THE
Care Quality Commission identified 3,200 deaths of
elderly people who were receiving care in their own home in the
twenty eight day period 10 April to 8 May. This figure is
about 2000more than the average number of deaths for
the same period in the past three years. I am sorry to have to say
that this jump in the numbers does not surprise me.
My
wife and I are both in this age group. For our own protection we
closed our door to the rest of the world on 21 March. Two kind
friends drop off food about once a week and we get occasional
deliveries from a supermarket. Milk is delivered to us three times a
week. Post arrives most days.
Before
anything is allowed into the house it is either sterilised or
quarantined for three days. Cans and bottles are sprayed with
diluted bleach, left for ten minutes, then washed bleach free.
Anything which is double wrapped, and most foods from supermarkets
are, has the outer packing cut away with scissors, the food tipped
out and the packaging goes straight into the outside bin. Other food
is quarantined. Post which has come from a mailing list and will
have been machine handled has the end of the envelope cut away, the
contents tipped on to the floor and the envelope goes straight to the
paper bin. After the weekly waste collection the handles on the bins
get the bleach treatment. Hands which have touched anything which
might be contaminated get the
Lady Macbeth treatment.
Pedantic,
careful, we don’t mind what you call us, we just intend to remain
safe.
One
of my neighbours who is much
the same age as I, has been
receiving ‘in home’
care since being discharged from hospital. There has been a regular
stream of people involved in that care going in and house. I watch
them. Some put on face masks, aprons and gloves, and some do not.
Some come in clean white uniforms; most do not; they
come in ‘clobber’
wearing backpacks. I have struck up conversations. If they come
with some kind of PPE I mention how seldom this happens. I can
usually guess, but ask politely,‘are you Care Service or
NHS’?
Yesterday
I tried this with someone I could tell was from the NHS. When I
mentioned how seldom people from the Care Service come with proper
PPE the response was ‘We keep trying to get into their
heads the importance of infection control’.Trying, but failing, it would seem.
Thankfully
it is not my wife who is receiving ‘in
home’ care. If it
were I would not let the buggers in the house until they matched the
standards of infection control
I impose on myself.
BETWEEN
10 May 1940 and 23 May 1945 Labour MPs were part of a coalition led
by Winston Churchill. Initially Clement Attlee was a
member of the five man Cabinet as Lord Privy Seal.
From February 1942 Attlee was also Deputy Prime Minister.
In
other words any planning for the post war world, including planning
for an overhaul of the health care system, was as much done by Labour
politicians as it was by those from other parties. Labour didn’t
just ‘get lucky’, implement existing plans drawn up by
someone else and take all the credit for the formation of the NHS, as
two recent contributors would have us believe.
Listening
to Jeremy Hunt this morning I was left with the impression
that one of the responses to the staggering number of deaths in Care
Homes and similar facilities is likely to be a coming together of
the Care Services and the NHS. This has been a long term ambition of
Andy Burnham who has written and spoken about this since he
was Health Secretary 2009-2010. If, as I expect, legislation
to bring this about will be in a future Queen’s Speech will
the two recent contributors who are so keen to deny Labour credit for
establishing the NHS be demanding that Burnham receives a share of
the credit for a coming together of the care and health services?
Personally I am happy to give credit for this to whatever government
brings it about.
As
for the ‘Libertarian Left’ if it does not like the
‘statist’ model we have now it has had 73 years to bring
into existence a viable alternative to the NHS and has done precisely
nothing. It is always ready to snipe from the sidelines, but never
wants to devote time and energy to giving some thought to exactly
how an alternative system would deliver specialist as well as routine
care; how it would deal with epidemics of, for example, winter flu;
provide a vaccination service for children which by its nature relies
on ‘herd immunity’ to be fully effective; or how it would
be funded. What would its response to the Covid19 pandemic look
like? How much thought has it given to international trade or
international terrorism, cyber hacking or effective strategies to
combat climate change?
Any
answers to questions like this will be a long time coming, not least
because so many of those who sail under the flag of the ‘LibertarianLeft’ have lost themselves on the barren shores of
‘trans issues’, both for and against.
ALMOST
every Sunday afternoon I
watch the Politics Scotland programme. Unlike his English
equivalents, the presenter Gordon Brewer, never tries to trap
the politician he is questioning into a ‘TV moment’ just
to boost his ego. Instead he is quiet, courteous, persistent and
gets results.
A
week ago I watched him question the Scottish Health Secretary,
Jeane Freeman, about the situation in Scottish care homes and
specifically about the release of people from hospital into care
homes. She ‘waffled’ her way through an answer claiming
that care homes should and could provide for such new residents an
unrealistic level of nursing support. On 15 May the guidance was
changed, perhaps because Freeman realised she had been well and truly
‘skewered’.
