Abuse of vulnerable adults: Why no inquiry?

Imagine if there had been a succession of child abuse stories in the media during the last six months. There would be an outcry. Every Baby Peter story that emerges, in all its grisly detail, somehow diminishes all.

The abuse of and suffering by the vulnerable affects all decent people deeply. We find ourselves asking, “how could this happen”? And “why did no one notice”? And worst of all, “what does this say about us and society”? Parents fear for their children and their children’s future. We collectively demand that something is done. Those involved become tabloid hate figures. Ministers condemn the perpetrators as evil and establish commissions to look at lessons to be learned. Our response is horror at the pain, misery and humiliation. We have a shared feeling that this abuse shames us all. And we have an angry determination that this abuse must stop.

The result is that over the years, there has been a succession of official commissions and investigations into the abuse of children. The Maria Colwell inquiry, the Cleveland inquiry, the Broxtowe inquiry, the Victoria Climbié inquiry (the Laming report) and most recently the Baby Peter inquiry.

Each tragedy has resulted in the strengthening of the law and procedures used by those responsible for protecting children. And thank goodness that this is the case. No child should suffer and it is a primary duty of us all to protect those who are unable to protect themselves.

And yet this is not always the case: not if you are an adult and vulnerable, for instance. Over the last six months there has been a succession of stories that have involved abuse of vulnerable adults in institutional care. The patient’s association, Listen to patients, speak up for change listed 17 shocking accounts of patient care in the NHS. Just read the stories and think about their suffering and the de-humanisation of them by those involved. And then ask why the names of Anne Robson, Elsie Pague, Brigid Wainwright and the other fourteen are not linked to sea changes in practice within the NHS.

Then there was the NHS ombudsman report, Care and Compassion that detailed the failings of care of older people in the NHS.

I have written about it before but it is worth repeating some of the abuse uncovered:

» Alzheimer’s sufferer Mrs J, 82, whose husband was denied the chance to be with her when she died at Ealing hospital in west London because he had been “forgotten” in a waiting room.
» Mrs R, a dementia patient, who was not given a bath or shower during 13 weeks at Southampton University Hospitals NHS trust. She was not helped to eat, despite being unable to feed herself, and suffered nine falls, only one of which was recorded in her notes.
» “Feisty and independent” Mrs H, who had lived alone until she was 88, was taken from Heartlands hospital in Birmingham to a care home in Tyneside but, when she arrived, was bruised, soaked in urine, disheveled, and wearing someone else’s clothes, which were held up with large paper clips.
Or the Panorama investigation into the systematic abuse of adults with learning disabilities at Winterbourne View in Bristol. I watched and wept as the secret filming uncovered the horrific torture of residents in their own home. Or the Dispatches undercover report Dignity in Dying that evidenced poor care of people at the end of their lives. Or the “abuse, lack of cleanliness and poor nutrition” uncovered in some care homes by consumer group Which?. Or, indeed, any one of the countless examples of poor care and abuse that make it onto news broadcasts and into our newspapers.

Just this week, the equality and human rights commission published a report into the abuse of older people’s basic human rights when they are being “cared for” at home. They identified examples of:

» People being left in bed for 17 hours or more between care visits
» Failure to wash people regularly and provide people with the support they need to eat and drink
» People being left in soiled beds and clothes for long periods of time
» A high staff turnover, meaning that some people have a huge number of different carers performing intimate tasks such as washing and dressing. In one case a woman recorded having 32 different carers over a two week period.
Of course, on the whole most care home providers are dedicated and professional and their staff provide excellent care. I have recently visited some excellent care homes where the quality of care was incredibly moving. Patients with severe dementia, who can be pretty tough to care for, were treated with dignity and respect by some fantastic staff. And most hospital care is first class and treats vulnerable patients as sentient human beings. But the stories of abuse are too common to ignore. They are already causing fear. Imagine if you had a vulnerable relative who went into care – you’d worry. Who wouldn’t?

