Annette Bruton CEO of Care Inspectorate explains her role

Guest blogger Annette Bruton, Chief Executive of the Care Inspectorate, explains how the organisation is developing its approach.  www.careinspectorate.com. 

Almost everyone in Scotland will use a care service at some point in their lives. That simple fact means everyone in the country has an interest in the quality of services provided across Scotland right now, from nurseries to care homes, and it means the question of what standards we expect will become an ever more important one in the future.

Care standards are always important..

As Scotland’s regulator for care services we have a duty to ensure everyone receives the best possible care; which means care that is safe, compassionate, meet people’s needs and respects their rights..

Talking about a duty is one thing. Putting it into practice is another.

But there’s more to our role than that, because not only do we have a duty to inspect and regulate, we also have a duty to inform people about the work we do.  Fundamental to the principle of respecting a person’s rights is respecting their right to choose.

Is that why an elderly person was taken into care against her will, perhaps?

And people can only make informed decisions if they have all the information they need. 

Is that why Mrs Kilbride was provided with no information, perhaps?

That’s why we have now embarked on a new way of highlighting some of the things we find out through our rigorous inspections.

GOOD. But you only have rigorous inspections for the situations you are prepared to inspect. Your department was certainly not willing to inspect the abuse of a Power of Attorney in Mrs Kilbride`s case, were they?  How many times has that happened?

On top of that we have just launched an innovative new way to communicate some of the other information we gather. The Hub is our new online resource aimed at Scotland’s 200,000 care workers.

Dare I tell you that the information you gather at the Hub is only as good as the people supplying the information?

Put simply our inspectors who are experts in early years provision inspect nurseries, and those with corresponding experience of care services for the elderly inspect care homes for the elderly...And that’s why we recently launched a bid to recruit more inspection volunteers.

Volunteers (?) who want to get close to vulnerable children and the elderly? I shudder to think ...and you are crowing about this?  How about stopping the banning of relatives from visiting their loved ones? That would be an even more robust system I assure you. How about dealing with complaints about it.

 To find out more about the work we do, (or less, as the case may be) and to get involved as a volunteer inspector, log on to our website www.careinspectorate.com

 

 

Care of elderly is not sustainable

Audit Scotland warns that: "Caring for older people in Scotland’s hospitals and care homes at a cost of billions of pounds a year is not sustainable as the elderly population continues to grow.

Audit Scotland said the Scottish Government has estimated that spending on health and social care for over-65s will have to increase from £4.5 billion to £8bn by 2031 unless there are changes to people’s wellbeing and how services are provided.
But Audit Scotland concluded that overall progress in delivering better services had so far been slow. It also found spending did not appear to be moving away from emergency and residential care and into local initiatives.

And it said the current way that services were delivered was "unsustainable". 

Their answer is to keep the elderly out of hospitals and care homes and to provide support closer to home but it does not say how emergencies can be dealt with in this way. This proposal is cunningly equated with improvement in delivering services.

But we have to ask what kind of services? Without the equipment and specialist medical knowledge available in hospitals anything on offer is going to be substandard for those who require emergency treatment.

http://www.scotsman.com/news/health/elderly-care-costs-unsustainable-says-watchdog-1-3295977

Division between age groups

Here is another report which divides young and old. According to the study `The State of Living Standards` by the think-tank  Resolution Foundation, young people and working families have seen their incomes fall in real terms compared with a decade ago while average pensioner households have enjoyed an 18% rise.  The trend is set to continue, as further cuts to working-age benefits come into force in the next few years, while pensions are protected.

The findings will highlight how falling real wages combined with political decisions about who should benefit from public spending have created a sharp divide across age groups, with the young faring worst and pensioners the best.

The RF report – the first of its type to look at inter-generational income patterns across the last decade – finds that the typical income of pensioner households grew from £313 a week in 2001-2 (at 2011-12 prices) to £370 in 2011-12, representing an 18% rise. By contrast, the weekly income of a couple without children in a median working-age household fell slightly from £453 (in 2001-2) to £445 in 2011-12, despite GDP growth of almost 10% over the decade.

