BBC
Analysis
Everyone is responsible for preventing further abuse There is no single solution to the complex problem of care home failings say experts. Christian Duffin reports A BBC Panorama documentary exposing poor quality care in nursing homes has prompted one of the company’s portrayed to consider the use of CCTV to tackle abuse and neglect of residents. The programme, which aired in April, used undercover filming at two homes, the Old Deanery in Braintree, Essex and Oban House in Croydon, south London. At Oban House secret cameras installed by a relative of 98-year-old resident Yvonne Grant revealed how she was repeatedly ignored after asking to go to the toilet. Instead, staff told Ms Grant to use the continence pad that she was wearing. HC-One, which owns Oban House, apologised unreservedly for the failings in the care of Ms Grant, who died in 2012. Two staff members have since been convicted of common assault. The company is now consulting on the use of CCTV cameras in all its care and nursing homes. At the Old Deanery residents were moved roughly, ignored and left in their own excrement. One care worker appeared to slap a resident with dementia. The worker was among seven staff sacked as 8
June 2014 | Volume 26 | Number 5
a result of the programme. At the time of writing, she had been arrested on suspicion of assault and released on bail pending further enquiries. Anglia Retirement Homes, which runs the Old Deanery, also apologised ‘unreservedly’. A spokesperson added: ‘These incidents involved a small number of staff and are not reflective of the high standards of care which we expect and demand from all our team.’ It is not the first time that CCTV has been considered as a solution to ill treatment. A Care Quality Commission (CQC) consultation on regulating, inspecting and rating care services, including views on whether CCTV cameras are the way forward, is due to close on June 4. Rating system CQC’s chief inspector of adult social care Andrea Sutcliffe said the CQC will introduce ratings systems for care homes later this year that will ‘drive improvement’. She added: ‘We cannot always know what goes on behind closed doors but I am determined that our new approach will strengthen our ability to uncover poor care.’
A BBC Panorama documentary revealed significant failings in the care of 98-year-old Yvonne Grant
But the complex issues underlying abuse cannot be solved with a single solution, according to senior nurses. RCN professional lead for the care of older people Dawne Garrett argues that the CQC should examine certain statistics about homes that could uncover abuse. ‘They could get the views of more relatives or look at figures on unexpected admissions to hospital,’ she says. ‘They should be considered alongside staffing levels, skill mix and training available for staff.’ Care homes should also set up networks to share good practice, she adds. ‘If you don’t share good practice and see what other providers are doing then you may not realise that you are failing.’ The Panorama programme highlighted that some staff were paid little more than £7 an hour. Ms Garrett believes this was a factor in their behaviour. Staff should be paid decent wages, offered training and generally be treated well, Ms Garrett explains. ‘You have to offer respect to staff. If these staff don’t respect themselves and are devalued as human beings, then how can they deliver sensitive care?’ Training vital Chair of the British Geriatrics Society older people’s specialist nurse and senior practitioner group Jane Buswell agrees that staff education and training are vital, and that a national accreditation scheme should be introduced. ‘Some of the smaller homes just don’t have enough money, and they take on staff with very little experience,’ she says. ‘Carers are paid less than the minimum wage. What is the incentive to do the job when you can work for Tesco for more money and less stress?’ Meeting residents’ needs can be challenging, she acknowledges. ‘Twenty or 30 years ago residents needed help getting dressed or getting to the dining table. There was little dementia. Now there is dementia, Parkinson’s and osteoarthritis. Health care is much more complex, but we haven’t upped the ante to address that.’ NURSING OLDER PEOPLE
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Analysis
