Stafford Hospital- The Shock that is no Surprise

The big story in health today is undoubtedly that of Stafford hospital and the maltreatment of the elderly in their care. People wandering the corridors, drinking water out of flower vases because they were so thirsty, patients lying in soiled beds.. The list goes on and on. Now heads are going to roll and already the media is trying to establish ‘who is to blame’. But do you know the shocking thing about this story? The shocking thing is that it’s not shocking, at least not to those of us who work in the care system or are recipients of it. Across Britain today, there will be nurses, doctors, carers and social workers nodding their heads grimly at this, because this problem is present to a greater or lesser extent everywhere in care homes and hospitals. It is endemic. But why is this happening? That is what I am going to talk about in this post.

As those of you who are regularly on this blog know, I care for my mum who has Alzheimers. One day six years ago, I came to the conclusion that every problem that I had with my mum’s care had a political root, and if anything was going to change, I had to get involved in politics and try to change it from there. The particular thing that triggered me was the closure of nursing homes in my area. Why, when we had a growing elderly population, was our council shutting nursing homes? Shouldn’t they have been increasing them? I went along to a carer’s conference to ask that question. There was a good crowd there and there was a mixture of carers and professionals from the NHS and social work. I got hold of the mike and put my question to the chair, ‘Why are we shutting nursing homes when we have a growing elderly population, and where are all the elderly going to go?’
I still remember the deathly chill that followed my question. Up until that point, things had been fairly cheerful and there was a buzz of chat; suddenly the whole place was quiet and the temperature dropped about ten degrees. The answer that I was given was that they did not want to shut nursing homes, but there was a problem with the cost as we had a growing number of elderly people. Afterwards, one of the social workers came up to me.
‘I really want to thank you for asking that question’, she said. ‘ We all wanted to ask that, but we were too scared to.’

The answer that I was given was in no way acceptable, but it is true. The reason that nursing homes are shutting and the reason that Stafford hospital happened, is because there are a growing number of elderly and we do not want to fund the cost of their care. This cost cutting has been going on for a number of years in various forms;

Closure of day hospitals, cottage hospitals and local authority nursing homes;

Re-defining care of long term conditions such as dementia as ‘social care’, thus shifting funding of the person’s care to the much smaller local authority budget;

Spending only £11 per head on dementia research as compared with £289 per head for cancer;

Reducing the numbers of beds in hospitals, so that there is no room for geriatric ‘bed blockers’;

Setting impossible financial targets that can only be achieved by cutting staff and therefore leaving wards understaffed;

Persecuting anyone who dares to complain about standards. Dr Rita Pal’s story is a salutory warning for anyone in the NHS contemplating rebellion.

But it is not just central government that is to blame. The media are very much to blame as well. Why? Because they have under-reported it. And they have done this, I believe, quite consciously. I have been on several media sites tonight looking at the Stafford story and a notable number of sites that usually have a comment facility for stories, have not enabled commenting. On the BBC site, commenting is allowed, but the person has to give a name and an email address. It has not included the story on its ‘Have Your Say’ section, which you would expect for a scandal like this. This means that NHS workers and other professionals who wish to report a similar situation, but remain anonymous, cannot do so.

Which brings me to my final point. Now there’s been a three week gap between this post and the last and there’s been a reason for that. And the reason was that I did not want to say what I am going to say now, but the Stafford hospital situation has given me the impetus to do so. It’s this. If you take away elderly care homes, if you do not fund research into elderly diseases, if you take away their hospital beds, if you take away dementia medicines as NICE has done, and if you leave them in soiled beds, and reduce them to drinking water out of flower vases because you are too busy to give them fluids; if you constantly say, ‘ We can’t afford to look after you’, what is the next logical step in this process?

Get rid of them.

And that is why, Margo, no matter who puts forward the argument (and you are an MSP that I like), no matter how many programmes the BBC puts on in sympathy, no matter how untrendy it is made to oppose euthanasia, that is why I will never, ever, ever, support a change in the law to make euthanasia legal and ‘give people a choice’. The elderly, the disabled and the weakest in our society would be left completely exposed in the face of such a ‘choice’ and completely at the mercy of the grey men with clipboards who are constantly striving for such ‘streamlining’. Money drives policy and this is an area of policy that would shift very quickly from compassion to economics. People rarely venture into territory like this on their own, but as with the Stafford situation, staff can be bullied, overworked, undermined and frightened into an abusive situation and come to regard it as normal and that is why the law should remain as it is.