For young people, the fall in real wages was even more acute. Between 2001 and 2011, median weekly wages for 18-21 year olds fell by 21.7%, and for 22-29 year olds by 7.6%

James Plunkett, director of policy at the RF, said that while many pensioners were still hard up, and their incomes remained on average below those of working-age families, they had enjoyed a recent good run that looked set to continue.

The report goes on to remind us that further cuts and more austerity is on its way. But isn`t that the problem, and the fact that there is no real recovery in terms of jobs which offer a living wage for young people and families?

http://www.theguardian.com/politics/2014/feb/09/pensioners-thrive-while-working-families-and-young-suffer

The LACDP

Following the review of the Liverpool Care Pathway we have this:

The Leadership Alliance (constituents listed at the end of this statement) has issued an update to its work on Care of Dying People (LACDP) following the report of the independent panel on the Liverpool Care Pathway (LCP). The LACDP is a coalition of the national organisations to which the panel addressed its recommendations, joined by charities with a strong interest in care for dying people.

The words in bold are the first that jumped out at me. We are referring to the care of very sick people - so sick, they are dying - so why is the panel joined by charities?  It would be more reassuring to know that the panel were joined by senior doctors.

LACDP members are committed not only to taking forward the panel’s recommendations, but also to implementing a consistent approach to caring for dying people across England, to ensure that everyone who is in the last days and hours of life, and their families, receive high quality care, tailored to their needs and wishes and delivered with compassion and competence.

What are they saying here? They are committed to implementing a consistent approach. What, in place of an inconsistent approach? Does this really require saying?  High quality care? What, in place of low quality care? More rubbish. So what is high quality care for the dying? Tell us. Tailored to their needs and wishes? What kind of needs and wishes is a dying person supposed to have then? There`s an awful reluctance to come out and say anything, isn`t there? This is waffle.

The alliance believes that the starting point for ensuring excellent care for everyone in the last days and hours of life should be a common understanding, between professionals, dying people and their families and between professionals themselves, about what such care should look like. The alliance aspires to a shared vision for care and is currently engaging with families, and professionals and organisations on draft outcomes and guiding principles, which would help create that shared vision.

I would have thought the starting point should be attending to the patient. But No. The starting point should be a common understanding between professionals, the dying and their families. Common understanding of what? Oh, about what excellent care should look like? You mean you don`t have that shared vision? But you are confident about getting it and drafting the outcomes and guiding principles anyway. The obfuscation and arrogance here is frightening.

The alliance recognises the continuing challenges faced by those caring for dying people, including following the review panel’s report. We understand that professionals are looking for further guidance and direction..

Patients did not fare well with the last lot of guidance and direction did they? But let`s brush that aside.

The independent review panel concluded that many of the issues around the LCP were that it had come to be regarded and used as a generic protocol – and sometimes as a tick box exercise - which is the wrong approach.

A tick box approach is the wrong approach. Yes indeed. I would have thought the right approach to the care of the dying would occur around the bedside not in the office.

The alliance will not produce a replacement for the LCP. Instead, we want to see the way in which a dying person is cared for, including the goals and other key aspects of their care, focused around the individual, in line with their needs and preferences; and developed and delivered in consultation with them, wherever possible and/or their family, and in line with the final version of the outcomes and guiding principles.

They want the goals and other key aspects of their care to be focused around the individual. Do these people know how ridiculous they sound? Why shouldn`t care of the individual focus on the individual?
 
That`s the problem when you try to hide the true intentions of what you are doing with your outcomes and guiding principles. It does not come across as sensible, never mind convincing.

