DAILY LIFE IN BRITAIN’S NURSiNG HOME INDUSTRY

 

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A large part of Britain’s care of the elderly and disabled is, as is widely known, outsourced to private companies. From time to time appalling conditions in some of these homes are disclosed to the public by undercover journalists and/or after complaints from relatives.

     This book is different from these newspaper stories and TV documentaries. It is different not only because it is written by an insider with extensive personal knowledge but also because it does not single out individual care workers for criticism and blame. Instead of finding easy scapegoats among vulnerable workers it takes the reader on a detailed tour into the profit-obsessed care home industry, and, by doing so, it paints a picture of not only shockingly low standards and abusive care but also of systematic staff exploitation and a catastrophically flawed control system.

• We get an insight into daily life of residents and staff both in low standard homes in England and in so called luxury establishments in Scotland.

 

• The book describes in detail the appallingly low standards of hygiene provided in a number of these homes.

 

• It describes the insecure, humiliating, unhealthy, outright dangerous working conditions to which a great number of care workers are subject.

 

• It describes blatant upper class racism of black health workers in Scotland, a condition openly condoned not only by home managers but also by the state watch dog, the Care Commission/CSCI.

 

• A major issue described and debated is the extremely time consuming documentation of care. Hours of valuable time are every day taken away from residents in order to write ‘evidence’ that care has been given (which due to shortage of time often has not been the case…). The written word is more important than the deed.

 

• After having used the first two parts (out of four) of the book to London and Scotland respectively, the author in the third has a close look into important legislation and the work of the government watchdog. When doing so we get an understanding of the discrepancies between the written words and the ‘real world’. We meet a failed system.

 

• In the final part of the book the author finds himself in a home in Surrey. Here we meet a deputy manager who (untrained) runs a dictatorial regime with blatant abuse of some of the most vulnerable people in Britain: elderly and also younger residents with severe disabilities. Trying to protect these people’s rights he was bullied out of his job.

 

• Now the system closes its ranks against the dissident. The council investigation that followed the author’s complaint was openly flawed (admitted by the council themselves (!) and a view further supported by Harry Cohen, MP) and every attempt to achieve justice was met (and is being met) with massive resistance. The council acknowledges the ‘errors’ but it is now ‘so long ago’ and the ‘procedures have changed’.

 

• The books recount of a seriously flawed investigation and massive cover up ends without conclusion. The MP threatens to take the matter to the Minister of Health, but, for some reason, even that does not happen….

 

• In the way the book ends it is a full recount of a flawed scandalous system where perpetrators get away and people in power cover up. It is a recount of cronyism and ‘helping hands’. However, the publication of the book could be combined with a journalist’s research into this scandalous case. There is no doubt this story in itself is worth front page coverage. The author has substantial evidence to prove his case.

 

                                              Part 1

On the day of the funeral of the Queen Mother, spring 2002, I had my debut in a south London nursing home. In spite of years as a professional nurse this day was a shock. Here, at Fig Leafs Nursing Home in south London, surrounded by tangible despair, I quickly felt I had ended up in a living hell.

• Poverty in all the word’s senses was widespread and the hopelessness was omnipresent. Why does it have to be like that? I wondered. Can a rich society really accept that people in need of care are left to such suffering, such deprivation? The more I got to know this new world the more things began to stand out. Facts became clear: it was basically about money; it was about greed, and those in the middle of the whole industry (those who were ‘cared’ for and those who tried to provide the care) they didn’t really matter.

 

• Minimum standards, health and safety and other regulations, all that which were meant to secure the rights of the most vulnerable, appeared to be little more than a show for the grandstand. In fact, instead of protecting and leading the way the regulations seemed more part of the problem than the solution; they stole time away from the care; what should be high standards were only there on the paper, making the inspectors happy, but invisible in real life. Yes, the real world was different, but that appeared not to matter.

 

• Protect yourself as a sacred tenet. I saw how a public control system did more harm than good. More than anything I learned how care of the ill, elderly and disabled had developed into a daily struggle for individual staff members’ own professional survival. I quickly learned how relevant especially one of all the official and unofficial rules which govern modern British nursing is: Write your care plans strictly adhering to the sacred principle of CYA (Cover Your Ass). What does it matter that people suffer, provided the paperwork has been completed?

