The Government is being urged to take immediate action to ensure a satisfactory standard of care in UK care homes after a highly critical report by the Commission for Social Care and Inspection last month revealed numerous cases of people in care being given the incorrect medication, drugs in the wrong dose or no medication at all.
This closely follows the General Medical Council’s (GMC) decision in January to remove two Birmingham GPs from the medical register for behaviour they found to be “inappropriate, irresponsible and inadequate” in relation to the running of the now closed Maypole Nursing Home. Despite the fact that concerns about Maypole are said to have been raised as far back as 2001, and that health officials conducted 17 inspections of the home, it was not closed until March 2003. In just one year, 28 residents died, with 16 of those deaths being identified as cause for serious concern. It is of further concern that some three years later many questions about the Maypole remain unanswered.
There was a catalogue of failings reported over the years at Maypole Nursing Home where, according to evidence presented at the GMC hearing, vulnerable residents lived and died in unacceptable conditions.
A number of bodies have carried out investigations, but despite this, many stones remain unturned. A police investigation found no evidence of unlawful killing. The concluded GMC proceedings and ongoing proceedings in the Nursing & Midwifery Council are concerned with professional codes of conduct and fitness to practice. A multi-agency review coordinated by the Birmingham and Black Country Strategic Health Authority looked at generic and largely local issues, rather than examining individual deaths and reviewing the national issues that deserve proper attention.
The unexpected deaths of residents such as war veteran Leslie Vines, who died at Maypole in 2002, remain uninvestigated and questions surrounding the deaths are unresolved.
Among a number of failings, it was reported that there were poor standards of medical and nursing care, insufficient staffing, no awareness of nutritional needs, dirty equipment and hazardous storage, no interaction between staff and residents and no respect for dignity. Cramped living conditions were found together with excessive use of restraint where residents were also receiving significant medication.
A number of issues arise out of the limited investigations to date. First, there is no clear allocation of responsibility for monitoring standards in private sector nursing homes where roles are divided between a number of agencies, and no clear guidance exists as to who should act when concerns arise.
Second, while the GMC may frown upon doctors owning and practising in nursing homes, there is no outright ban or any meaningful regulation of the position.
The cases also raise questions about the systems in place for reporting deaths. At Maypole, bronchopneumonia was given as a cause in more than 80 per cent of cases. The GMC findings cast doubt on the accuracy of certificates issued in the cases of many residents, and in many cases no satisfactory evidence was found to support the stated cause of death.
The failure to maintain adequate prescribing standards, picked up and highlighted by the commission’s report, is only the tip of the iceberg and does no more than highlight the current piecemeal approach and the need for a more comprehensive, independent and, preferably, public inquiry into the wider issues.
One way or another, with an ever increasing elderly population, the public needs reassurance that systems are in place to protect the elderly in homes. Is the Government prepared to investigate fully and legislate for the protection of the most vulnerable of our elderly? We await its answer with interest.