The Leadership Alliance for the Care of Dying People is comprised of: Care Quality Commission (CQC); College of Healthcare Chaplains (CHCC); Department of Health (DH); General Medical Council (GMC); General Pharmaceutical Council (GPhC); Health and Care Professions Council (HCPC); Health Education England (HEE); Macmillan Cancer Support (also representing the Richmond Group of Charities); Marie Curie Cancer Care (also representing Help the Hospices and the National Council for Palliative Care); Monitor; National Institute for Health Research (NIHR); NICE (National Institute for Health and Care Excellence); NHS England; NHS Trust Development Authority (NTDA); NHS Improving Quality (NHS IQ); Nursing and Midwifery Council (NMC); Public Health England (PHE); Royal College of GPs; Royal College of Nursing (RCN); Royal College of Physicians (RCP); and Sue Ryder (also representing the National Care Forum and the Voluntary Organisations Disability Group).


http://www.bgs.org.uk/index.php/readingsubjectlist/155-eolc/2703-care-of-dying-leadership

Power of attorney advertising campaign

Martha Wardrop, Green Party councillor, Hillhead, wrote the following in her blog:

On 11th December 2013, I received a briefing about the Power of Attorney TV Advertising Campaign at a meeting of the Dementia Working Group established by Glasgow City Council.

The need for this campaign arose from the delayed discharges from hospital when a person is lacking the capacity to make the decision to return home, be taken in to care or seeking an alternative option. This can result in the person being forced to remain in hospital leading to an increased risk of infection or complications. If the power of attorney is held by a third party or relative, this decision can be made promptly and the person returned to safe and comfortable surroundings within the community in line with their wishes.

Without the power of attorney, the State has to apply for guardianship and this is a time consuming and costly process, of on average 256 days.

There is a need to encourage discussion on the process to apply for a Power of Attorney and the option to apply prior to the loss of capacity.  

http://marthawardrop.blogspot.co.uk/2014/01/start-conversation.html

　
If the person without capacity (whatever that really means) can be returned to the community promptly via a third party `power of attorney` why can`t they be returned promptly without one? I mean all parties should know where the old person lives, surely?
But I don`t think this is about returning the old person home is it? It`s about putting the old person in a care home and getting a third party to deal with their finances - including covering the costs of the care home and selling off, or taking over, the old person`s house.
　

This is an abusive system set up by the state and there are no safeguards that actually work - no matter what the law says. The Office of the Public Guardian is another body like the Ombudsman working for the Government, as the true story in this blog reveals.  All that office does effectively is collects the registration fees for those power of attorneys it advertises for, whilst batting away the complaints for its lack of proper regulation.

Glittering UK award

News from NHS Lanarkshire informs us that the Integrated Community Support Team (ICST), made up of staff from NHS Lanarkshire and South Lanarkshire Council, has won a glittering UK award which was presented to them at the Patient Experience Network (PEN) National Awards in Birmingham on Wednesday.

The Integrated Community Support Team aims to prevent the elderly being subjected to unnecessary hospital or care home admissions and has been successful in nine out of ten cases. They operate in East Kilbride and Strathaven. 
http://www.nhslanarkshire.org.uk/news/news/Pages/powerofpartner.aspx


So NHS Lanarkshire and South Lanarkshire Council have won a glittering award for keeping elderly people out of hospital or care homes.

No curative treatments for this group then !  So what actually happens to them ? Perhaps the next post gives us a clue ..
 

The Missing 90 year olds

Thousands of elderly people are missing. The last UK census found far fewer people in their 90s than expected, and the same thing happened in the US with people over 100. Could this be an early sign that gains in life expectancy made in recent decades will not be repeated in future?

We've seen amazing improvements in life expectancy over the past few decades. Six years have been added to global average life expectancy at birth, over the past two decades. Much of this increase has been down to improvements in child mortality in low- and middle- income countries.

But in countries like the UK, post-retirement life expectancy has also increased rapidly.

"Life expectancy of a man aged 65 has increased from 14 years in the early 1980s to 21 years now - so that's a 50% jump in just three decades," says Richard Willets, director of longevity at insurance company Partnership.

Which is why, when the 2011 census was published, he went straight to the statistics about elderly populations.

And there the data revealed a surprise.

"There were 30,000 fewer people aged in their 90s than previously believed," he says - 429,000 instead of 457,000.

http://www.bbc.co.uk/news/magazine-23126814

Does this not reveal how the Liverpool Care Pathway has been successfully giving the elderly a `dignified death`?

