Category Archives: World Gone Mad

A&Es further hampered by staff having to get wretched ‘Friends & Family’ test completed…

Twitter: ‘Your Humble Servant ‏@yrhumbleservant  “Tales emerging that A&E crisis being worsened by staff having to take time out to get Friends and Family Test filled in by patients.”‘

Sounds entirely plausible.

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Wanda Maddocks: Jailed in secret – for trying to rescue her father from care home where she believed he would die | Mail Online

“Her family said Mr Maddocks, a retired painter and decorator from Stoke-on-Trent, had been held ‘like a prisoner’ on the orders of a local council.”

via Wanda Maddocks: Jailed in secret – for trying to rescue her father from care home where she believed he would die | Mail Online.

Although not specified in the article, it is reasonable to assume that the Local Authority had granted the care home a ‘Deprivation of Liberty’ order.

It is the Alice in Wonderland logic of the Mental Capacity Act 2005 – as amended by the Mental Health Act 2007, which brought in the ‘Deprivation of Liberty’ regulations – that the agency [in this case the Council] that commissions a provider [the care home] to meet the needs of the person, congruent with his rights of liberty as a citizen, is the same agency that will then – on application by provider – authorise that the person be deprived of their liberty because the care home does not believe it can meet the needs of that person without so depriving him of his rights to liberty as a citizen.

There is no independent agency that can look at the case objectively and then determine if the person can be lawfully deprived of his liberty, or whether the Council as commissioner or the care home as provider could and should meet the person’s needs without depriving of his liberty. There is no equivalent to the Mental Health Tribunal to which appeal can be made, as can happen if a person is being detained under the Mental Health Act. The Court of Protection only becomes involved if – as in this case – there are disputes about, or challenges to, the Deprivation of  Liberty order. It is – or should be – astonishing that in this country a person may be lawfully deprived of their liberty by administrative process only.

That one secret incarceration then led to another ought to be a matter of deepest concern and alarm. That all of this is entirely congruent with the statutory and regulatory powers of the Mental Capacity Act strongly argues that the law should be changed. From an instructive historical perspective it is worth remembering that the Mental Capacity Act 2005 was the Labour government’s response to the Bournewood case and judgement in 2004.  The European Court of Human Rights had determined that the nub of the problem was that HL’s de facto detention had not been  ‘in accordance with a procedure described by law’. Not that it was a bad thing in itself, not that the UK could or should do better, but that there had been no proper procedure that could be followed. This gave the green light to the Government not to find better ways of caring for people with complex mental capacity problems, but to invent the administrative process of ‘Deprivation of Liberty’. Cunning or what?

Why is there not the greatest public outrage and protest at the intent and the operation of the Deprivation of Liberty regulations? Because the people to whom they are applied, the people who are being detained in care homes and hospitals, are by and large older people with dementia. They have the least voice and they are perhaps society’s least concern. Some several years ago I visited a care home as part of a ‘due diligence’ process for its possible sale from public to private ownership. On the outside of every bedroom door in the ‘dementia wing’ was a bolt high up accessible only to staff. This was – the home freely admitted – in order to lock the residents in at night “to stop them wandering, or hurting themselves or going into other people’s bedrooms”. Of course, also a brilliant way of cutting night time staffing costs: one sleeping warder, not three waking care workers. Ten years ago that was as unlawful as it was disgusting. Under the Mental Capacity Act it remains disgusting, but it may now be lawful. All it takes is the penny-pinching care home to ask the cash-strapped Council if they think it’s OK and for the Council to say “It’s not ideal, but it is cheap, so carry on.”

 

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Points Mean Prizes…

“I’ve given extra weighting to some of the criteria. For example, if they say they need personal care that scores three times the value of asking for help with shopping and six times wanting transport for leisure activities. That’s the essence of it for year one. But here’s the cunning part – we’ll wait and see which categories are least in demand and then shift the weighting towards those areas: they less they want it, the more we’ll invest in it. If something is too popular then we can cut back on that too. It’s important to recognise that we’re in charge of this system, and we can make it work for us not them.”

– 2009: Early discussion about the creation of a local RAS (Resource Allocation System) for determining the indicative level of a Personal Budget in Self-Directed Support (‘personalisation’ / ‘cash for care’).

“Today the Complex RAS is a disaster area.”

– 2012: Simon Duffy says sorry.

So what should we now do? How about sweep away the entire fantastical and discredited ‘points mean prizes’ system and go back to the lawful process of determining eligible social care needs then determining and agreeing the most cost-effective means of meeting those needs, using a Direct Payment where that is workable and wanted?

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World Gone Mad [a frequent series] #23,165: “Hospital faces fines because it is too popular – Health News – Health & Families – The Independent”

“One of Britains best hospitals is facing fines of more than £500,000 a month from April because it is too popular.The hospital, a specialist orthopaedic centre in Shropshire, has regularly topped league tables for the quality of its clinical care.But its popularity has meant it has come bottom of the league for the length of its waiting list as patients have flocked to the hospital.Now, a new Government drive to rid the NHS of excessively long waits for treatment means that hospitals will be fined £5,000 a month for each patient who has waited more than a year. The Robert Jones and Agnes Hunt Orthopaedic NHS Foundation Trust, which specialises in spinal surgery, has 101 patients who have waited more than a year for their operations .”

via Hospital faces fines because it is too popular – Health News – Health & Families – The Independent.

– Remember folks: ‘All Targets Create Sub-Optimal Outcomes’

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