“Neglect Shames Britain” – 5

Headlines in the Daily Mail again on the subject of the inhumane treatment of the elderly in NHS hospitals – “Elderly patients dying of thirst“.

This is a continuation of a campaign started nearly six months ago under the front page headline “Neglect Shames Britain” (see my follow-up blogs dated 6 December 2010, 22 December 2010, 23 December 2010 and 1 March 2011).

What brought this back to the Daily Mail’s rather half-hearted and sporadic campaign are reports coming from the Care Quality Commission visits to inspect hospitals and elderly wards in particular.

Here are some of the shocking findings:-

  • 800 patients die partly from dehydration
  • 300 patients die from malnutrition

Both these statistics are likely to be grossly understated because of doctors not wishing to invite further investigations.

A quarter of the hospitals inspected were failing to meet basic standards, for example:-

  • Major concerns over malnutrition – meals being left beside sleeping patients and then later cleared away uneaten.
  • Patients having to use commodes at their bedsides  – indignity becomes the order of the day.
  • Patients being examined in an open ward without adequate screening.
  • Emergency call buttons left out of reach of patients, or when they are used not being answered.

These are everyday occurrences in a failing system of care of the elderly.  Yet the outcry is muted to say the least.  Relatives’ complaints are fended off with excuses or passed into a black hole of bureaucracy.  For many less critical issues – student loans, fox-hunting, poll tax – thousands take to the streets to protest.  For every soldier that dies in Afganistan, hundreds line the streets of Wootton Bassett with heads bowed in respect.

Meanwhile the Patients’ Association, Age UK and the Daily Mail beat their breasts to no avail because they don’t know how to campaign.

Now the CQC can be added to the list with their next step being the threat of fines – which are hardly going to help hospitals that are already short of money.

Above all of this strides the teflon Health Secretary, Andrew Lansley, proclaiming his hollow wish to “stamp out poor care”, uttering platitudes about “patients are the most important people in the NHS”.

One thing is certain – this problem will not go away.  This grumble will rumble for a very long time to come, and more elderly patients will die unnecessarily in NHS hands.

The fundamental issue is that the NHS is being overwhelmed by the increasing numbers of frail elderly people.  With cruel irony, this is in part brought about by the success of improving medical advances, which have led to increased longevity.  Sadly this has not been matched by corresponding increases in resources, nor is it helped by the obvious inefficiencies and often ineptitude of the NHS.  Politicians are reluctant to confront these issues for fear of the defensive reaction from the battalions of NHS staff, the medical professions and the trade unions.

 

1.  Don’t take on the whole NHS – think divide and rule.  Put more money into some specialist areas e.g. Cancer, hip replacements and obesity aimed at achieving “best in world” status and better outcomes for everybody.

2.  Outsource care of the elderly to nursing homes and extracare housing with greater medical support in the community.   However, in the light of the Southern Cross debacle, a necessary pre-condition will be to ensure that organisations are on a firm financial footing before any out-sourcing contracts are placed. Although as far as I am aware, this has always been the regulators responsibility, they just haven’t been doing it very well.

3.  Also introduce a new qualification of “nurses for the elderly” to upskill the social care sector with practical training.

4.  Make hospital a last resort for older people who have complex and chronic conditions.  Ensure essential visits for acute treatment are kept as brief as possible and then support this approach with convalescence and rehabilitation in nursing homes and extracare housing.

5.  Stand up to vested interests in NHS unions and some self-serving clinicians in the interest of better outcomes for elderly patients.

Posted in ELDERLY UK POLICY, Residential Care | Tagged , , | 1 Comment

“Breakfast Exercise” 6

The New York Times regularly has good coverage on ageing. Recently I was sent a very interesting article entitled “Tai Chi eases depression in elderly”, by someone who knows it is a regular early morning pastime of mine.

The report cited research at the University of California.  After 10 weeks of Tai Chi a group of 70 year olds who had previously suffered from depression, made a marked improvement.   The outcomes were dramatic – 94% improved significantly in terms of physical function and cognitive tests.

Other studies have shown Tai Chi can also relieve stress and anxiety and improve sleep quality.

Two thirds of older people with depression don’t respond to initial drug therapy.  Tai Chi is a simple and easy to do alternative to more and more drugs.  Why don’t doctors prescribe it on the NHS?

So no excuses Pilly Galore, get out in the garden and get started on some gentle exercise.  I’ll be out there too !

tiachi2 (2)

p.s. If you have not read about Pilly Galore, click on “pills” in the blog cloud.

