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| Cash-starved, demoralised and sometimes cruel: how England’s social care system fails the most vulnerable | Cash-starved, demoralised and sometimes cruel: how England’s social care system fails the most vulnerable |
| (1 day later) | |
| It is written in the dry language of the bureaucrat. But an inspector’s report published just last week into the red-brick Birdsgrove Nursing Home, near Bracknell in Berkshire, accommodating the elderly and frail, as well as people stricken by dementia still makes for uncomfortable reading. “We spoke with a person who was still in bed in night clothes,” the Care Quality Commission (CQC) inspector writes. “It was mid-morning and the person told the inspector they had been awake since 7am and were waiting for two staff to help move them from their bed to their chair, wash them and help them get dressed. The person said they were unsure if they were going to be washed today as they had not been told. They said: ‘You have to get used to it here, it’s a routine.’ | It is written in the dry language of the bureaucrat. But an inspector’s report published just last week into the red-brick Birdsgrove Nursing Home, near Bracknell in Berkshire, accommodating the elderly and frail, as well as people stricken by dementia still makes for uncomfortable reading. “We spoke with a person who was still in bed in night clothes,” the Care Quality Commission (CQC) inspector writes. “It was mid-morning and the person told the inspector they had been awake since 7am and were waiting for two staff to help move them from their bed to their chair, wash them and help them get dressed. The person said they were unsure if they were going to be washed today as they had not been told. They said: ‘You have to get used to it here, it’s a routine.’ |
| “We left the person’s room and shortly afterwards heard them shouting for help. They were shouting: ‘Please help me’ and ‘Help me, please’. The person was in very obvious distress and their shouts for help were loud enough for any staff nearby to hear them. No staff responded to the person’s calls for help. | “We left the person’s room and shortly afterwards heard them shouting for help. They were shouting: ‘Please help me’ and ‘Help me, please’. The person was in very obvious distress and their shouts for help were loud enough for any staff nearby to hear them. No staff responded to the person’s calls for help. |
| “We went into their room and reassured the person and they became calm. We said we would get a member of staff to come and help them. One inspector spoke with a care worker on the corridor outside the person’s room and told them the person needed help. The care worker said they were helping another person adding: ‘I’m doing her, I don’t want this one wandering off as well.’ | “We went into their room and reassured the person and they became calm. We said we would get a member of staff to come and help them. One inspector spoke with a care worker on the corridor outside the person’s room and told them the person needed help. The care worker said they were helping another person adding: ‘I’m doing her, I don’t want this one wandering off as well.’ |
| A registered nurse stood in the corridor not reacting to cries for help. We had to ask another member of staff to help | A registered nurse stood in the corridor not reacting to cries for help. We had to ask another member of staff to help |
| “We left the room as the person remained calm. Shortly after we left the room they began shouting for help again in the same manner. A registered nurse was observed standing in the corridor near to the person’s room not reacting to their cries for help. We had to find another member of staff and ask them to come to help the person. A few minutes later a care worker arrived to assist the person. The person’s cries for help were repeatedly ignored.” | “We left the room as the person remained calm. Shortly after we left the room they began shouting for help again in the same manner. A registered nurse was observed standing in the corridor near to the person’s room not reacting to their cries for help. We had to find another member of staff and ask them to come to help the person. A few minutes later a care worker arrived to assist the person. The person’s cries for help were repeatedly ignored.” |
| This account is by no means extraordinary, although it raises deeper concerns about the standards of behaviour when an official wasn’t in the room. No one was physically hurt. Inspection reports of other institutions tell of “inappropriate physical constraints”, the dispensing of medicines without records being kept or care being taken, and a complete disregard for reporting complaints of bullying, fraud and filthy conditions. | This account is by no means extraordinary, although it raises deeper concerns about the standards of behaviour when an official wasn’t in the room. No one was physically hurt. Inspection reports of other institutions tell of “inappropriate physical constraints”, the dispensing of medicines without records being kept or care being taken, and a complete disregard for reporting complaints of bullying, fraud and filthy conditions. |