So it is time to take a stand. Piecemeal investigations are no longer enough. Vulnerable adults deserve the same protection as vulnerable children. The government should establish an inquiry into the standards of care for vulnerable adults. It should be wide ranging: looking at staff training, accountability, rights and responsibilities. The failure of multi-disciplinary cooperation to pick up abuse should be looked at. And most of all there should be a framework set in law as to how vulnerable adults should be better heard in determining their own care.

This abuse causes pain, misery and humiliation. It shames us all. It must stop.

Posted by Peter Watt, Chief Executive of Counsel and Care

This blog first appeared on Labour Uncut on 23.06.11

Supporting carers is not just right, it's rational

This week is carers week, when the fantastic contribution and role played by the millions of carers in the UK is celebrated. It is all very big, or even good, society. The numbers of those with a caring role is on the increase. But there is one particular group of carers whose numbers are increasing fast, and that is older carers who care for very old relatives. The reasons for the increase are clear. According to the ONS, the fastest population increase has been in the number of those aged 85 and over, the “oldest old”. In 1984, there were around 660,000 people in the UK aged 85 and over. Since then the numbers have more than doubled reaching 1.4 million in 2009. By 2034 the number of people aged 85 and over is projected to be 2.5 times larger than in 2009, reaching 3.5 million and accounting for 5 per cent of the total population. This is, of course, a fantastic success story with people living longer and living healthier for longer. But it also means that there are many older people who are themselves caring for very old and frail relatives.

The statistics are not even half the story. Behind them are hundreds of thousands of human stories of love and care that are a source of pride and inspiration. But they should also be a source of shame that as a society we are still allowing people to struggle so appallingly. Take Mrs M who is 80 and cares for her husband, Mr M, who is 87.

They have been married for forty years and until Mr M was diagnosed with dementia 6 years ago they had plans to travel in their retirement. He was once a pre-eminent science lecturer and it has been difficult for Mrs M to adjust to the changes in Mr M’s behaviour. On top of all of this, Mrs M has arthritis and has been suffering from exhaustion due to her caring role. She loves her husband but is struggling to support him – she will not give in willingly though.

She is not alone in this. It has been reported that 75% of carers have suffered with health issues as a result of their caring role. Unfortunately, reductions in the budgets in Mrs M’s London borough mean that her husband has had his needs reassessed by the local authority. Because it is not seen as a “critical” need to go to a day centre, Mr M will no longer have his one day a week outing. This break gave Mrs M three hours of time to take care of paper work, do the shop, and possibly attend GP appointments for her arthritis.

The problem is that Mrs M’s own health is deteriorating because of her arthritis and the decreasing amount of support she gets from her local council. Losing just three hours a week in respite means that pretty soon Mrs M won’t be able to take care of her own needs. This could, and in fact often does, lead to a crisis where two people end up very ill and without support.

If Mrs M couldn’t care for her husband, then the state would have to step in. And that costs. In fact, the replacement value of a carer is £18 an hour. With an estimated 6,440,713 carers in the UK, people like Mrs M, pound for pound, save the UK economy £119 billion per year by caring for a partner or family member. Even if Mrs M only cared for her husband five hours a day, instead of her usual 12 (including being woken up each night), she would have saved the economy £32,850.00 a year. That is for five hours a day. The fact is, most carers report that they care for someone for over 50 hours a week, saving the economy, on average, £52,560.00 a year per carer.

According to carers week:

» 76% of carers are worse off financially since taking on their caring responsibilities;
» 75% of carers have suffered with health issues as a result of caring;
» 49% of carers have a disability, condition or illness themselves;
» 48% have been a carer for more than 10 years;
» 78% are female.
So carers are a massive and undervalued resource. They save us all money and provide the ultimate welfare state to their loved ones. Successive governments’ track record in supporting this group is pretty poor – none of us has much to be proud of. But as we look at making savings in the public purse, we should take care that we don’t make the situation even more difficult. The long term cost to the taxpayer would be much more than the savings. The human cost would be incalculable.

Remember that in the future Mr and Mrs M could be you.

Posted by Peter Watt, Chief Executive of Counsel and Care

This blog first appeared on Labour Uncut on 16.06.11