Almost
a half of the deaths in Scotland resulting from Covid19
disease have been in care homes. At one such care home in Portree,
the main town of the Isle of Skye, nearly all its 34 residents
and half its staff have contracted Covid-19 and in the last 10 days
seven residents have died, with dozens of staff sent home and told to
self-isolate.
In
order to stabilise the situation NHS Highland has stepped in
to play a greater role in running of the home on Skye after the Care
Inspectorate raised concerns. The Scottish Government has
announced it will fast -track emergency laws which will allow it to
step in and take over the running of failing care homes. On
yesterday’s programme Gordon Brewer raised the question of whether
the care home sector should be ‘Nationalised’.
Using
the ‘N’ word will not be well received in some circles,
but it is surely worth asking why we are farming out the nursing care
of the elderly and frail to private companies, designed to return a
profit, instead of giving them the best nursing care available from
NHS staff.
'It could be argued that is was predictable that the NHS was established
by a Labour government due to it being elected in 1945 - when plans for
what was to be called the NHS were well advanced but lost in the mists
of time.
'Contemporary news reports from 1944 demonstrate that
plans for the NHS were already well advanced. They had moved on
considerably from the Beveridge Report in 1942 (see: Towards A Healthier
Britain - (Minister Of Health's Speech 1944)
'Unfortunately, the
whole issue has been claimed by Labour and its supporters as 'theirs',
with seemingly total and utter reverence towards one man.
'Like
the substitute who makes his first appearance late on and scores the
winning goal in the FA Cup finaal, it is often the politician who is in
the right place at the right time, who receives all the praise - even
if they never claimed nor asked for it themselves.'
CARL Faulkner’s comment above about
my original article rather misses the point of what I was trying to
say. As my Libertarian friends endlessly remind me there were other
schemes in operation even before the NHS was a gleam in anyone’s
eye.
Bevan
would have been familiar with the Tredegar
Medical Aid Societyas
he was the local MP. In
return for contributions from its members
it provided health care free at the point of use. (my
emphasis)
This
model of funding was rejected by Bevan. The
scheme that was eventually introduced was, and is, funded from
taxation. That
is why I think we should be happy to say; ‘Thank
you Nye Bevan’.
And
I make no apology for saying so.
The
advantages of not making it a contributory scheme can best be seen by
contrasting it with National Insurance. In the 1970s many married
women were seduced into paying reduced NI contributions. When
they reached the pensionable age for women they only then realised
the disadvantage they had brought upon themselves.
At
some point we are going to have to rethink how the elderly, infirm
and disabled members of our society are cared for in
order to bring some parity between the Care Service and the NHS in
terms of provision of resources in the form of personnel and
resources. I would argue strongly for a service funded by taxation
on the basis that we all run the same risk of needing such care at
some time in our life just the same as we all run the same risk of
needing care by the NHS.
ON the 28th, April, Milton Pena placed the following comment on this NV Blog:
'It’s Gerineglicide
Derek, it has been happening for more than a decade and it has
worsened by the Pandemic.
'I read that the life span of
the elderly have been shortened by TWELVE years as a result of
becoming ill with this virus and dying of it.'
On the 29th, April, Blanco Posnet posted:
'I'm no conspiracy theorist, but I'm
beginning to wonder if that Bunteresque Johnson, and his sidekick, Dom Cummings,
aren't exploiting this national emergency to kill off the elderly and the
baby-boomer generation in order to cut the social security/pension bill. It may
be a kind of “Shock Therapy”, disaster capitalism, approach to cutting public
expenditure.'
Social Care is a poor relation!
YET, what is happening in the social care sector is not new. For donkey's years under different governments social care has been the poor relation of the welfare sector. You can call it 'Gerineglicide' if you like. Or as I would prefer 'constructive manslaughter'.
It is 'constructive manslaughter' and not murder, since the intent is not to kill the victim, the mens rea required for murder
does not exist because the act is not aimed at any one person. Rather it is systemic in that it is built into the procedure for looking after the people at the end of their lives.
Most government including the current one under Boris have promised to resolve the problems of tackling social care, but have yet to come up with a satisfactory plan. The public have allowed this to happen partly because they are confused and think that their end of life care will be tackled by the NHS.
Clean plate club & one step nearer the grave!
People are closing their eyes to what's happening, and have been for ages.
Alan Bennett in his diary entry in 1995 describes events at a care home his mother was in, in Somerset:
'The turnover of residents is quite rapid since whoever is quartered in this room is generally in the late staged of dementia. But that is not what they die of. None of theses women can feed herself and to feed them properly, to spoon in sufficient mince and mashed carrot topped off with rhubarb and custard to keep them going, demands personal attention of a helper per person. Lacking such one-to-one care, these helpless creatures slowly and respectably starve to death.'