Finally, to go back to the carer’s conference. A few weeks later I was attending a meeting with some of the people who had been there and we started talking about care of the elderly. One of them said how she had asked the same question as myself in her office and the person in charge said, ‘In a few years, the elderly won’t be a problem.’

You have been warned.

After the Storm, the Deathly Silence

So the day after it is reported that 400 people have died at a hospital as a result of maltreatment and neglect, what has the media got to say about it? I did a trawl of the various news sites and this is what I came up with

BBC Homepage - no mention of Stafford on the front page. No mention in 'Have Your Say'. Article relegated to a regional page for England, so that you have to use the search facility for it. Any comments have to have an email address and name and they are not published underneath the article.

BBC News - No follow up in the main news bulletin of the Stafford story.

The Herald - One article, around 200 words long, on an inside page. Not comment enabled. Nothing in yesterday's paper either.

Channel 4 - Nothing about Stafford on the front page of the website. Article is a couple of clicks in. Not comment enabled.

STV News - Nothing on front page of website. Nothing in the UK News section further in.

The Scotsman - One article yesterday, not comment enabled. One article today, 61 words long, comment enabled.

Daily Record - one article, not comment enabled.

I found two honorable exceptions; the Daily Mail, which has a substantial article on the front of its website, and the Guardian has an excellent opinion piece on the scandal by Allyson Pollock. Everywhere else there is nothing but the sound of silence.

The last time I remember this happening was when the junior doctors marched on Parliament. There were 20 000 of them, including the Queen's own surgeons. Channel 4 did a piece about 10 seconds long on them, with a video. In a later bulletin, there was no video and just a fleeting reference to the march. There was a rumour at the time that the government had slapped a DA notice on reporting of the march. This is a request/demand by the government to the media not to report on a subject for reasons of national security or sensitivity. I don't know what is going on here, but someone somewhere has definitely put the kabosh on this story.
If you want to do something about it, here is the BBC page with the story. I have sent them an email asking them why they have not comment-enabled this in the usual fashion; maybe you can do the same. As to all you editors out there, shame on you. Here's what Martin Neimoller had to say about not standing up for people;



First they came for the Communists, and I didn’t speak up,
Because I was not a communist
Then they came for the sick, the so-called incurables, and I didn't speak up,
because I wasn't mentally ill.
Then they came for the Jews, and I didn't speak up,
Because I wasn't a Jew.
Then they came for me, and by that time there was no one left
to speak up for me.

Disappearing Headlines - the Elderly Care Cover Up

Yesterday, I was going through the BBC health RSS feed. Near the top was a report that in an honesty test, 58% of people thought it was ok for a care home nurse to persuade an elderly person to change the will in the carer's favour. The story was headlined with this statistic. I was going to do a post on it and then I was distracted. Some hours later, I came back to the feed and at first I couldn't find the story. That was because it was now headed, 'Women judge, but do they convict?' Today, I went back and found that the story was 21st on the RSS list, way below older articles on swine flu and others.

It's not the first time that this has happened with the Beeb. The Stafford story disappeared off the radar after two days. This story about people with learning disabilities being starved to death, was mentioned first in a news trailer and reported on third. Now this. I note it's also well below the article on assisted suicide; wouldn't want anyone to make a connection between changing wills and helping the old dears on to inherit, would we?

I don't know what's more shocking to me. The fact that nearly two thirds of people think it's ok to swindle an old lady, or the fact that somebody very well connected seems to be leaning on the Beeb to cover it up. The older I get, the more I understand the function of the court oath,' The truth, the whole truth and nothing but the truth'. To be dishonest you don't actually have to lie. It's enough to change a headline or move a story down the RSS list. This is one honesty test that the Beeb has failed miserably.

Why so Shy?

Happy Christmas and New Year to everyone. I've polished off the last of the chocolates and felt like a class traitor for watching Jools Holland on Hogmanay instead of BBC Scotland's offering, but it's their own fault. Can anyone at the Beeb please explain to me why it is that when all the Scottish/Irish bands in the world are congregating on Glasgow for the Celtic Connections Festival, that they can't invite some half decent bands on their channel? Brewery/ piss up etc?