 

• It wasn’t long before I realized the truth: the cheaper the care the bigger the profit. After all, shareholders and private owners had an interest in maximum returns for their investments. In this business money was of paramount interest.

 

• Unsafe frugality. The fewer incontinence pads and protective gloves that could be used, the more money would be left to line the investors’ pockets. The hygienic consequences seemed not to matter. Yes, against all rules of basic hygiene; disposable gloves are used from one resident to another – regardless of infectious diseases, dirty or not as long as they can ever last.

 

• Serious implications on public health. Not only is the standard of hygiene generally at a very low level, the even more serious it gets then residents infected by MRSA, the dangerous ‘super bug’ is treated the same way. The risks for contamination of staff, other residents and the public in general are enormous, but still not considered.

 

• We cannot do that to fellow human beings. It wasn’t easy for the eighty years old woman to be dragged out of bed at 5 am just to spend the next four hours stooped over the breakfast table waiting to be served. Unfortunately it was common practice to start ones day like that. ‘Squeeze her into a ragged skimpy pair of knickers, give her a wet cloth on the face, pull a much too small tattered dress on, and off she go….next.’ Yes, this was how old people lived in many of these homes.

 

• Care staff absorbed in office work. There is an enormous amount of time spent on writing care plans, but they are read by virtually nobody. Why? Basically because there is no time for that. Still, the book keeping has long ago taken priority over nursing care. Defenceless elderly and disabled are left to themselves because care plans have to be updated in honour of the Care Commission/CSCI.

 

• The abuse of the adaptation nurses. After being given permission to work in the UK, large numbers of foreign nurses are placed as so called adaptation nurses for the first three months of their British career. It is allegedly in order to assess the nurses’ professional qualifications and to provide them with an opportunity to adapt to the new country and British standards. Basically not a bad idea, but in reality it is more a question about cheap labour. The adaptation nurse is on close to minimum wages, is given sparse training (often by newly qualified peers) and it is all a world away from nursing at NHS level – a travesty of its purpose, a flawed system which ultimately could be dangerous.

 

Part 2

The second part of the book tells partly another story, that of a nursing company serving for the upper-class. Yes, things were different at my new destination. However, it wasn’t much easier to adjust, maybe even worse. In Upmarket Home, Edinburgh, staff were largely seen as servants, as a new breed of butlers and chambermaids.

• Contrary to all theories about how to treat a work force and how to make one’s employees feel respected and valued, leadership was based on intimidation and fear. The basic tenet was a request for an unquestioning obedience and respect for the revered Sister, the woman in charge of the service.

 

• On top of that, in Rowan Homes racism and xenophobia was widespread; it was directed at non native staff, and what was worse, it was widely accepted by the management. Nelson, a handsome very polite and hard working African immigrant, was the one most severely affected. After a long struggle to survive in the job, calls from a ‘gentleman’ resident – ‘get that bloody nigger out of here’ – finally ended his carer career. That comment, after months of humiliation, was finally what broke his back; the day after he was gone. The sister had been fully aware of the situation, but still, Nelson had been left to bear the brunt of the abuse himself, or take the consequences and leave.

 

• It was all condoned. Yes, the old man was obviously in his right to abuse him; at the end of the day he paid £110 a day to live in the home, and that obviously – as later became clear to me – included the right to behave as he wished. Sir Morgan, however, was far from the only person digging Nelson’s grave at Morningside; there were many more, and they were all more than happy the day they had got rid of the ‘nigger’. Now they only had the slitty-eyed Chinese girl’s look to irritate them. The racism was obvious for anyone to observe. No, it wasn’t only Sir Morgan, it was widespread, and it was allowed and condoned, even pandered to by the silent policy of the manager, Sister Stewart, who willingly deferred to the whims of the wealthy.

 

• There was an upstairs and downstairs in this place even among the staff. On one side there were the trained people (registered nurses like myself), and on the other there were the ‘untrained’. We were treated differently in all aspects of life. Trained could have special dishes made if they didn’t like the main course that was served: untrained not. The trained had it for free: the untrained, though earning half or less, had to pay.