A neighbour of Mr. Bennett's mother has some difficulty:
'Joined the clean plate club, Lily,' says the girl who is feeding Hilda, her neighbour. 'Aren't you a good girl?'
Mr. Bennett says Hilda doesn't want her sweet and 'it is left congealing on her the tray while tea in lidded plastic beakers is taken round, which goes untouched also.' And he adds: 'So another mealtime passes and Hilda is quite caring and with no malice or cruelty at all pushed one step nearer the grave.'
Whose fault is it?
Not the government's surely?
Alan Bennett says: 'Her own a little. Her relatives, if she has relatives. And the staff's of course. But whereas a newspaper might make a horror story out of it, I can't.'
What would Milton Pena or Blanco Posnet do? Or, come to think of it, Charles Charalambous and those who signed his Woke Manifesto for trade unionists and other lefties, do about this?**
Alan Bennett concludes: 'Demented or not, if Hilda were a child there would be a story to tell and blame attaching. But Hilda is at the end of her life not the beginning. Even so, were she a Nobel Prize winner, or not a widow from Darwen but the last survivor of Bloomsbury, yes, then an effort might be made. As it is she is gradually slipping away, which is what this place is for.'
We need something better than slogans, rhetoric and virtue signalling to tackle these complicated questions. Essentially the problem in this country with regard to elderly people is a largely cultural one, as Alan Bennett's considerations suggest.* Milton Pena is a Chilean-born surgeon who arrived in Britain with his family in 1974 after being forced to flee General Pinochet’s brutal regime. Being Chilean he will probably have found it hard to understand the English attitude to old people as expressed by Alan Bennett and all too deeply embedded in our Anglo-saxon attitudes. * 'Untold Stories' [2005] by Alan Bennett
CARE HOMES across Western Europe
have been ravaged by coronavirus and in Spain alone there have been more
than 16,000 deaths, many around the capital Madrid. The true number may
never be known, but families are asking why so many of their elderly
relatives were lost.
Around lunchtime on 8 March, Rosana Castillo met up
with some close friends not far from her house in Lucero, a
working-class neighbourhood in west Madrid, and, as they did every year,
joined a protest to mark International Women's Day. They gave each
other a warm hug, held hands and marched to chants of "Down with the
patriarchy" and "Feminism will win".
Spaniards, then, could still
venture freely outside and coronavirus, which had already killed several
hundred in Italy, felt more like someone else's pain. Castillo, a
60-year-old retired primary school co-ordinator, had seen a few people
on the underground wearing surgical masks as a protection, but thought
most of them were probably tourists. "We weren't really talking about it
here," she said.
But it was preying on her mind. She had visited
Carmela, her 86-year-old mother, hours before at Monte Hermoso, the
care home near the square where the women had gathered. Arriving at the
main gate, Castillo was told she could not come in. A worker said two
residents had contracted Covid-19, the disease caused by the virus, and
visits had been suspended.
Castillo had seen Carmela, who had
advanced Alzheimer's, three days earlier, when her mother was discharged
from hospital after a week's treatment for breathing difficulties. The
doctor told her Carmela was going to be fine, that her case was not
related to the virus even though she had not been tested.
To
Castillo's frustration, the worker said nothing else and went back
inside Monte Hermoso. As she exchanged phone numbers with some
relatives, Castillo saw another worker rushing away, covering her mouth
with a piece of cloth. They had known each other for a long time but
when the woman left, without stopping to talk, Castillo became
suspicious. "At that moment," she told me, "I felt something wasn't
right."
It was already widely known, first from China, then Italy, that
elderly people with existing health issues were especially vulnerable to
the virus. Yet in Spain, where a fifth of the population is above 65,
or some 8.9 million people, the government of Prime Minister Pedro
Sánchez had announced little in response.
As Castillo followed
news of the outbreak, she wondered if enough was being done to protect
her mother or, indeed, anyone else. Unable to visit Carmela, who had
lived there for five years, her only source of information came from
infrequent, and usually very brief, phone calls from Monte Hermoso. No
matter how much Castillo asked, few things were said.
Consuelo
Domínguez, a long-time friend, coincidentally, also had her mother
living in Monte Hermoso, a red-brick, private centre with large windows
and rooms for up to 130 residents. She, too, struggled to get details.
Both daughters knew some staff had gone into isolation with coughs and a
fever, the most common symptoms of Covid-19, and were pretty sure there
was more going on.
Coronavirus was spreading in Spain at an
alarming speed and, on 14 March, the prime minister imposed a state of
emergency with a nationwide stay-at-home order. No-one was truly safe.
On that afternoon, Domínguez received an unexpected call from Monte
Hermoso. The worker was "very tense," she said, "you could feel it."
Surreptitiously, Domínguez was told that 70 people had been infected
with the virus and at least 10 patients had already died. "I was
frightened," she said. Domínguez called her friend. "I couldn't believe
it," Castillo recalled. "We weren't being told the truth."