Anyway, enough of that. As it is, I would like to ask the Beeb something else of a little more import. This article cropped up on Christmas Eve re a nursing home in Halifax called Elm View. It's the usual depressing story of neglect/sub-standard care. What is unusual about it, highly unusual, is that the care owner and the care manager got 12 month jail sentences.

Whoah! 12 months? When did that last happen? I think it was Mid Stafford and that took a massively raised mortality rate for that to occur. So was this a major news article?

Well, no. It stayed on the regional page, quite low down the Beeb's list of articles and by Boxing Day it was buried. I kept an eye on it in case it was just a matter of them garnering more details, but no. It hasn't re-appeared since. The local paper has more detail on it here.

So what's going on? The Beeb and others have revelled in stories of neglect of old people in homes and how the Can't Quite Cope Care Commission have been toothless tigers. Now they've found their teeth and it's banished to a back page? Isn't this what you wanted and isn't this a good sign that finally the law is starting to take the care of old people seriously? What's going on?

Answers on a postcard please.

If a Person with Learning Difficulties Dies of Neglect in a Hospital and Nobody Reports It, Do They Make a Noise?

I feel sick. Absolutely sick. Less than a week after Stafford, the Department of Health orders an inquiry into the deaths of six people with learning difficulties in hospital.This has been prompted by a report from the Ombudsman, which largely upholds the complaints made by relatives through Mencap's 'Death from Indifference' submission to the Ombudsman. One of those who died was left without food in hospital for 26 days.

So, how did the Fourth Estate react to it all?

At lunchtime, the BBC reported it as the third story on the news bulletin. On the six o clock news, the one that most people watch, it was reported towards the end of the programme. On its website, again it has not comment enabled the story; you can send an email to the Beeb, if you're brave enough to do so, which of course most people won't be. And it has no mention on the 'Have Your Say' page. Still, that was better than Channel 4, which did not report the story at all, but instead did a report on a paranoid schizophrenic who was convicted of the murder of a policeman in Luton. He was an asylum seeker as well, so that's two prejudices supported for the price of one.

I've still to do a trawl of other media sites, but I'm not holding out much hope. I can hear the furious sound of digging and I am sure that this story will be buried by tomorrow.

Two questions.

1.What has to happen for us to take abuse of the elderly, disabled and those with learning difficulties, seriously?

2. If a person who is elderly, disabled or with learning difficulties dies of neglect in a hospital and nobody reports it, do they make a noise?


The picture of the screaming tree is from the excellent Alexandre Jay art blog.

The Importance of Being Honest

A solitary truth-seeker who is unsupported either by tradition or community will degenerate into

mere eccentricity, eventually to be intimidated and crushed by the organized power of
 untruthfulness.

Read this and more here. Courtesy of Cybertiger in the
 comments section at Dr Aust's Spleen.
 Relevant in science, Stafford and politics too I might add.


Update: yes, I've noticed the wonky font, but left it because it added
 to the message. 

When was the Last Time a Health Minister Lost in Court?

Sometimes, just sometimes, something happens to give you hope. Today has been a huge win for the NHS and a shot across the bows for would be privatisers. Lewisham hospital campaigners won their case at court, which stated that Jeremy Hunt had acted illegally by attempting to downgrade Lewisham A&E. The rationale behind this was that it was being done because a neighbouring trust, South London Healthcare Trust, was in deficit. Two things can be taken from this.

1. The devolving of the health secretary's duty to provide healthcare backfired on Hunt today. The key element in the judge's ruling, in his own words were, "I considered that it was the absence of support from the local GP commissioners which constituted an additional reason why the decision of the Secretary of State cannot stand."

2.  This means that it may be possible to use GP commissioning against the privatisers. It remains to be seen what is going to happen to the rebellious GPs who would not give their consent to this, but it means that the fight for the NHS is not over, and we could be looking at the health equivalent of a guerrilla war, trust by trust. It vindicates Dr No's surmisings that if the rank and file GPs refused to cooperate, the government could not win.

