually universal. Thankfully the great contagions and crippling diseases of the past have generally been vanquished, or relieving treatments found, so there is more focus on unconventional or non-traditional ailments with the risk that specific sections of the community attract irrational comment.

Gerald says:
13 September 2013

Dear John,
Blanket whitewash for the NHS, once again, you blaim everything on to the British Public, surely this is rather a blinkered point of view. When it comes to other, Private Providers, you do not have the same understanding towards them and seem to have a totally different set of criteriors in place.
By the way, I am suprised that haven’t noticed that Jane’s conversation was digressing from the the main course of this conversation ?

I was aware that we were diverging along a new path but I felt I could not let Jane’s attribution of the NHS’s failings to cultural issues within the Muslim community, and to speculative apprehension over migrations from eastern Europe, pass without a balancing comment. My point in my post of 12 September was to show that there are a lot of burdens on the NHS and that picking on certain ethnic sections of the population [as some newspapers have done] is over-simplistic.

Back on care home provision, and picking up on Gerald’s frequent criticisms that I and others have a biased outlook on the subject – seeing the NHS as doing no wrong and the private care- home sector as deserving much closer scrutiny – I must say I welcome today’s news that ” . . . a new hospital inspection regime for England is getting under way, with the chief inspector promising to ‘expose poor and mediocre’ care. . . . The Care Quality Commission has agreed to overhaul its inspections following the Stafford Hospital scandal” (BBC News). I also look forward to the forthcoming Which? Conversation on funding for care; I think we can all agree that funded care is almost exclusively undertaken through the private sector.

Whenever I hear of a promise of an organisation doing it better – or “lessons will be learnt” – I shudder. By now, if these people were properly trained, whether in the NHS, social services or wherever – you would think these basic principles would be second nature. I can only conclude they are not properly trained or experienced, or understaffed.

I dislike the term “whistleblower” – it takes on the connotation of “snitch” or “telltale”. Individuals should not assume they know better than anyone else – why do Edward Snowden and Bradley Manning, or Julian Assange believe they have a superior status that entitles them to undermine national security? However, I do believe that people, including the latter, who may have disturbing knowledge of the profession they are associated with, should have a route to express their views and to be listened to. The NHS, for example, should find a way to encourage this without any penalty; enough comments from those at the coal face should trigger an investigation and hopefully begin to address issues. A combination of the CQC aided by information from such people would be surely better than just inspections alone?

Two final rants – how many times do we hear “we cannot discuss individual cases” – they are all individual cases. Stop paying people (gagging clauses”) to keep quiet if they leave – I’d call that bribery or blackmail in the real world.

I should get out more!

Whenever I see an organisation promising to do better – “promising to expose poor and mediocre care” I shudder; it is a bit like the stock response “lessons will be learnt”. Why did they not do their job properly in the first place, and why will it now be different?

People at the “coal face”, and clients, see problems first hand. They should be encouraged to report these without fear of penalty to the CQC. If sufficient evidence from these accumulates then this should surely lead to better targetted investigations and inspections, and more positive outcomes?

We should also ban gagging clauses when employees leave – this, in the real world, amounts to bribery or blackmail, and individuals should not be rewarded for witholding information.

Gerald says:
17 September 2013

Dear John,

You fail to mention that the system failed to respond to numerous serious complaints for years and numerous insiders have been involved in smoke screening for years. My issue has always been that the Private Sector Care Homes have also been used for years to deflect the Publics attention from the failings of the Public Sector. Fortunately the Public have always been able to see through this farse and have supported the Private Sector with their custom.

Please refer to Malcolm R’s comments he has a much better way with words than I have all I can add is that if the Private Sector had tried to bribe and intimate people as the Public Sector has done we would have seen far stronger acions been applied.

At last the CQC seems to be applying a more even handed approach just remember the state the NHS and the Public Sector Care Homes were in whilst they were self monitoring, it is only since there has been the “independant” CQC inspection that there has been any form of response to the numerous complaints.

Bye the way the NHS are still by far the biggest provider of Palliative Care charging at least 4 times the rate given to the Private Sector maybe it is time for WHICH? to do a “Best Buy” analysis.

Gerald says:
17 September 2013

Totally agree Malcolm,

unfortunately this is rife all over the Public Sector and the MPs jsut do not seem to have any solutions.

Gerald, I would be pleased if you did not talk about me and my comments as if I wasn’t here. I consider it to be very rude. If you have an issue with me or my postings I would be pleased if you would address you comments to me directly. Thank you.

Gerald says:
21 September 2013

Dear Jane,
Where I have replied to your comments I have addressed my reply to you directly, where I been conversing with say John I was just pointing out his inconsistencies not yours ,if this offends you please accept my apologies.

With regard to my final sentence above I can now see from the new Conversation that it is not about the charges for living in a residential care home [which is dominated by the private sector although, as Gerald rightly pointed out below, palliative care is largely provided through the NHS] but about the financial support mechanism for people who need domiciliary care services in their own dwelling. This is the responsibility of local authorities although private sector companies might be contracted to deliver the service; the support available is inconsistent across the country and frequently inadequate in my experience.

I got a bit lost in the threading here!

I was referring to the final sentence of my post at 11:53 on 17/09/13 and to Gerald’s response three posts later at 12:58 on the same day.

Gerald says:
3 October 2013

Dear John
The reality of the situation is that the Public Sector “control” through provisioning and purchasing Billions of pounds of our money whoever has looked at the overall situation in the last 20 years has, after numerous Reports etc condemned the mmajority of Services provided by the Public Sector.
I am old enough to remember the battery farming of elderly people in geriatric wards, we are still getting abysmal reports about Elderly care and child care all the time,what is the response from the Public Sector, they give the perpetrators a large pay off,then find them another high paid cushy number on another useless committee somewhere and the finally retire them on a large index linked pension, all before some reach 50all this when we in the Private Sector are being made to work longer .why do people turn a blind to the atrocities in the Public Sector funded by Billions of our money and then vent their rath on the small providers in the Private Sector is it a matter of frustration I wonder or just a large dollop of old fashioned Politics.It is definitely not a matter of common sense or value for money

Our latest Convo is about personal care in the home and the postcode lottery with costs: https://conversation.which.co.uk/money/paying-for-personal-care-services-council-financial-support/

New inspections by the Care Quality Commission have been announced, and will include secret filming: http://www.bbc.co.uk/news/uk-24523895

Surely the first step is to listen more closely to reports from residents, relatives and staff and to encourage such reporting to a listening organisation that is prepared to investigate and act. The knowledge that such reporting will be taken seriously may well discourage poor quality care?

Gerald says:
16 October 2013

If the BBC can film it surely “everyone ” knows there is something dramatically wrong, why can’t people just work together and sort the problems out, this sort of approach just wreaks of which hunts which by now we should be aware are not don e with the best of motives.
I would also suggest that the BBC have got enough in house problems of their own to sort out and far bigger problems in the NHS to concentrate on.

Gerald says:
16 October 2013

Dear Malcolm,

Now we are talking sense, if the Local Community were encouraged more to get involved surely everyone would soon react, I have tried to get the Residents and Relatives Association involved on a Local Level by nominating Local Reprentatives in each Care Home, but I am still waiting for any positive action , they seem to busy dealing on a National Level, I have also tried to get Help the Aged and Age Concern similarly involved with the same response ,Lots of Nockers , not many Helpers. I have even tried to arrange a “Friends of the Care Home” system, apathy reigns I am afraid.Either that or the just isn’t the disatisfaction there which certain people would like us to believe ??
It would be great if you could try to organise something down the above lines in your area and let us know how you get onif you need any help, please ask.