Castillo and Domínguez alerted journalists and, on 17 March, Monte
Hermoso became national news. Only then did the Madrid government
reportedly become aware of the devastating outbreak. Nineteen people
were already dead.
In the evening, Castillo received a call from
Monte Hermoso. Her mother, who shared her room with another woman in
similarly poor health, had a fever. "It shocked me," Castillo said. She
knew Carmela was unlikely to survive.
The relatives created a WhatsApp group, and
disturbing messages flowed in. "Staff were very nervous... Some
[residents] were even a little bit delirious," said one of a visit two
days before they had been halted. Aurora Santos, whose mother was also
at Monte Hermoso, recalled seeing residents unwell in the cafeteria
around the same time. "We didn't know anything the management had done,"
she told me, "the protocols they had followed, nothing".
She
joined Castillo and Domínguez in gathering information. They believed
patients with symptoms had not been separated from those without, before
the virus spread rapidly through the home. Staff who had been in
isolation after falling ill were reportedly not being replaced, while
those who continued to work were having to do longer, exhausting shifts.
Lacking adequate protection, workers had to make face masks at home.
"We were trying to help, our loved ones were there," Domínguez said.
"Why weren't they being honest with us?"
Monte Hermoso, it turned
out, was not alone. In fact, nobody seemed to know the true scale of
what was going on. For years, Carmen Flores, head of the Patients'
Defenders ombudsman group, had warned about precarious conditions in
some of Spain's 5,417 care homes. "The amount of messages we were
getting those days was insane," Flores told me. "I was thinking: You
can't let these people rot."
Three in every four homes in Spain are privately run and many
patients, like Carmela, have some of their costs publicly funded. José
Manuel Ramírez, president of the federation representing social care
managers, said fees received by the residences had not changed in the
past decade, a result of years of austerity in Spain.
Many
companies had to carry out savings somewhere to make a profit, claimed
Flores, who also alleged that some lacked equipment even in normal
times, while many operated with minimum staff. (Workers' unions also say
staffing was insufficient, which Ramírez rejected.) A worker at one
care home where more than 90 patients died told me: "For a long time we
had been saying something serious would happen. The conditions were
unsustainable. This isn't a surprise at all."
Crowded hospitals
were having to turn away patients from care homes and send them back,
often to die. Many residences did not have oxygen bottles, crucial in
treating a disease known to cause severe respiratory problems, or even a
doctor - Monte Hermoso, Castillo said, had one doctor, who most days
worked only in the mornings.
The Spanish government had
centralised the purchase and distribution of medical material amid a
worldwide run, so the homes asked officials to send tests and protective
kits. However, Ramírez alleged they were not given priority, and
pictures emerged of carers wearing gowns made of plastic bags. "There
was nothing that could be done without support," he said. "It was a
catastrophe."
The army was deployed to disinfect 1,300 care homes and Monte Hermoso
was one of the first. Margarita Robles, the defence minister, said
patients, in some places, were found abandoned without care, sometimes
dead in their beds, the bodies left for funeral services to retrieve. "Un horror," Flores told me.
Almost
6,000 people have now died in nursing homes in Madrid, after showing
Covid-19 symptoms. Spanish public prosecutors are investigating possible
crimes including manslaughter for neglect, mistreatment and
abandonment.
"I think there was a lot of wrongdoing," said
Castillo. "These people couldn't shout or say they were unwell. They
died in silence and alone." Monte Hermoso has not replied to interview
requests by email; when contacted by phone, an employee told me they
would not talk to journalists.
THE
juxtaposition of my
article There’s No
Pockets In A Shroud
with articles dealing with the iniquities of local councils might be
taken to mean that I think that this is the main issue to be solved
with regard to the social care of those who require
it
due to age, infirmity or accident. That
is not my view and I have some sympathy with local councils who have
to implement a social care system they did not establish and are
expected to do so without the necessary funding, by cutting their
budget in other areas of operation. That some will resort to dodgy
practices tells us more about the integrity of the officers and
councillors involved than about how the flaws in the present system
can be remedied.
As
I tried to stress we have a system of social care in England
which has a strong resemblance to the health system we had in the
1930s and which was found wanting. In other words our social care
system is funded partially by central government, partially by local
government, partially by individuals who
are unfortunate as to need to make use of it, and
partially by those who work in it via
poor pay and poor conditions of service.
The
1930s health care system was swept away by the coming of the National
Health Service
in 1948. This was (and is) both universal
and comprehensive.
It is based upon the principle of shared
risk
and shared
funding.
In
other words we acknowledge that we can all become ill or have an
accident, and so all of us should pay our share to fund it. ‘Our
share’
means not that we all pay the
same amount,
but that those who earn more, pay more. In other words it is
redistributive.Some
fortunate
people
will be able to boast they ‘never
had a day’s illness in their life’and
someunfortunate
people will have child born with chronic condition.
