Monday 12 May 2014

“Will you help me, please?”

These are the heart-breaking words of 98-year old Yvonne Grant, calling for someone to help her to the toilet in secret filming captured by her family and aired by Panorama ‘Behind Closed Doors: Elderly Care Exposed’.

In this hour-long programme, viewers are shown older people in care homes being neglected and abused, call bells being ignored, verbal and physical assaults, and staff who are either completely unsuitable for the job they are doing or, as a few glimpses of footage show, some very good staff who - whilst overstretched - are caring people who want to do their best for the frail older people who are depending on them.

For me, having been by my father's side through 9 years in social care (punctuated by spells in hospital), I saw things then that didn't represent good care on more than one occasion, and as I have already written about, I had cause to call in CQC when my father's care deteriorated (‘From care to catastrophe’). Whilst I have never seen the type of physical abuse depicted in the programme, it's important to remember that many aspects of poor care aren't any less abusive just because they don't involve physical violence. 

You will struggle to find anything in this programme that represents what most people would want care for their loved one to look like, defined in the current overhaul of CQC’s inspection process as ‘The mum test’ – namely asking if a provider is delivering care good enough for our mums and dads, grans and granddads, siblings, cousins and wider network of loved ones. New key-lines of enquiry for CQC inspectors will ask if a service is safe, caring, effective, responsive and well-led – everything that is absent in this footage.

In the consultancy work I do now I've seen practice that wouldn't pass the 'mum test' for me. Providers don't always get it right, sometimes through failings they want to learn from and make long-lasting improvements because of. However in other cases, as we heard in the Panorama programme, there are some providers who are ‘content’ to bump along the bottom, treading the fine line of previous inspection regimes that defined a provider as being either compliant or non-compliant.

As members of the public we expect that regulation of care providers will root out all poor practice, but as the Panorama programme clearly showed, regulation alone isn't enough. From my personal perspective, it certainly wasn’t enough to prevent my father from aspirating on his own vomit five times and being admitted to hospital with aspiration pneumonia and pressure sores.

The overhaul of the CQC inspection process that is currently out for consultation  – including looking at the issue of cameras in care homes -  gives me some hope for the future, but however robust inspection becomes, and however much quality and innovation is made an intrinsic part of the regulator's role, CQC alone cannot ensure that every service is good enough for our loved ones.

Inspection is but a snapshot of a service. Done well by a team that includes a well-trained inspector, an expert by experience and (where necessary) a specialist expert (for example in dementia, palliative care or pharmacy), against key lines of enquiry that focus on what good should look like, it will expose most services that require improvement or are inadequate.

For me, however, the real key to unearthing insidious poor practice (and equally excellent practice) comes from intelligent monitoring. In other words, whistleblowing staff, relatives and visitors, including visiting health and social care professionals - the people who see what happens on all the days of the year when the CQC team aren't present. 

In an ideal world we would all be the eyes and ears of CQC, but in practice whistleblowing has become a concept that instils fear whenever someone considers it, as I described in ‘Putting your head above the parapet’. Fear in professionals that they will be ostracised and deemed unemployable, fear in relatives that their loved one will be victimised because they have spoken out, and fear from those receiving care that they will be silently killed for complaining.

In that climate, poor care and abusive practices can proliferate and this must change. We need the culture of whistleblowing to be encouraged and respected. Confidentiality, alongside a proper weighting of evidence - rather than a previous attitude of ignoring what hasn't been corroborated over a long period of time by numerous others (who may be too frightened to speak out) - is vital.

There are other suggestions too. One of the most innovative ideas I’ve read is that care homes should have boards of governors in the way that schools do. Private sector care providers are offering a service in the same way that private schools are, and both exists to nurture vulnerable members of society, just at different ends of the age range. Governors that are drawn from a cross-section that includes representatives of those receiving care, relatives, friends, health and social care professionals and wider community leaders could rejuvenate every aspect of social care.

It cannot be the case that we rely on TV programmes to occasionally shine a light onto the plight of a minority who receive a service that is so short of being caring it shocks the nation. Families resorting to installing cameras to prove what is happening to their loved ones, and then watching in tears as the full extent of their suffering is revealed, proves that we woefully short of a culture of open accountability.

As a nation we have to demand better for our loved ones. As professionals we have to find a way to deliver better care. And as the majority of good social care providers would say to the minority who are failing: If you can't deliver a service that is safe, caring, effective, responsive and well-led then go into another sector, far away from the care of vulnerable people. 

As Yvonne said: “Will you help me, please?”

Until next time...
Beth x

You can follow me on Twitter: @bethyb1886


  1. I read this with such dread for the future, with a mother with the early stages of dementia, I fear for the future. Well written article and only wish this would go global so we can inforce change.

    1. Thanks for your comments Laura. I know exactly how you feel after what I went through with my dad, but I would say that the vast majority of the care he received was excellent. Indeed we are still friends with some of the people who helped to care for my dad.

      If you search under the 'elder abuse' label in the right-hand menu, there are far fewer posts than if you search for more positive terms, like 'positive approach', 'personalisation' or 'communication', which hopefully demonstrates the many positive experiences we had. Most social care providers are committed to improvement and education and recruit staff with the compassionate, caring values that the sector needs. We absolutely must deal with the minority who don't work in this way, but I hope you can take some comfort from knowing that there are many of us out there trying to make a difference and ensure that your mum and the loved ones living with dementia in other families receive the best possible care.

      All the best, Beth