| Scandals that have rocked the social care sector, in large part due to undercover work by journalists or the installation of cameras in bedrooms by concerned relatives, have exposed even more shocking abuses. | Scandals that have rocked the social care sector, in large part due to undercover work by journalists or the installation of cameras in bedrooms by concerned relatives, have exposed even more shocking abuses. |
| The frail suffering from chronic illness have been found left lying in excrement for hours. A man in his eighties was filmed by reporters as he was mockingly called a bitch over and over again by a care worker cleaning his private parts. | The frail suffering from chronic illness have been found left lying in excrement for hours. A man in his eighties was filmed by reporters as he was mockingly called a bitch over and over again by a care worker cleaning his private parts. |
| But what is extraordinary, campaigners say, is that inspection reports such as that about Birdsgrove are still, despite all the publicity over social care in the UK, relatively commonplace. | But what is extraordinary, campaigners say, is that inspection reports such as that about Birdsgrove are still, despite all the publicity over social care in the UK, relatively commonplace. |
| Related: Social care chief savages failing system for elderly | Related: Social care chief savages failing system for elderly |
| Last week the CQC published its most recent inspections – of 42 adult social care services in the north of England. None was outstanding, 24 were good but 14 required improvement and four were inadequate. | Last week the CQC published its most recent inspections – of 42 adult social care services in the north of England. None was outstanding, 24 were good but 14 required improvement and four were inadequate. |
| The CQC, following a freedom of information request from the Observer, revealed that regulators were notified of 30,000 allegations of abuse involving people using social care services in the first six months of this year. The allegations ranged from physical, emotional and sexual abuse to financial fraud. | The CQC, following a freedom of information request from the Observer, revealed that regulators were notified of 30,000 allegations of abuse involving people using social care services in the first six months of this year. The allegations ranged from physical, emotional and sexual abuse to financial fraud. |
| More than 11,000 of the alleged incidents were in nursing homes; 12,775 in care homes where there were no nurses; and 7,604 in cases where a care worker had visited someone’s own home. Nearly 400 claims regarded incidents in community-based services for people with learning or mental health needs or addictions. The rate at which allegations of abuse have been made in 2015 is double that of 2011. There are 17,000 nursing homes and 8,000 home care services in the UK. | More than 11,000 of the alleged incidents were in nursing homes; 12,775 in care homes where there were no nurses; and 7,604 in cases where a care worker had visited someone’s own home. Nearly 400 claims regarded incidents in community-based services for people with learning or mental health needs or addictions. The rate at which allegations of abuse have been made in 2015 is double that of 2011. There are 17,000 nursing homes and 8,000 home care services in the UK. |
| According to an official analysis of the figures in the previous year, in nearly two thirds of allegations (57%) in care homes, it was a carer who was the alleged source of the abuse. Across the social care sector, including cases of abuse in people’s own homes, carers were identified as the abuser in a third of cases. | According to an official analysis of the figures in the previous year, in nearly two thirds of allegations (57%) in care homes, it was a carer who was the alleged source of the abuse. Across the social care sector, including cases of abuse in people’s own homes, carers were identified as the abuser in a third of cases. |
| The increased frequency of allegations can in part be explained by an improved performance by the CQC in recording abuse. There is also a genuine fear within the sector of repercussions should they fail to inform authorities of allegations of abuse. There is also perhaps a greater awareness among those receiving care of what is and is not acceptable. Nevertheless, it is deeply concerning that such numbers are coming in, according to Gary Fitzgerald, chief executive of Action on Elder Abuse. | The increased frequency of allegations can in part be explained by an improved performance by the CQC in recording abuse. There is also a genuine fear within the sector of repercussions should they fail to inform authorities of allegations of abuse. There is also perhaps a greater awareness among those receiving care of what is and is not acceptable. Nevertheless, it is deeply concerning that such numbers are coming in, according to Gary Fitzgerald, chief executive of Action on Elder Abuse. |