It
is unrealistic to expect to fund a similar universal and
comprehensive system of social care via further taxes on income so we
must look towards implementing
taxes
on wealth, specifically taxes on inherited wealth.In
this context the term universal means free at source to everyone
regardless of income or wealth, and comprehensive means both
residential and non-residential support. Universal
means the rich, the poor and everyone in between.
For
most of us our ‘wealth’
is tied up in the house we live in. House price inflation
comfortably outstrips the general rate of inflation of the cost of
other goods and services, and
has done for many years.
Hence those fortunate enough to be a house owner have had to do
absolutely nothing as the cash value of their house increases, nor
have their beneficiaries after they die, so I see little moral
objection to a tax on inherited wealth. Unless
that is you think personal greed is a virtue.
The ombudsman found that Havering council in East London allocated Mrs Y, who has
advanced dementia, its standard rate for live-in care in November
2018 in the knowledge that none of the agencies on its provider list
met this rate. This meant she had to cover the shortfall using
her own savings. This was in breach of the requirement under the Care
Act for a personal budget to be sufficient to meet the needs a
council is required to meet.
A council breached the Care Act by setting an arbitrary upper limit for a woman’s live-in care that failed to cover the costs of meeting her needs, the Local Government and Social Care Ombudsman has found. The ombudsman found that Havering council allocated Mrs Y, who has advanced dementia, its standard rate for live-in care in November 2018 in the knowledge that none of the agencies on its provider list metthis rate. This meant she had to cover the shortfall using her own savings. This was in breach of the requirement under the Care Act for a personal budget to be sufficient to meet the needs a council is required to meet. The failingwas one of a number of faults by the council uncovered in the investigation including:
failing to meet Mrs Y’s eligible needs for home and day care following an assessment in September 2018, which resulted in her having to meet the costs herself and her daughter, Ms X, having to contact the council to say her mother’s condition had deteriorated;
failing to arrange overnight care for Mrs Y after a reassessment in October 2018 concluded she needed this, which led Ms X to set this up herself;
waiting six weeks to carry out an urgent assessment of her capacity to make decisions about her accommodation and care, during which she was left at risk;
not backdating payments for care Mrs Y should have received to the correct date;
causing Ms X “unnecessary stress and frustration” by requiring her to chase the authoritynumerous times for responses to communication, copies of documents, financial assessments and to start a direct payment application.
Full reimbursement
Havering has agreed to the ombudsman’s proposed remedies: to establish how much Mrs Y has paid to cover the shortfall in her care and reimburse her in full; reassess her personal budget, taking account of the cost of available care and providing Ms X with a written apology and £250 for the failings and the trouble she had been put to. It also accepted his recommendation to consider whether other service users have been affected by arbitrary upper limits on care rates and take any necessary action to address this, andamend procedures to ensure it doesn’t set arbitrary limits on any care provision. Until July 2018, Mrs Y had privately funded her homecare. Then her funds fell below the threshold for help with care fees,leading Ms X, who manages her mother’s paperwork and finances, to contact the council requesting an assessment.
A
care home resident was forced to pay an unlawful top-up fee after
Tameside Council made changes to the fees it paid her home, a
Local Government Ombudsman investigation has found.
THEinvestigation, whose findings have been strongly disputed by
the council, was launched after a man complained that his mother had
had to pay additional costs for her care after the authority cut the
fee it paid her home.
The woman, Mrs Y, who had dementia, moved into the care home in
October 2010, in a placement arranged by the council. Under the
contract, the authority was responsible for meeting the weekly fees
of £470.70 a week, incorporating a £381.70 basic fee, £30 for an
en-suite bathroom, £9 for a larger room and a £50 quality premium
for the home. Mrs Y made an assessed contribution of £113.20.
In 2012, Tameside reviewed the rates it paid for residential and
nursing care placements and decided to introduce a new quality
framework for homes to address an oversupply of beds in the borough.
Under the framework, care homes providing a high quality of care
received an enhanced payment from the council.
Mrs Y’s care home was not admitted onto the quality framework,
meaning it could charge council-funded residents what it chose.
However, the council also reduced the fees it paid for her care to
£382, from March 2013. The council told Mrs Y’s son, Mr X, that,
as the home had maintained the same fee of £470.70 he would have to
make up the £88.70 shortfall as a top-up payment – but as he did
not have these funds he began paying the top-up from his mother’s
savings from March 2013 and informed the council of this fact.
Though Mr X believed it was not in his mother’s best interests
to move from the home, he asked the council to assess the risk of
moving her to another home. However, the council said it would only
reassess her needs if it had been decided that she should move, and
Mr X appeared unwilling to consider this. Failure to follow law
The ombudsman, Jane Martin, found that the council had failed to
act in accordance with the law and government
guidance on choice of residential accommodation arranged
under section 21 of the National Assistance Act 1948.