3. We are fighting a new kind of media war. The BBC and others did the usual 'la-la-la-nothing-to-see-here' rubbish which we have become used to over the past three years. The health news today was completely dominated by an article on assisted suicide and yet another article on Stafford. I have no objection to either, but when was the last time a health secretary or any cabinet secretary defeated in court? The Beeb previously ignored a 30 000 strong march of protestors through London about Lewisham. But here's the important point. 38 Degrees funded this court action. And this means that those of us fighting for the NHS have found a way round the problem of all the placemen that the government put in the Royal Colleges and other institutions. It is possible for those of us so minded, to act together and get a result without having to go through the colleges or any of the normal channels. And a result can be got without help from the Beeb. A new frontier has opened via the net and the government is going to be hard pushed to fight it.

Health politics has just become interesting again...

The Naming of the Dead

There’s a book called ‘The Naming of the Dead’ by Ian Rankin. The title comes from a section in the book when Rebus the detective, contemplates his job and concludes that most of what he does is naming the dead. To name who died, why they died and who was responsible. Sometimes it can seem pointless, but it’s not. Naming someone means that they matter. Telling what happened to them and who was responsible is basic justice. And when I get weary of blogging and wonder if there is any point, I remind myself of that. At the very least, record what happened. Why it happened and who was responsible. It means that when things go belly up like they did at Stafford, everyone will know why it happened and who was responsible. And so in this post I record what is happening to mental health services in my area, North Lanarkshire. Who is slipping through the cracks and why.

It all goes back to a document called ‘A Picture of Health’ that NHS Lanarkshire (NHSL) brought out in 2005. The main bone of contention was the downgrading of Monklands Hospital from a level 3, to a level 2 hospital, but in amongst the bumf was their proposals for mental health. The basic plan was to build two new 112 bed wards, one for North Lanarkshire and one for South Lanarkshire. This was very quickly modified to two new 55 bed wards, then one new build and one refurbishment. In addition to that there were plans to shut Hartwoodhill, which takes patients with long term severe psychiatric disorders and brain injury. Where they were going to go was anyone’s guess; it was mooted that they would be found places in the community and in nursing homes. When I asked the then health minister Andy Kerr what nursing homes were going to take these people, he didn’t know and neither did his civil servant, which is when you really have to worry.

All of this happened before May 2007, which was the Holyrood election. When the SNP got in and reprieved Monklands as a level 3 hospital, NHSL had the perfect excuse to cut mental health services. And this is what they are going to do.
Acute mental health needs 153 beds. NHSL are going to provide only 130. In addition to that, 20 of those beds are going to be set aside for alcohol/drug rehab. NHSL used to buy this service outside the authority; it is now going to provide its own beds, but at the expense of 20 acute mental health beds. So we actually only have 110 beds for acute mental health.

Hartwoodhill and Caird House, which both take the same kind of patients are closing. There are 72 patients altogether from these institutions. 27 have been moved into Coathill, which is a hospital for the elderly; the elderly have been moved into the orthopaedics ward in Monklands hospital, and orthopaedics has lost 27 beds.
For the rest a new facility is being built called Beckford Lodge. It will be a medium secure unit and it will have only 27 beds.
So as I said; there are 72 patients. 27 beds at Coathill + 27 beds at Beckford Lodge = 54. 72 -54 = 18 patients with brain injury/severe psychiatric disorder without a place to go.

So how many beds are we losing in total? 43 beds in acute mental health and 18 + 8 unoccupied beds from long term psychiatric care. That adds up to 69 beds lost from mental health services altogether or 27% of capacity.

Where will these people go? Who is going to look after them? That’s anyone’s guess. Most of them will end up in the hinterland between the NHS and social work funding pots, known as ‘care in the community’. Some might be lucky enough to be adopted by a local church; my own church gives employment and protection to a group of adults with learning difficulties that live in sheltered housing near the church hall. Others will simply fade into the anonymity of the community will all its casual cruelties to anyone who doesn’t ‘fit in’. And some will slip through the cracks altogether, turning up in the ‘death by misadventure’ statistics.

How sly we have become with ourselves. How the mind will manoeuvre itself so that cuts become rationalisation, abandonment becomes care in the community, negligence becomes death by misadventure. God know what is going to happen in Lanarkshire when these measures fully kick in. But I record here and now what has happened and I ask NHSL, the media and all ; is it nothing to you, all you who pass by?

Is There a Split in Beeb Editorial Policy?