| It is, he said, a sign that the system is falling apart as politicians duck the big questions about how a society should look after its most frail and vulnerable. | It is, he said, a sign that the system is falling apart as politicians duck the big questions about how a society should look after its most frail and vulnerable. |
| Since 2010, there has been a £4.6bn cut in the social care budget as local authorities have had to cut services and freeze fees. The number of people receiving social care has dropped from 1.25 million to around 800,000 – a reduction of 40% at a time when the elderly population has increased by 15.6%. | Since 2010, there has been a £4.6bn cut in the social care budget as local authorities have had to cut services and freeze fees. The number of people receiving social care has dropped from 1.25 million to around 800,000 – a reduction of 40% at a time when the elderly population has increased by 15.6%. |
| Those who do receive social care in their homes are receiving rushed 15-minute visits as local authorities seek to squeeze the most out of care staff, who are often on the minimum wage – or worse. The Resolution Foundation thinktank estimates that, because of the refusal to pay carers for the time between visits to people’s homes, a total of 160,000 of direct care jobs were paid below the minimum wage in 2013-14. | Those who do receive social care in their homes are receiving rushed 15-minute visits as local authorities seek to squeeze the most out of care staff, who are often on the minimum wage – or worse. The Resolution Foundation thinktank estimates that, because of the refusal to pay carers for the time between visits to people’s homes, a total of 160,000 of direct care jobs were paid below the minimum wage in 2013-14. |
| There are not enough nurses or care workers. According to the CQC, in 2013-14, one in five nursing homes did not have enough staff on duty to ensure “residents received good, safe, care”. | There are not enough nurses or care workers. According to the CQC, in 2013-14, one in five nursing homes did not have enough staff on duty to ensure “residents received good, safe, care”. |
| And with money tight, providers have cut back on training. A recent report from Skills for Care found that only two thirds of care workers had completed an on-the-job induction course. Only half the workforce had any recognised social care qualifications, while a survey of employers found that 89% had no emergency aid awareness, 83% lacked training in control and restraining techniques and 66% had not received training in helping people with dementia. Low-paid and low-status, social care has a 20% turnover of staff, meaning a lack of the continuity of care that builds relationships and consoles those suffering from dementia. | And with money tight, providers have cut back on training. A recent report from Skills for Care found that only two thirds of care workers had completed an on-the-job induction course. Only half the workforce had any recognised social care qualifications, while a survey of employers found that 89% had no emergency aid awareness, 83% lacked training in control and restraining techniques and 66% had not received training in helping people with dementia. Low-paid and low-status, social care has a 20% turnover of staff, meaning a lack of the continuity of care that builds relationships and consoles those suffering from dementia. |
| Andrea Sutcliffe, chief inspector of adult social care at the CQC, fears that it is the sheer dysfunctionality of the system that turns good people into “the sort of care worker that you wouldn’t want them to be”. | Andrea Sutcliffe, chief inspector of adult social care at the CQC, fears that it is the sheer dysfunctionality of the system that turns good people into “the sort of care worker that you wouldn’t want them to be”. |
| “This is not about malicious people,” Fitzgerald adds. “At times the workers are as much the victims. There has been a dishonesty in the whole system in saying that somehow we are reducing money for the system but no one is getting hurt.” | “This is not about malicious people,” Fitzgerald adds. “At times the workers are as much the victims. There has been a dishonesty in the whole system in saying that somehow we are reducing money for the system but no one is getting hurt.” |
| Judy Downey, chair of the Relatives & Residents Association, agrees. “It is just extraordinary that we have evolved a system where the least skilled and least well paid are doing the most stressful jobs with people with high needs and vulnerability. People who need social interaction as well as their bottoms wiped and food shoved in.” | Judy Downey, chair of the Relatives & Residents Association, agrees. “It is just extraordinary that we have evolved a system where the least skilled and least well paid are doing the most stressful jobs with people with high needs and vulnerability. People who need social interaction as well as their bottoms wiped and food shoved in.” |