Posted in HEALTH, SMILES | Tagged | 3 Comments

Southern Cross card game televised. 6

  The Southern Cross card game is now being watched by millions on TV.  The Chairman was forced to come out into the public gaze and submit to an inquisition by John Snow on Channel 4 News. Meanwhile, the newspapers were having a feeding frenzy by re-exposing old news and declaiming the apallingly rash lending of the financial institutions.

What a pity they were so disinterested a few years ago when the deals first were being struck. Could it be that they were all mesmerised by the glamorous profits being made by the vulture capitalists and the astronomical bonus’s being “earned” by some of our well known high street banks ?   As Gordon Gekko said in the 1987 film “Wall Street”  —- “greed is good”.

    Who wasn’t greedy :-

?  the shareholders in the banks who benefitted from the high dividends ;

?  the savers in the banks who got higher rates of return before the crunch ;

?  The investers in venture capital funds who were aided by tax-free ISA’s ;

?  The Local Authorities who were able to hold down care home fees thanks to their near monopoly purchasing power, and the rapid growth of the commercial residential care companies ;

?  the relatives of residents who secured cheap care provision and didn’t worry too much about the quality of care ;

?  the toothless regulator ( now the Care Quality Commission )  who accepted poor quality and turned a blind eye to financial viability ;

? the  Governments of the day ( from the late 1980’s onwards ) who were all pleased to see capital pouring into the “business” of care of the elderly so that public money was not required .

                         We all had a hand in the game, one way or another.

   The final hands of the Southern Cross poker game are still being played out :-

Southern Cross Management  have now unilaterally decided to reduce rents by 30%. This must be the last card they have to play and it probably signals the end of this management team in the near future.

The Landlords have now had their stonewalling bluff called, but with loans already extended to 30 years they have no real room for manoeuvre. This means they will have to face a significant down-valuation on their loan book.  The banks will be large enough to accept this unpalatable medicine ( Lloyds will again be bailed out by it’s taxpayer shareholders i.e. us ). Some of the landlords (NHP and Four Seasons ) are themselves already in a precarious position and further damage to their balance sheets might well tip them into bankruptcy.

The Care Quality Commission are out of the game now. Their only remaining card was to close future admissions to Southern Cross homes and that has probably already happened by default through the public and Local Authorities voting with their feet. The CQC has no cards and no credability left.   Though no doubt they will try to hide behind their recent change of name and blame the regulators of the past.

The Government   which hitherto has been playing a waiting game, is now having it’s hand forced by the glare of publicity. A spokesman for David Cameron in a carefully worded statement of platitudes and hollow promises said “It may not be in the interests of residents to move them”     What a remarkable insight that is !      He went on to say  ” we will do what we need to do to ensure there is effective protection for any one affected”   Presumably he means all 31,000 residents, but not the bankers and other landlords.     ” We are clear that we are putting the interests of the residents first”     Bull**** !  They haven’t done that for the last six months of worry that the residents and their relatives have already suffered.

                So what card playing options does the Government have ?

  • It could step in with the £100 million investment that Southern Cross has been seeking, perhaps in exchange for a controlling in the company. In practice this would be a small price to pay if it would resolve the problem. But is it enough ? Will it trigger similar requests from other hard pressed providers ? And will it mean stepping from the frying pan into the fire ?    I very much doubt if the Government will want to do this  — it won’t want to get its hands dirty even if this would reassure the residents. 
  • It could broker a deal for another provider to step in and save the day — ? BUPA or a national charity ? Housing 21, Anchor or MHA. They would need to be able to fund this without recourse to further borrowing, but they could be given grants through the Homes and Communities Agency.
  • It could sweeten the deal with the promise of higher funded rehabilitation beds as suggested in my earlier blog ( see Southern Cross Poker Game – 5th April 2011 – ref. Ace of Diamonds   )    Probably only BUPA has the financial strength and management and nursing skills to do this.

     None of this will happen until the current landlords accept lower rents or go bust. So for the time being the Government will continue to sit on its hands, unless publicity forces it to act sooner.

In the meantime with the approaching publication in July of the Dilnot Commission report on funding care and support, the landlords might be tempted to hang on for a more favourable climate in which to settle the deal.

Government will equally be happy to wait so that any parliamentary discussion is cut short by the summer recess.       Best to do such unsavory deals behind closed doors.

                                     The Poker Game is  far from over.

Posted in Care Funding, Residential Care | Tagged , , , | 1 Comment

“The Last Chance Saloon” – Southern Cross 5

I first started talking about Southern Cross in my blog “Houses built on Sand” (16th January 2011), when I forecast the melt down of the company unless the Government took action – which I did not expect them to do.