■■ My Home Life http://myhomelife.org.uk Initiated in 2006 by the National Care Forum and Help the Aged, it has become a high-profile social movement to promote quality of life in care homes. ■■ Preventing Abuse and Neglect in Institutional Care of Older Adults www.panicoa.org.uk A research initiative to enhance dignity in care homes and hospitals. ■■ Sit and See http://sitandsee.co.uk An observation tool to capture and record positive, passive or poor care. ■■ Social Care Institute for Excellence www.scie.org.uk Resources that can help improve the knowledge and skills of all those working in social care. Nurses have a role in whistleblowing, says Ms Buswell. ‘A lot of nurses have links to care homes and we have a leadership responsibility to highlight poor practice. We also need to remind providers about their legal responsibilities on human rights and when someone lacks capacity.’ Ms Buswell urges care homes and general hospitals to develop a culture of compassion by exploring best practice strategies (see box). These include the My Home Life programme, developed by nurse Julienne Meyer, which promotes quality of life. Consensus There is some consensus on the way forward, however, say senior nurses such as Ms Buswell and Ms Garrett. They believe that everyone has a role to play in preventing abuse: from nurses and doctors through to inspectors and care home managers. Ms Buswell adds: ‘The danger is trying to find one single answer. I was at a conference recently and someone said that for every complex problem there’s a simple, obvious solution that is always wrong.’ See opinion, page 12 Christian Duffin is a freelance writer NURSING OLDER PEOPLE
Health hazards from loneliness put pressure on NHS and local services Getty
Good practice resources for care settings
‘Social prescribing’ by healthcare staff could ward off risks of early death and depression in older people who are isolated and friendless, as Nick Triggle hears NURSES AND other front line health staff are being urged to be on the lookout for people who are lonely, following the publication of new figures that suggest numbers are on the rise. A survey by Age UK of 2,000 people aged over 65 found that one in ten described themselves as ‘often’ or ‘always’ lonely – a rise from 7% a year ago. If that figure is applied across the whole population, it equates to more than one million people. Meanwhile, four in ten surveyed said their TV or pet was their main form of company and 30% said they wanted to go out more. The research strengthens the evidence that social isolation is becoming a major consequence of the ageing population. Last year health secretary Jeremy Hunt described such loneliness as a ‘national shame’, while the Winter Friends campaign – led by NHS Choices and designed to encourage people to keep an eye out for older friends or neighbours – called for a return to the ‘old-fashioned sense of neighbourliness’. But the Age UK figures also raise the question of what the NHS could be doing. Research has shown that chronic loneliness can increase an older person’s risk of early death by 14%, which is twice the effect of obesity.
Campaign to End Loneliness director Kate Jopling says: ‘Quite often the NHS is quick to treat the symptoms, without recognising that the problems people present with are linked to loneliness. ‘Social isolation increases the risk of alcohol abuse, unhealthy eating, mental health problems, smoking and physical inactivity. We would like to see GPs, practice nurses and community nurses recognising loneliness more. Emergency department staff too will see people repeatedly presenting,’ adds Ms Jopling. ‘People need help maintaining or developing social connections. By doing that, we can help reduce the chances of them needing expensive treatment and care later in life.’ RCN older people’s forum steering committee member Sue Edwards agrees. ‘Conventional medicines have their place but they won’t cure loneliness,’ she says. ‘Older people who are lonely are at risk of depression and potentially suicide, therefore the first line of treatment can all too often be an antidepressant. What many people fail to realise is the consequences of taking such medication in terms of interaction with other drugs and the effect on physical health.’ There needs to be much more ‘social prescribing’, Ms Edwards says. ‘I will always encourage patients to engage in social activity where possible. This can range from going to the gym or playing card games through to art classes, walking groups or day centres.’ This need is beginning to be recognised in some places. In April, Calderdale council and Calderdale clinical commissioning group announced £1 million of funding for schemes aimed at tackling loneliness. They want to see more partnerships with the voluntary sector and greater community engagement to enable local clubs, activity groups and befriending schemes to flourish. However, shortages of funding in local government and the NHS could restrict them. ‘There are plenty of good schemes out there,’ says Ms Edwards. ‘But services are also being cut. That is a worry.’ Nick Triggle is a freelance writer June 2014 | Volume 26 | Number 5
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Analysis