| Colin Angel, campaigns director at the UK Home Care Association, said it should now be clear to the political class that the system is cracking at the seams. “Abuse or neglect of people who use social care services is never acceptable and cannot be excused,” Angel said. “However, the extreme strains placed on social care services, which are increasingly rationed and grossly underfunded, present an urgent warning for the future. | Colin Angel, campaigns director at the UK Home Care Association, said it should now be clear to the political class that the system is cracking at the seams. “Abuse or neglect of people who use social care services is never acceptable and cannot be excused,” Angel said. “However, the extreme strains placed on social care services, which are increasingly rationed and grossly underfunded, present an urgent warning for the future. |
| Related: I love my care job, but can I afford to do it? | Letters | |
| “Underfunded care risks creating rushed and undignified services for older and disabled people; a lack of investment in training and supervision, and unacceptable terms and conditions for the workforce. Care that has to be crammed into 15-minute slots to maintain councils’ budgets, or is delivered by workers paid at or just about minimum wage, indicates a broken system.” | “Underfunded care risks creating rushed and undignified services for older and disabled people; a lack of investment in training and supervision, and unacceptable terms and conditions for the workforce. Care that has to be crammed into 15-minute slots to maintain councils’ budgets, or is delivered by workers paid at or just about minimum wage, indicates a broken system.” |
| Edited extract from the final report of the Commission on the Future of the Home Care Workforce | Edited extract from the final report of the Commission on the Future of the Home Care Workforce |
| My 15th day without a break My first call today is to assist a lady out of bed. When I arrived there was an awful smell; her commode had not been emptied the night before. I left the other carer to help with her breakfast, as my next call often takes much more time than is allocated. | My 15th day without a break My first call today is to assist a lady out of bed. When I arrived there was an awful smell; her commode had not been emptied the night before. I left the other carer to help with her breakfast, as my next call often takes much more time than is allocated. |
| Mrs A is asleep when I arrive; she likes a lie-in, but she regularly receives a 9am call so that we can fit in more people. I offer her a drink to entice her to get up. This alone can take 20 mins. Today I’m lucky, 10 mins and she is ready to go to the bathroom. I am left with five minutes to get her washed, dressed, meds prompted and make her breakfast. | Mrs A is asleep when I arrive; she likes a lie-in, but she regularly receives a 9am call so that we can fit in more people. I offer her a drink to entice her to get up. This alone can take 20 mins. Today I’m lucky, 10 mins and she is ready to go to the bathroom. I am left with five minutes to get her washed, dressed, meds prompted and make her breakfast. |
| My next client lives with a family member, but as it is several miles away I condense a 45-minute call into 20 minutes, giving me time to get to my next call. | My next client lives with a family member, but as it is several miles away I condense a 45-minute call into 20 minutes, giving me time to get to my next call. |
| Mrs B has dementia. She has no family nearby and suffers from agoraphobia, so the three calls a day she receives are her only social contact. I make an effort to sit and chat while she has her breakfast. Reading through her file, I notice that yesterday evening the carer was here for only 10 minutes. | Mrs B has dementia. She has no family nearby and suffers from agoraphobia, so the three calls a day she receives are her only social contact. I make an effort to sit and chat while she has her breakfast. Reading through her file, I notice that yesterday evening the carer was here for only 10 minutes. |
| As we are very short-staffed in a different area, I have been given some new calls to cover 15 miles away. I am running behind, so, after preparing a microwave meal and a cup of tea for the service user, I run out without having had time for a conversation. By the time I arrive at my next call, it is 1.45 and the lady is very unhappy at my time-keeping. I can feel my head pounding knowing that I am going to be late for a sit I have to do next. | As we are very short-staffed in a different area, I have been given some new calls to cover 15 miles away. I am running behind, so, after preparing a microwave meal and a cup of tea for the service user, I run out without having had time for a conversation. By the time I arrive at my next call, it is 1.45 and the lady is very unhappy at my time-keeping. I can feel my head pounding knowing that I am going to be late for a sit I have to do next. |