Later on in Southern Cross Poker Game (5th April 2011), I talked about how the various stakeholders were setting about playing the game.  Of course the frail elderly residents had no part in this process and it appears that none of the players had any regard for the residents’ welfare.  This includes the Care Quality Commission who are the regulators responsible for the care of vulnerable adults!

I asked some key questions which are now being answered by the passage of time:-

Who has the strongest hand? -it belongs to the Government (alias the Department of Health) although they are playing a waiting game and forlornly hoping not to have to declare their hand.

Which player has the most money? – again the answer is the Government but they certainly don’t want to spend it on a bail out, at least until the landlords have conceded much lower rents in future.

Who will be the first to back down? on the face of it Southern Cross management laid down a strong card by forcing the landlords to accept a big drop in rent.  In practice, I believe this was like a bee sting – painful for the landlords although they will get over it, but death for Southern Cross who will not survive the banker’s revenge.

Who has the strongest nerve?   More through procrastination than courage, the answer to this question is again the Government.  If they continue with callous disregard for the elderly residents, they can afford to wait and see if the landlords break ranks and try to secure better deals with new operators.

Should public outcry, which is remarkably silent at present, finally break out, then the politicians will have to face up to the consequences.  The Government’s first card will be to use the puppet hand of the Care Quality Commission.  Out of feigned and very belated concern for vulnerable adults, they will play their Ace of Clubs and stop all new admissions to Southern Cross homes.

This move will flush out the other players by forcing the landlords (banks and vulture capitalists don’t forget) to foreclose on Southern Cross’s management and appoint administrators to break up the company.

Between one and two hundred homes will likely close during this process, but that is collateral damage that the Government seems willing to accept.  No corporate manslaughter charges are likely to follow even though higher death rates are the certain outcome of all this upheaval for residents.

                          

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“Swimming with Sharks” – Southern Cross 4

In my time with ExtraCare Charitable Trust, we often did very adventurous things with our elderly residents.  Sailing, climbing, canoeing, absailing and horse riding were all accomplished by the hundreds of residents who went to the Calvert Trust Outward Bound Centre in Devon.   The oldest, frailest and most disabled elderly people were able to conquer their fears and achieve great things.  It was an inspiring experience.

Even more scary were the residents who met the ‘Animal Man’ and went walking with wolves, or had the opportunity to hold a tarantula, wrap a boa constrictor snake around themselves or fly a bird of prey.  Not to mention those ten brave souls who helped sail a tall ship across the English Channel, or the 93 year old who looped the loop in a glider.

One event that some residents dreamt up for themselves was to go swimming with sharks at a Sea Centre on Merseyside.  It is one of the few things I did not choose to join in.

The risks were all fully assessed in advance, and there was the support of professional coaching staff as well as the constant encouragement and reassurance of the ExtraCare Team.

The residents survived these challenges with renewed self-confidence and regained self-esteem.

At Southern Cross, they too are, in a much less supportive way, also giving their 31,000 elderly residents the experience of swimming with sharks, but this time there are only hollow reassurances about safety and security.  The senior management and directors have been taking risks with residents’ lives for a long time.  Now the residents must be in a situation of constant worry and concern about their future, given the perilous conditions caused by Southern Cross.

In the midst of this financial melt down, the Southern Cross management team even have the temerity to launch a document referred to as a “National Care Strategy which they say they hope will be adopted by everyone.

                                                            What an insensitive sick joke!

It says to me this management team has no compassion and no regard for their residents.                 

 

Posted in Residential Care | Tagged , | 1 Comment

Dream Chocolates

It has to be too good to be true – anti-wrinkle chocolates.

Just 3 a day smoothes wrinkles away!  Not only that, research on this new product also suggests it may lower blood pressure and improve memory.

This could be the most important discovery in this “century of ageing”.  Still, don’t start getting your hopes up too soon.  The health warning that comes with the research, is that it is closely linked to chocolate manufacturers.

You may save pounds on anti-wrinkle cream but you may also have to get on one of those pensioners exercise bikes to shed the pounds you put on.

Posted in HEALTH | Tagged , | 4 Comments

“A Public Inconvenience”

Bladder weakness is a cause of great inconvenience and embarrassment to many elderly people.  It often limits their ability to go out because of the difficulty of finding a public toilet when you need one.  The fact that Local Authorities are closing down so many public toilets shows that they either don’t understand or do not care about the needs of the older generation.

Over 17% of people over the age of 40 have bladder problems which mean they need to go to the loo frequently and urgently.  The condition affects three times as many women as men.