 

• Discrimination and abuse was not only dominant in daily life, it was also obvious in the astonishingly exploitative work contracts handed out to staff. I was shocked to read that even ‘absences resulting from accidents at work are treated as illness absences and the Company’s normal rules will apply to such absences’ basically meaning that, even if injured at work, the afflicted will be left with nothing for the first days and SSP thereafter. Even in such a case rules like the following apply: ‘the Company reserves the right to deduct an appropriate amount from your salary if it finds your explanation unsatisfactory….’ This basically means that the company arbitrary can sentence you to a fine - the size of which they decide themselves (and the money goes back into their own pocket).

 

• Yes, we were entitled to annual leave (trained staff of course longer than untrained…) but, according to their own rules, including bank holidays, leaving paltry two weeks as a result.

 

• For ‘crimes’ defined by the company wages could be confiscated and fines could be issued. Among the reasons for this to happen was ‘refusing to allow a search to be carried out in accordance with the rules of the company’. This right, normally only given to police and custom officials, was given to the manager by the company itself and any grievance would be dealt with by the owners as last resort. According to themselves it all stopped there; they were the arbitrator of law at this nursing home company. In their own law book this was clearly stated: ‘The directors’ decision is final, and the grievance procedure is exhausted following this stage.’

 

Part 3:

The ‘National Minimum Standards for Care Homes for Older People’, published by the Secretary of State under section 23 (1) of the Care Standards Act 2000, are rules set for treatment of residents in care homes settings.

• These rules, if seriously adhered to, should be safeguarding the rights of vulnerable users of the private care industry, people seriously in danger of abusive care. Does it work? I seriously question that and, with the help of detailed reports issued by the Care Commission following regular visits to one of the homes I worked in and my own experiences from the same place I find myself in a position able to meticulously evaluate that crucial question. My answer is no, and in the third part of the book I give a large number of examples substantiating that verdict.

 

• The Minimum Standards for care homes and the governmental watchdog, the Care Commission/CSCI, are definitely steps in the right direction, necessary instruments in the struggle to come to terms with at least the worst offenders within this often shady business. But, indeed, there are serious deficits in the system, which to a large extent make it all into a show for the grandstand. The broad range of regulations has been written to cover almost all details in the art of running nursing homes. This they do, but to what extent does this benefit the old and disabled users of the system. I argue that their wellbeing, which should be paramount, only comes in second to the paper work. It seems much more important that the standards are met in writing than in deed.

 

• No, some of the individual plans were not as individual as they were supposed to be but routinely filled out in order to meet the requirements set. In other words, reality often looked very different from what had been documented. Hygiene or something else, it was very often the same old story.

 

• Lack of functioning equipment and severe shortage of time very often offered nurses under severe stress no other option than writing what they knew was expected to be looked for, had it happened or not. As long as that is the case owners, managers and unfortunately also health care inspectors are all happy. Even in the common case that the standards are not met nothing seems to happen. Abusive care homes tend to get away with it.

 

• Complaints from the Commission about the standards are just ignored by the company and rarely this leads to consequences; this we clearly see in the twice yearly reports issued by the Commission. The home where I started my British career, Cravemore’s Fig Leafs Nursing Home in London, for years only met a fraction of these paragraphs, without ever being taken out of business. Like with others in the business it obviously did not matter; they were allowed to continue to operate; the non compliance had no obvious consequences.

 

• Used correctly the care plans – personal files documenting all care needs – would be crucial for good individual care. People, including inspectors, might still think they are. The truth is that they very often – I have seen no exceptions from this – have very little connection to real life, the residents daily life. Why? Because there is no time for anything better. There is no time to write them properly; and those carrying out the care have no time to read them – in some cases they are not allowed to.

 

• Not only a filthy home for the poor in London but also Upmarket House in Scotland to my surprise did not live up to the recommendations – and got away with it. I talked to the Commission about that, but they were not interested. Due to this lack of interest, especially one old woman lived out her last years of life in a confined room permanently frightened of her room companion. Two residents in a small room meant increased profits, the owners were happy and the Care Commission turned a blind eye, though the evidence for breaking their own rules were clear cut. There was no one speaking out for the old people.