Everyone is responsible for preventing further abuse There is no single solution to the complex problem of care home failings say experts. Christian Duffin reports A BBC Panorama documentary exposing poor quality care in nursing homes has prompted one of the company’s portrayed to consider the use of CCTV to tackle abuse and neglect of residents. The programme, which aired in April, used undercover filming at two homes, the Old Deanery in Braintree, Essex and Oban House in Croydon, south London. At Oban House secret cameras installed by a relative of 98-year-old resident Yvonne Grant revealed how she was repeatedly ignored after asking to go to the toilet. Instead, staff told Ms Grant to use the continence pad that she was wearing. HC-One, which owns Oban House, apologised unreservedly for the failings in the care of Ms Grant, who died in 2012. Two staff members have since been convicted of common assault. The company is now consulting on the use of CCTV cameras in all its care and nursing homes. At the Old Deanery residents were moved roughly, ignored and left in their own excrement. One care worker appeared to slap a resident with dementia. The worker was among seven staff sacked as 8
June 2014 | Volume 26 | Number 5
a result of the programme. At the time of writing, she had been arrested on suspicion of assault and released on bail pending further enquiries. Anglia Retirement Homes, which runs the Old Deanery, also apologised ‘unreservedly’. A spokesperson added: ‘These incidents involved a small number of staff and are not reflective of the high standards of care which we expect and demand from all our team.’ It is not the first time that CCTV has been considered as a solution to ill treatment. A Care Quality Commission (CQC) consultation on regulating, inspecting and rating care services, including views on whether CCTV cameras are the way forward, is due to close on June 4. Rating system CQC’s chief inspector of adult social care Andrea Sutcliffe said the CQC will introduce ratings systems for care homes later this year that will ‘drive improvement’. She added: ‘We cannot always know what goes on behind closed doors but I am determined that our new approach will strengthen our ability to uncover poor care.’
A BBC Panorama documentary revealed significant failings in the care of 98-year-old Yvonne Grant
But the complex issues underlying abuse cannot be solved with a single solution, according to senior nurses. RCN professional lead for the care of older people Dawne Garrett argues that the CQC should examine certain statistics about homes that could uncover abuse. ‘They could get the views of more relatives or look at figures on unexpected admissions to hospital,’ she says. ‘They should be considered alongside staffing levels, skill mix and training available for staff.’ Care homes should also set up networks to share good practice, she adds. ‘If you don’t share good practice and see what other providers are doing then you may not realise that you are failing.’ The Panorama programme highlighted that some staff were paid little more than £7 an hour. Ms Garrett believes this was a factor in their behaviour. Staff should be paid decent wages, offered training and generally be treated well, Ms Garrett explains. ‘You have to offer respect to staff. If these staff don’t respect themselves and are devalued as human beings, then how can they deliver sensitive care?’ Training vital Chair of the British Geriatrics Society older people’s specialist nurse and senior practitioner group Jane Buswell agrees that staff education and training are vital, and that a national accreditation scheme should be introduced. ‘Some of the smaller homes just don’t have enough money, and they take on staff with very little experience,’ she says. ‘Carers are paid less than the minimum wage. What is the incentive to do the job when you can work for Tesco for more money and less stress?’ Meeting residents’ needs can be challenging, she acknowledges. ‘Twenty or 30 years ago residents needed help getting dressed or getting to the dining table. There was little dementia. Now there is dementia, Parkinson’s and osteoarthritis. Health care is much more complex, but we haven’t upped the ante to address that.’ NURSING OLDER PEOPLE
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Analysis