Now a skin patch has been developed to treat overactive bladders.  Applied twice a week to the stomach, it reduces the symptoms by relaxing the bladder muscles.  It’s called a Kenters patch.  At £27 per month it’s not cheap but it will reduce a lot of stress and worry and enable people to be less isolated in their communities.  It could also save on incontinence pads at between 70p and £1 a time and your bum won’t look so big when you are wearing patches.  Should also save me 30p a pee at Euston Station, especially when I have to queue at the change machine.  The delicate indignities of old age ! 

This should not be a taboo subject.  It is a major limitation on the way so many elderly people have to live their lives.

Posted in ELDERLY UK POLICY, HEALTH | 4 Comments

Mountains and Molehills

I went for a walk this morning for the first time since I retired six months ago.  At the very time when I had the time to go walking I stopped walking.  When you have all the time in the world, time disappears.  When there are no obsticles in your way it’s easy to invent some.  It’s too early; it’s too late; it’s too cold; it’s too hot; there is too much traffic on the road.  It’s dangerous in the misty morning.  There is something I want to watch on the news.  I can’t fnd my walking shoes.  It’s slippery underfoot.  There’s no fruit to take with me.  I have no apple for the horses.  Where is my asthma puffer?  Best of all perhaps and the most frequently used is “I will do it tomorrow”.

I am sure I must have thought of hundreds more excuses.  It’s easy to make mountains out of molehills, especially when you don’t really want to do something but you feel you should.

Three miles today felt like 30 miles and the slight hill half way around the walk seemed like the north face of the Eiger.  It took me longer than in the past and by the time I got back home, my legs ached a bit and I was hot and tired.  But these thoughts were dwarfed by a real sence of achievement.

As we get older it is not difficult to see more and more barriers rising before us as our age advances.  Excuses are more frequently found and “taking it easy” can become your watchword.  Molehills can quickly become mountains, if we want them to.

Fortunately, I have been lucky enough to see many older people belying their age and overcoming adversity in their lives.  Achieving things they never imagined they could do.  From pottery to poetry; gambling in Las Vegas to walking on the Great Wall of China; from swimming with sharks to skiing with Eddie the Eagle, climbing and abseiling rock walls at an outward bound centre in Exmoor to looping the loop in a glider at 93.  Over the years at ExtraCare, I have been priviliged to see literally hundreds of elderly people with every kind of frailty overcome their age and apprehensions to conquer amazing new challenges in later life.

Let’s carry on turning mountains into molehills and then there will be no more excuses left for me.

Posted in SMILES | 2 Comments

“Preach what you Practice”

Somewhat ironically Esmee Russell recently published a blog on the Age UK website entitled “Food for Thought”.   It reflects the comments Age UK received when they attended the Royal College of Nursing Conference, in response to questions about why older patients are malnourished in the NHS.   According to some statistics, 185,000 people left hospital in 2008-09 malnourished .

The usual excuses were trotted out by the nurses they spoke to:-

  • “The food is poor quality”
  • “We need more money spent on food”
  • “Meal times are too short”
  • “There are not enough nurses to feed residents who need help”

These are hardly rocket science matters to solve, so what is fundamentally behind the issue?  The basic problem is a lack of leadership.  The nursing profession has been deflected by the RCN into chasing academic qualifications at the expense of patient care.  Meanwhile, the RCN has also tied NHS managers in knots over rigid personnel practices and a concern for their own liability, rather than ensuring that the patients’ needs come first.

The nurse matrons of old would never have allowed this to happen !

There is a supreme irony in Age UK reporting on this, especially when they had earlier produced a very good report on malnutrition in the NHS.

At their own Annual Conference, “Agenda for Later Life 2011”, they had a perfect opportunity to question Jo Webber, the Deputy Director of the National Health Confederation, who was one of their platform speakers.  Instead, they allowed her to tell everyone how well the NHS was doing,  how committed the staff were to learning lessons and  how patient satisfaction was very high.

Whether out of wrong-headed politeness or misplaced tactics, there was not a murmur about malnutrition and Jo Webber walked away with her head still in the clouds.

If malnutrition doesn’t stir Age UK into some firebrand preaching, what will?

                                               Where is the Age UK rage?

Posted in HEALTH | Tagged | 3 Comments

“Fruitful Research” 4

Baylor in Texas must be the carrot growing capital of America.  So here’s a message for my gun-toteing, cattle ranching, oil-prospecting cowboy friend John T. in Pampa, Texas.  When the oil runs out you can always turn to carrot farming, providing you can shoot all those gophers first 🙂

Scientists at Baylor College found that overweight people who drank a glass of carrot juice a day shed 4 lbs in 12 weeks.

 

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