 

• As said, being a witness to neglect and abuse for such a long time, I had finally reached the end of my tether and had to act: I went to the Care Commission. I asked for their comments. I expected them to be on my side. I was wrong. I soon realised that dreams and expectations like that were very far from reality, in fact nothing but wishful thinking. Racial and gender discrimination of the workforce was not their business, I was told. An obvious breach of their own rules was no concern either.

 

• Open racism against the workforce did not remotely concern the representatives of the Care Commission; they were not interested. What did it matter that this policy of theirs was in blatant disregard of the policy of another commission, the Commission for Racial Equality. Their message was non-equivocal. If the management of Rowan Homes and the officers of the Care Commission condone racism, then they both were acting in contrary to the Race Relations Act.

 

Part 4

In the fourth part of the book we are back in southern England. We meet the dictatorial deputy manager Betty Bumble and we will see how a single person can be allowed to make life a hell for both vulnerable clients and staff. We will also see how CSCI and social services arrange for a flawed ‘investigation’ to cover up for a regime the author calls criminal.

• ‘Please, dear God, help me! Please let me out! I am claustrophobic; I can’t take this any longer; don’t lock me up like this. PLEASE, somebody!! PLEASE!!!’

She was in a panic, terrified, frightened to death. She begged; she pleaded; she cried. Every night her screams tormented nerve racked neighbours…. Yes, every night around ten the same old story started all over again. As soon as Agnes Havisham in her wheelchair was taken close to her upstairs room a fierce struggle started. Screaming and fighting back she had to be put to bed by physical force and then the bedrail went up: she was trapped.

• Though this case was to be the straw that finally broke the camel’s back and brought me into a final confrontation with the industry and those overseeing it Agnes wasn’t alone having her human dignity encroached upon this place…..What was going on here was, as I saw it, an outright crime against humanity.

 

• Michelle was a woman in her late forties suffering from a debilitating disease that had left her totally dependent on outside help and care. Except for severely restricted movements of her contorted hands, with which she (on days her mental state allowed) was able to feed herself, she was totally paralyzed. This, however, was no reason for mercy. For several weeks, actually months, Michelle had been exposed to severe restrictions of movements, all based on arbitrary orders from Ms Bumble and meted out as punishment for ‘bad behaviour’. The imposed regime of isolation had been common knowledge for all people around – residents, management and staff – but was carefully kept away from the official written records. This mental harassment constantly went on while I was there, and to me it appeared like this was regularly happening when she didn’t toe the line and ‘behaved’.

 

• There were a number of other examples of how a modern-day small dictator was allowed to make life extremely difficult for some of the most vulnerable people in Britain.

 

• I couldn’t believe it one day when Bumble told me about new orders not to allow Rosanne, a young disabled resident, to be hoisted to the toilet during the night…. According to Bumble it had come from the community placement officer in charge of her care (and whose department later would investigate my complaint about the case) and we had a duty to execute the orders.

 

• Reading the investigators findings, it was interesting, rather shocking, to note that the investigators had chosen to investigate the entire complaint by interviewing the two people accused of wrong doing, two new senior administrative staff (none of whom employed at the time of my complaint…) and only one resident, the most vulnerable of them all, a woman completely dependent on her tormentor. NO OTHERS. Not myself, nobody.

 

• I don’t know who had set the rules for the process of investigating my complaint, but it all seemed clear: the person being investigated had been allowed more or less to dictate the outcome. No serious witnesses had been heard and unchallenged Bumble had been given free reins to hit back. This way serious allegations about abuse of power had been swept aside and not the slightest sign was left showing that anybody had ever made any attempt to look for the truth. The opposite was the case: everything seemed to have been done to cover up. I was shocked by this reading, though not surprised.

 

• After that I wrote a detailed respons to a deeply flawed investigation. This was supported by my MP who demanded a new investigation into both my original complaints as well as into the way the ’investigation’ had been carried out. A review board (also appointed by the same council that was deeply involved in the cover up) met and decided that the investigation indeed had been flawed, but that it was all too long ago now and too late to look into it again. They recommended the council to give me an appology for having refused (they called it ’delayed’) to communicate with me. Thereafter they declared the case to be closed.