The guidance states that a resident may only top-up their
council’s fee if they have a deferred payments agreement or are
subject to the 12-week property disregard, otherwise any top-up must
be made by a third party. Neither condition applied to Mrs Y, but the
top-up came out of her resources.
Also, Martin pointed to the fact that a top-up requires the
agreement of all parties, but said it had been “effectively forced”
on the family, as Mr X felt there was no option but to make the
top-up because of the risks of moving his mother to another home.
The ombudsman also said the council was at fault for not
reassessing Mrs Y’s finances after changing her care fees, to check
willingness and ability to meet the new costs.
The report also said the council failed to adhere to the terms of
the contract governing Mrs Y’s care, which contained a “legitimate
and reasonable expectation” that the council would meet the
contractual fees agreed on admission unless there was a change in her
needs.
Mrs Y died in March of this year. ‘Significant injustice’
The ombudsman said that Mrs Y and Mr X had suffered a “significant
injustice” because of the council’s actions, and recommended that
it:
reimburse Mrs Y’s estate for
the full amount of the third-party top-ups that have been made;
provide Mr X with a full written
apology;
pay Mr X £250 to recognise his time and trouble in
pursuing the complaint.
The ombudsman’s report also suggested that a further 160
residents may have been affected by the council’s changes to care
commissioning, as they were resident in homes that were not admitted
on to the council’s quality framework.
But Tameside council strongly disputed the findings and
“categorically denied” that it failed to act in accordance with
the law. A spokesperson for the council said that the report was
fundamentally flawed and raised questions about whether the ombudsman
herself had “unlawfully exceeded” her powers.
The spokesperson said: “The council reviewed its commissioning
arrangements to ensure that only those homes that offered the highest
standard of care get paid a quality premium rate. This was not about
cost cutting.
“Tameside council continues to pay one of the highest care and
nursing fees across the North West of England to support the most
vulnerable in our community. The purpose of this change, made
in 2012, was to raise and maintain the quality of care in Tameside
care homes whilst ensuring they remained financially sustainable.”
Claims rejected by council
The council also rejected the ombudsman’s claim that 160 other
residents may have been affected. “This is inaccurate as the
information provided by the council makes clear that the number at
its highest is no more than 10, who we are in the process of writing
to directly,” said the spokesperson.
“As the majority are in the same home, it is important this is
kept in proportion, and that the poorer quality homes do not, as a
result of this finding, believe they have been given the green light
to charge what they like.”
Speaking in response to the case, Janet Morrison, chief executive
of charity Independent Age, which campaigns strongly against the
wrongful use of top-ups, said: “Too many families now find
themselves paying top-up payments, sometimes amounting to be hundreds
of pounds a week, for essential care. The root cause of this problem
is a residential care system that is chronically under-funded.
“Families are increasingly having to subsidise local councils to
meet the costs of care it is really the responsibility of councils to
meet, so we need the government to protect people from paying unfair
‘top-ups’ as part of the shake-up of the rules from April 2015.”
WHENTheresa
May
called a General Election in 2017 one proposal in the Tory Manifesto
was immediately dubbed a ‘Dementia
Tax’.
At
present councils
pay for all or part of a person’s social care if they have less
than £23,250 in capital.
This applies if a person is in a residential home or nursing home.
The cost is then recouped from their estate after their death. May
also wanted to recover from
their estate the
costs of care given to people in their own home, to raise the
protected sum
to £100,000 and
axe the Winter Fuel Allowance for more affluent pensioners.
These
proposals went down like the proverbial ‘lead
balloon’.
They
were attacked by both Labour and the Liberal Democrats. The
Tories could reasonably argue that this was a better deal for
relatively poorer people who needed residential care and
would mean that the costs of care given in the home would be recouped
only
from
the more wealthy. Strictly speaking of course that’s not quite
true.
Until someone finds a foolproof, (and fire proof?) way of putting
‘pockets
in a shroud’
it will be the beneficiaries
of the estate
who will have their inheritance reduced.
Social
care today is in the same state as health care was in the 1930s, a
hodgepodge of partly national and partly local provision, and funded
partly by those who have the misfortune to need long term care, often
with pressure applied to their spouse or family, and partly from the
public purse. Unlike the NHS which is ‘free
at the point of delivery’
social care is not built around a ‘shared
risk model’.
Such
a model would
recognise that throughout
our life we
all
run a small risk of requiringsocial
and
residential care
due to age, infirmity or accident, hence we should all
make a contribution to funding that
care
for those who need it.