Contradictory messages

 

According to NHS Lanarkshire the Liverpool Care Pathway is "a document which should be used to facilitate best practice and improve care of the dying patient. Adapted from the hospice model of care the LCP is a holistic, multidisciplinary and evidence based tool which focuses on the physical, psychological and spiritual needs of the dying patient (and their families) in the last few days of life.  The LCP allows health care practitioners to identify the dying phase and initiates appropriate comfort measures required at this phase of a person’s life. The LCP is a legal document, replacing all other documentation at this time. It aims to standardise and improve end of life care throughout Lanarkshire."

 

So the LCP we are told is a legal document which allows practitioners to identify the `dying phase`? Never mind that identifying the `dying phase` is not an exact science and doctors are not always able to diagnose dying - this legal document can do it. Then we can suppose that health professionals can rush in with their `anticipatory` comfort syringes thus ensuring that death results.
http://www.nhslanarkshire.org.uk/Services/PalliativeCare/Pages/Palliativecareliverpoolcarepathway.aspx

There is an update on the same website: 18 December 2013

Press reports and feedback from families indicated that not everyone was getting the high quality care that the public has a right to expect.

In July 2013 the findings from an independent review, led by Baroness Neuberger, into the Liverpool Care Pathway (LCP) were published. The report highlighted failings in the implementation of the LCP and recommended that the Government replaces it with individual care plans over the following 12 months.

More Care, Less Pathway: A review of the Liverpool Care Path found that although when used well, by well-trained staff, the LCP did enable people to have a comfortable and dignified death, too often it was used inappropriately, by poorly trained staff, resulting in a breakdown in communication and poor end of life experience for not just the patient but also those close to them and their carers...

Isn`t it about time that NHS Lanarkshire stopped singing the praises of the Liverpool Care Pathway and removed the first post from their website?  Find out more about the Leadership Alliance for the Care of Dying People

New pharmacy service is first of its kind in UK

The drive to keep the elderly out of hospital, (with the risk that they might be provided with curative treatments), continues unabated. We are told that people living in the Glasgow and Clyde area can now benefit from an innovative new service, co-ordinated from their local pharmacy – the first of its kind in the UK. It means patients and their carers will have improved access to the medications for end-of-life care - (those which assist the `dying process`, or should we call it a journey? - even for those with `life limiting` conditions who are not actually dying.)

It will ... support patients, should they choose to die peacefully at home rather than spending their final days in hospital.

Yes I`m sure it will. It will also support carers who make decisions on behalf of their patients. This is the care plan for which ten new Macmillan pharmacy facilitators will be working with existing community pharmacies.

http://www.nhsggc.org.uk/content/default.asp?page=s1192_3&newsid=17420&back=home

The OptCare study

A number of people in Sussex have been invited to take part in what is called a research project to test a new palliative care service for frail older people living at home or in a care home. 900 people who registered the death of a relative, friend or cared for person are being contacted to give their views on a questionnaire. The purpose is to be able to analyse why some people received care which met their needs and preferences, while others did not.

Your views are very important and will greatly help to provide better care for patients and families in Sussex and across the United Kingdom in the future.

Can this possibly be true? The important thing to notice is that the needs and preferences of the 900 dead people are being requested from third parties, some of them with conflicts of interest regarding any assessment of the dead person`s care or preferences.
http://www.csi.kcl.ac.uk/files/Link%20to%20patient%20information%20sheet.pdf

So what drives this kind of nonsense research which no doubt will find in favour of keeping the elderly out of hospitals with `Do not resuscitate notices`?

 

 

The demographics of an aging population is, again, the core concern and driver. The UK’s ageing population has “considerable consequences” for public services as is discussed in UK Parliament –

The pensioner population is expected to rise despite the increase in the women’s state pension age to 65 between 2010 and 2020 and the increase for both men and women from 65 to 68 between 2024 and 2046. In 2008 there were 3.2 people of working age for every person of pensionable age. This ratio is projected to fall to 2.8 by 2033.

 http://liverpool-care-pathway-a-national-sc.blogspot.co.uk/2014/01/liverpool-care-pathway-trials-and.html