 

• In the meantime (about a year and a half) the same (untrained) deputy has continued to be in charge of this home for both elderly as well as seriously disabled younger residents. Managers have only lasted for very short time before they have been forced out again, mainly by the same deputy. Apart from short interim periods of time she has ruled the home with an iron fist. Despite using methods like month-long isolation for ’naughtiness’ (for requesting help from staff), refusing toileting and other home-invented methods of ’care’ she has unchallenged been allowed to carry on as usual.

 

• Without the help of my MP I wouldn’t even have got as far as to read this report (as they refused to share it with me before he became involved), and without a very sharp complaint from his side, which fortunately followed, the case would have ended here. However, confronted by the parliamentarian the council saw themselves forced to give ‘justice’ one more chance. They realized that one more step would have to be taken before this nuisance finally could be brought to an end: a reviewing panel would have to look at the case.

     Good news? Probably it all looked better than it was. Alright, the bureaucrats had been pushed into a corner, but they wouldn’t remain there. The reason for that was obvious: the power to appoint the reviewing panel remained in their own hands, and that was what counted. Basically, there could be as many investigations and reviews as we liked, but each and everyone would just be one more for the grandstand. As long as investigators or members of panels weren’t truly independent the result would always be the same. The system and its actors had decided to close this case and closed it would be.

• Dear Mr Y,    (letter from my MP to the head of social services)

 

You will recall my letter regarding Nightingale Lodge Nursing Home. I have not heard further from you…. the review and the report barely mention the serious allegations about abuse of vulnerable residents that Mr Petersson claims were commonplace. I am extremely sympathetic to him as I feel that there are still a number of serious allegations into specific incidents of abuse that have not yet been properly considered and investigated.

Your department’s original report, which was written after the first investigation concluded that ‘there is insufficient evidence, either written or verbal, that would support the allegations made by LP’ and that there was no case for any individual to answer. Your most recent investigation suggests that this first investigation was flawed and that there have been a number of serious errors in the way this matter has been handled. This does not inspire much confidence in the way investigations have been conducted in your borough. I agree with Mr Petersson that a more detailed investigation is urgently needed and am writing again to you to urge that you now – personally – ensure this happens. If you are not prepared to agree that a further, fuller and completely independent investigation is carried out into the running of this establishment then I will bring the whole case to the personal attention of the Minister and will make a formal complaint about the way your council has refused to take this matter as seriously as it most certainly should have done.

Yours Sincerely

M Smith MP

 

 

• Dear Mr X, (CSCI),

 

You will recall that I wrote to you on 25/09/08 regarding serious allegations about conditions and care in the above nursing home. (…) Despite the seriousness of the allegations and a follow up letter from me dated 22/12/08 I am appalled to say that I have still not received a reply from you. I cannot stress how important I think this matter is and how angry I am at your discourtesy in not replying to me. I would now be grateful for your most urgent attention to this matter. I think these allegations are so serious that I will need to write to the Minister, make personal representation to him and speak to the local MPs to ensure that they are fully aware of the allegations and the difficulties an honest ‘whistle blower’ has experienced. I still hope that a completely independent investigation is carried out, as a matter of urgency, into the original allegations, the way the first investigation was carried out, into Mr Petersson’s further comments in his extremely detailed report and into how my complaint has been handled. I would now ask for your immediate response.

Yours Sincerely

 M Smith MP

 

Here this story ended. The MP’s threats were empty. He was appalled that the local services didn’t answer him about this precarious matter. When I politely asked him to act in accordance with his own words he himself stopped answering me…. I have found this is the way people in power deal with difficult questions and whistle blowers who do not go away.

CSCI and social services just refused to budge; the MP ‘forgot’ his threats, and this far nothing else has happened; unless this story is published and a powerful journalist take further action to investigate this cover-up (which is now about to happen), perpetrators of crime against vulnerable, defenseless elderly and disabled citizens will remain unpunished and in the dark.