The
simplest and
most effective way
of doing this is via the tax system. But here we have a choice we
can either raise the money through a tax on income or through a tax
on wealth, specifically
a
tax on inherited
wealth. When
the costs of care are recouped after
someone’s death the burden falls on the estate not
the deceased individual. If you doubt this you might like to
consider that a dead person does
not
own their own body, so
how can they be said to own property or
other assets?
Switching
to such a funding model would go much further than Labour’s 2010
proposal for a ‘National
Care Service’.
Labour shied away from a fully tax funded system as being too costly
to be a sustainable model on
the basis that it would put too high a financial burden on the
decreasing proportion of the population that is of working age (p126
below).
I fail
to see that a tax based upon inherited wealth would not be
sustainable.
The
distinction between social (or personal) care and medically required
care is an artificial one. Dementia is a chronic medical condition;
it results in sufferers requiring social care in their own home. Why
should the necessary care for both the condition and its side effects
not come from the same source?
May’s
‘crime’
was to try to have an adult conversation with people who prefer not
to think about the problem of funding care for older people and send
to parliament people who are similarly reluctant to talk about it.
In
2019 the lesson was learned, no
one wanted a caning for talking out of turn.
The
Tories pledged an extra £1bn, the Lib Dems £3bn and Labour £10bn
by 2024 to
fund in home social care for all who needed it and to ensure that
carers were paid at least £10 an hour with no ‘zero
hours contracts’.
These
are significant sums of money, but even Labour’s proposals leave
the question of funding residential care for those who need it
unresolved. This
matters because the available funding has an impact on the quality of
care which is provided. Nothing illustrates this more sharply than
the spectacle of the owners of ‘run
for profit’
residential homes asking to be provided with kit to protect staff and
residents against coronavirus, and being told it is their
responsibility.
We
need a politician with vision and determination to keep fighting for
a universal and comprehensive care model for those who need it due to
age or a chronic medical condition funded by a tax on inherited
wealth, in the face of short sighted claims that it is a ‘death
tax’
or a ‘tax
on the sick’.
As I said earlier, ‘there’s
no pockets in a shroud’.Even
though I am unlikely to be the recipient of inherited wealth it seems
to me it would
be
better to have the
certainty 80%
of something rather than run the risk of 100% of nothing!
Spain has today [17/O4/20] launched criminal investigations into 37 care homes after grieving relatives of thousands of elderly coronavirus victims claimed 'they were left to die'.
The
Public Prosecutor is also looking into 124 private cases whilst the
country's 'Patient Ombudsman' is investigating another 200 complaints.
These
claim that the elderly in care and nursing homes were not tested for
COVID-19, were not provided with health care and their families were not
allowed to take them home.
One relative told the Spanish press: 'They have been left to die.'
If negligence is found, charges of manslaughter or criminal neglect could be filed against owners, local authorities or staff.
However,
health chiefs say the prosecutor would have to take into account the
exceptional circumstances of the coronavirus health crisis, the lack of
previous experience and the pressures staff were under before deciding
to take any court action.
More than 19,000 people have died from
COVID-19 in Spain. It is being estimated that at least 11,000 old folk
in care, nursing or residential homes have been victims but it is not
known how many of these are included in Spain's official death toll.
The
Ministry of Health has asked all regions to supply precise details of
how many people have died in nursing homes but admits that not all of
the information has yet been supplied.
Dolores
Delgado, Spain's attorney general, says the investigations are being
carried out in eight autonomous communities, including Madrid (19
investigations).
The others are
Catalonia (seven) with five in Castilla-La Mancha, two in Castilla y
León and Murcia; and one each in the Canarias, Valencia and Cantabria.
The probe follows confirmation that the
Military Emergency Unit had found the abandoned corpses of elderly
residents when disinfecting care homes.
The establishments under investigation have not been named.
The shocking toll of deaths in nursing homes has included more than 20 in one centre alone in Madrid.
The Ministry of Defence says it has so far disinfected 3,800 care homes across Spain.
As with many people who have been observing Rochdale
Council'sAdult Social Care crisis I was
heartened to read Rob Greig, Chief Executive Officerat NDTi precision dissection of Rochdale
Councils current ' consultation'on
Adult Social Care cuts. Families&
Campaigners are clearly vindicated in their concerns ,and the 'outrage' felt
locally & nationally by those opposed to the Councils plans , so soundly
demolished by Rob Greigs articles ,will not be abated by his correct
observation that :
'Sadly the Director’s article largely confirmed my belief
that some key people in the Council may be pushing this change without really
understanding policy and practice.'
(Rochdale’s ‘Transformation’ of Learning Disability Services
by Rob Greig, Chief Executive at the National Development Team for Inclusion,
25 October 2016.
It's also important to note that the massive cutbacks ahead
willnot just affect Learning
Disabilities alone.
Our Community is under attack by Tory Austerity . Our
majority Labour Council appear to be colluding in continued Tory Austerity
rather than protecting their Labour voters against it.