Something very odd happened today on the Six O'Clock News.

The normal procedure for the news, is that they do a trailer of the three leading stories in order, during the title sequence. They then report those three stories in that sequence when they go to the newsreader in the studio.

Only that didn't happen today. They reported the three main stories, and then they did the second and third stories first of all, then did the first story third.

So what, you might ask. Well, this was the first story, and as I've been pointing out for the past few weeks, there seems to be editorial pressure on stories of this type; Stafford disappeared off the radar with just a little less than indecent haste, and so did the story of the six people with learning disabilities that died of neglect in hospital. Btw, the other stories were nothing special; one was a story on the financial crisis, and the other was on the mass walkout at the UN when the Iranian president called Israel racist. Important, but not worth disrupting a news bulletin for.

So what's going on? Who's putting the pressure on the Beeb and are they finally resisting it? We'll have to wait and see. I'm just glad that this stuff is finally getting reported.

Thoughts on the End of Life Assistance Bill

So the End of Life Assistance Bill gets rejected by 85 votes to 16. A day later Lord Falconer sets up a commission on the subject of assisted dying. A certain ethicist had a wee trip up to Scotland during the evidence hearing. This, to paraphrase Margo McDonald, ain't going away. So what happened and what's going on?

I confess I have more questions than answers. Although I expected the bill to be defeated, I didn't expect it to be quite so comprehensive. There were several obvious reasons for its defeat. First and foremost, it wasn't going to do what it said on the tin. It was called 'End of Life Assistance' when in fact the bill allowed those who were not at the end of their lives, but who could not live independently (whatever that meant) and found life intolerable, to avail themselves of this. Politicians had been given comparisons with Oregon, when it actually should have been compared with the Netherlands and they don't like being misled. Secondly, Care Not Killing played a big role in leading the opposition. It is a combination of religious and non religious organisations and includes amongst its membership the National Palliative Care Council for Great Britain and Northern Ireland, Inclusion Scotland and RADAR, which is an umbrella disability organisation representing 900 disability groups. So the opposition got their sh*t together. Finally, Margo McDonald herself didn't perform well. She spent most of her opening speech attacking Care not Killing and made this comment;

According to Care Not Killing, elderly people in care will feel that it their duty to die. Some elderly people stuck in below-standard care homes do wish for an early death, but the bill's provisions do not cover them. I hope that we do not hear a litany of sanctimonious remarks about improving care provision. We have had more than enough time to do that.

The vote was a free one and I expected it to go against the bill, as I say. But I didn't expect 85/16 (and it would have been 87 if Karen Whitefield and Elaine Smith, my local MSPs hadn't been snowed in and who had declared their intentions). And it has left me with an intriguing problem. I thought that all the media attention and sympathy for euthanasia was being driven by the political classes. But in this vote, the political class has turned its face against it. I'm not sorry to be wrong on this, but it leaves me asking; who is driving the media on this? Who invited an English ethicist to a Scottish committee? Who ensured that the programme 'A Journey to Switzerland' was shown twice up here during the bill's passage? Who ensured that cases like Stafford and Dr Jane Barton got the minimum of coverage whereas Diane Pretty and others got the maximum? Who is doing this?

It may be that there is a difference between Scotland and England on this. We do have a higher church -going population, but Holyrood is quite capable of ignoring opinion from the churches. It is also quite capable of ignoring opinion from disability groups. There is a huge financial reason to legalise euthanasia; as it said in the explanatory notes to the bill;

Cost of means required to assist in death
97. The costs required to deliver an assisted death will be minimal and will inevitably be less
than those associated with providing ongoing medication and care.

Mike Rumbles did give a hint as to what had happened. He quoted Burke in his speech

As parliamentary representatives, we must resist the temptation to legislate because of opinion polls. In a representative parliamentary democracy such as ours, we are required to use our judgment. As long ago as 1774, the classical liberal Edmund Burke said:
"Your representative owes you, not his industry only, but his judgement; and he betrays ... you, if he sacrifices it to your opinion."

But this ain't enough. So - any thoughts? Is it the media class themselves running this perhaps? Or them, plus some political friends? Or is this perhaps a zeitgeist, a debate that surfaces every generation, when we have forgotten all the reasons why we do not and should not go down this path? That will be my next post..