■■ My Home Life http://myhomelife.org.uk Initiated in 2006 by the National Care Forum and Help the Aged, it has become a high-profile social movement to promote quality of life in care homes. ■■ Preventing Abuse and Neglect in Institutional Care of Older Adults www.panicoa.org.uk A research initiative to enhance dignity in care homes and hospitals. ■■ Sit and See http://sitandsee.co.uk An observation tool to capture and record positive, passive or poor care. ■■ Social Care Institute for Excellence www.scie.org.uk Resources that can help improve the knowledge and skills of all those working in social care. Nurses have a role in whistleblowing, says Ms Buswell. ‘A lot of nurses have links to care homes and we have a leadership responsibility to highlight poor practice. We also need to remind providers about their legal responsibilities on human rights and when someone lacks capacity.’ Ms Buswell urges care homes and general hospitals to develop a culture of compassion by exploring best practice strategies (see box). These include the My Home Life programme, developed by nurse Julienne Meyer, which promotes quality of life. Consensus There is some consensus on the way forward, however, say senior nurses such as Ms Buswell and Ms Garrett. They believe that everyone has a role to play in preventing abuse: from nurses and doctors through to inspectors and care home managers. Ms Buswell adds: ‘The danger is trying to find one single answer. I was at a conference recently and someone said that for every complex problem there’s a simple, obvious solution that is always wrong.’ See opinion, page 12 Christian Duffin is a freelance writer NURSING OLDER PEOPLE
Health hazards from loneliness put pressure on NHS and local services Getty
Good practice resources for care settings
‘Social prescribing’ by healthcare staff could ward off risks of early death and depression in older people who are isolated and friendless, as Nick Triggle hears NURSES AND other front line health staff are being urged to be on the lookout for people who are lonely, following the publication of new figures that suggest numbers are on the rise. A survey by Age UK of 2,000 people aged over 65 found that one in ten described themselves as ‘often’ or ‘always’ lonely – a rise from 7% a year ago. If that figure is applied across the whole population, it equates to more than one million people. Meanwhile, four in ten surveyed said their TV or pet was their main form of company and 30% said they wanted to go out more. The research strengthens the evidence that social isolation is becoming a major consequence of the ageing population. Last year health secretary Jeremy Hunt described such loneliness as a ‘national shame’, while the Winter Friends campaign – led by NHS Choices and designed to encourage people to keep an eye out for older friends or neighbours – called for a return to the ‘old-fashioned sense of neighbourliness’. But the Age UK figures also raise the question of what the NHS could be doing. Research has shown that chronic loneliness can increase an older person’s risk of early death by 14%, which is twice the effect of obesity.
Campaign to End Loneliness director Kate Jopling says: ‘Quite often the NHS is quick to treat the symptoms, without recognising that the problems people present with are linked to loneliness. ‘Social isolation increases the risk of alcohol abuse, unhealthy eating, mental health problems, smoking and physical inactivity. We would like to see GPs, practice nurses and community nurses recognising loneliness more. Emergency department staff too will see people repeatedly presenting,’ adds Ms Jopling. ‘People need help maintaining or developing social connections. By doing that, we can help reduce the chances of them needing expensive treatment and care later in life.’ RCN older people’s forum steering committee member Sue Edwards agrees. ‘Conventional medicines have their place but they won’t cure loneliness,’ she says. ‘Older people who are lonely are at risk of depression and potentially suicide, therefore the first line of treatment can all too often be an antidepressant. What many people fail to realise is the consequences of taking such medication in terms of interaction with other drugs and the effect on physical health.’ There needs to be much more ‘social prescribing’, Ms Edwards says. ‘I will always encourage patients to engage in social activity where possible. This can range from going to the gym or playing card games through to art classes, walking groups or day centres.’ This need is beginning to be recognised in some places. In April, Calderdale council and Calderdale clinical commissioning group announced £1 million of funding for schemes aimed at tackling loneliness. They want to see more partnerships with the voluntary sector and greater community engagement to enable local clubs, activity groups and befriending schemes to flourish. However, shortages of funding in local government and the NHS could restrict them. ‘There are plenty of good schemes out there,’ says Ms Edwards. ‘But services are also being cut. That is a worry.’ Nick Triggle is a freelance writer June 2014 | Volume 26 | Number 5
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