We will all have our quality of life diminished and eroded.
We did not elect majority Labour Councils , to have Labour
Councillors enter by the front door of Town Halls the length and breadth of the
Northof England, merely to have them enable the
implementation of Tory policies smuggled in by the back door.
I tried yesterday to find paper copied in Riverside for
those without internet access with no success. Another worrying flaw in this
supposed 'consultation' process. As is the apparent total lack of alternative
versions such as large, print, braille or BSL British Sign Language. But that
aside these cuts will affect thousands of local people for the worse.
All the council spin in the world can not sugar coat a very
bitter and unpalatable pill indeed ; And this medicine will not make the
patient better , far from it.
CS-2017-305 Rationalisation of additional funding for Child
and Adolescent Mental Health Service (CAMHS) will negatively affect Mental
Health Service Users,
NH-2017-312 Continued provision of School Crossing Patrols
at a charge to schools , will negatively affect Children & Parents ,
NH-2017-310 Proposal to review the Legal Advice: Welfare, Debt and Housing
support will negatively affect those needing advice, NH-2017-311 Review of
Community Centre grant funding , people using Community Centres .
Millions of people are going to go under the hammer
&anvil of Tory Austerity , with the
Westminster Tory's stoking the furnace and Labour Councils and Councillors
doing the hammering. Hundreds of thousands of local people will be directly or
indirectly emotionally , physically, mentally and financially damaged by this
slash & burn economic process.
Barrister Steve Broach has helpfully published an article
called 'Challenging local cuts – some key legal questions' for campaigners and
communities to ask of their Councils who are consulting on cuts with their
local tax payers. With this in mind I'd like to ask of Rochdale Council's
officials about to wield the axe to vital services :
Will the council be able to meet all its ‘specific’
statutory duties owed to individual residents? For example:
1.The duty to meet
all 'eligible' needs for disabled adults and their carers under the Care Act
2014
2.The duty to meet 'eligible' needs for disabled
childrenunder section 2 of the
Chronically Sick and Disabled Persons Act 1970
3.The duty to provide free suitable home to school travel
arrangements for all 'eligible' disabled childrenunder section 508B of the Education Act 1996
4.The duty to secure special education provision in health,
educatiin, health and care plans for disabled children and young peoplein section 42 of the Children and Families
Act 2014
5.The duty to provide advocacy to disabled people and carers
during the care and support assessment and planning process under section 67 of
the Care Act 2014.
Will the council be able to meet its ‘sufficiency’ duties to
have a sufficient level of particular services to meet local needs? For
example:
1.Childcare,
including childcare for disabled children up to the age of 18, under section 6
of the Childcare Act 2006
2.Short breaks for disabled children under regulation 4 of
the Breaks for Carers of Disabled Children Regulations 2011
3.Education and care services for disabled children, under
section 27(2) of the Children and Families Act 2014
4.Children’s centres, under section 5A of the Childcare Act
2006
5.Services for disabled adults and their carers, under the
‘market shaping’ duty in section 5 of the Care Act 2014.
Has the council had ‘due regard’ to the needs specified in
the PSED (see above) – for example the need to advance equality of opportunity
for disabled people (children and adults)?
Will the proposed cuts give rise to unlawful discrimination
between different groups, contrary either to the Equality Act 2010 orArticle 14 of the European Convention on
Human Rights ?
Has the council had regard to the need to safeguard and
promote the welfare of children under section 11 of the Children Act 2004 ?
Has the council treated children’s best interests as a
primary consideration in its decision making, as required by Article 3 of the
UN Convention on the Rights of the Child ?
Has there been ‘fair' consultation on the proposals? In
particular (quotes are from the leading consultation case of ex parte Coughlan:
1.Has consultation
taken place at a ‘formative stage’, i.e. sufficiently early in the decision
making to influence the outcome?
2.Have consultees been provided with ‘sufficient reasons for
any proposal to permit of intelligent consideration and response’ – i.e. do
residents know what cuts are being proposed and why?
3.Have consultees had ‘adequate time’ for consideration and
response?
4.Once the consultation has finished, has ‘the product of
consultation’ been ‘conscientiously taken into account’ in the final decision.
It was Hannah Arendt who spoke of the terrible consequences
of blind obedience, the ' banality of evil' , these proposed cuts are quite
simply evil.
Sometimes no other word will suffice.
Those making them should pause to examine their moral
compasses for they will have to live with their consciences - if they still
have one?
To decide which side they are on
History will record
their names and actions for posterity.Just as surely as students of local history are today utterly
incredulous at the callousness andhorrific actions resulting in the cruelties inflicted on the poor and
vulnerable by the ' guardians of the Parish' hundreds of years ago with regard
to those seeking PoorRelief or recourse
to the notorious Workhouse .So with absolute certainty will future historians
and public opinion judge their individual actions today .
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