Examination of Witnesses (Questions 40-45)
MR GARY
FITZGERALD, MS
TESSA HARDING,
MR JONATHAN
COE AND
MRS JENNY
POTTER
11 DECEMBER 2003
Q40 John Austin: I would not say it was
a golden era, but a number of local authorities, including my
own, had specialist health visitors for visiting elderly people
in their own home and that seemed to disappear around about 1974.
Is that one way that we might think about monitoring the care
of elderly people in their own homes?
Mrs Potter: Concerning the accident
and emergency departments and GPs, the answer really is no and
mixed. Some GPs and accident and emergency departments are very
good, but others have no training and are not good at all. I have
lost my train of thought, I am sorry.
Mr Coe: In terms of training,
just to be clear, I think there are two aspects to this. One is
about ensuring that health and social care workers are skilled
up to detect abuse and then to deal with it and to know what systems
to use. The second part of it is to train people to take a collective
responsibility for abuse by other health and social care professionals.
If you look at inquiries and indeed current court cases into abusive
doctors, for instance, they are often allowed to abuse not just
for years, but for decades and this follows victims and others
coming forward and telling their stories and not being believed,
and it also follows the other doctors, nurses and social care
providers being aware of these issues happening, but not taking
them forward. I am sure we could take up the next hour with discussions
about the reasons for that, but it is a fact that that does not
happen. There were two fairly major cases over the last year where
there was very clear evidence that very serious abuse was taking
place and it was known about and action was not taken, so I think
there is a very clear need for what is sometimes called `collegiate'
responsibility.
Mrs Potter: As regards training
of detection and response to abuse, often even if the nurses do
detect it, without the training there is nowhere to take it once
you have got it. You go home with that problem because no one
will take it off your hands and you worry about that patient.
We have to abide by our code of conduct which says that we have
to protect our patients. I think as regards the whole medical
profession, we are very paternalistic and we know what is best
for our patients and that is where I think most professional abuse
comes along. Our patients do not get the choice and in many cases
they are told, and our older patients get less choice and because
of shortage of resources, they do not go on then to get the rehabilitation
that they should get and we are not maintaining our elderly people
at their optimum and they are allowed to slide. Your earlier question
about death certificates in old people's homes, they are not investigated
as much because they have gone there to die. Once they get in
there nobody bothers about them, the doors are closed and they
are left. There is no rehabilitation that goes in to maintaining
them in any way. There is no stimulus in most of the homes.
Q41 Dr Taylor: Can we turn very briefly
to regulation and inspection. Firstly, the National Care Standards
Commission, has it made a difference? Secondly, with its successor
CSCI it is going to have extra combined duties, how do you feel
about that, really to each one of you? NCSC, has it made a difference?
CSCI, will it be better?
Mr Fitzgerald: There are some
wide open questions.
Q42 Chairman: Briefly, please.
Mr Fitzgerald: Yes, the Care Standards
Commission has made a difference in that it has brought together
hundreds of individual regulators and has established one global
position. Yes, it has done so in that it has brought adult protection
protocols about how it works as a regulator with local authorities.
Has it made a difference on the ground? I am concerned that it
has not in the degree to which we all had an expectation that
it would.
Q43 Chairman: Richard, on this question,
in view of Mrs Potter's last answer, again comparing the procedures
in relation to children in care and elderly people in care or
receiving care services in the community, can I ask how would
you feel about a reviewing system along the lines of the one for
children in care where there are regular reviews and monitoring?
I picked up Tessa Harding's point about advocacy and it just struck
me as a very interesting point on the two systems of care. When
a child is in care in a care home there is somebody there at least
every six months, medicals take place, etc. Is that a system which
might be of any assistance in some way?
Mr Fitzgerald: I think that would
move towards more of a person centred approach to the support
of older people rather than what we have got which is an inspection
process which is quite narrowly defined in terms of what its approach
is. To go back to the issue of the Commission, why has the Commission
not made an impact? There is a limit to what external inspection
can actually achieve. It is not possible from one unannounced
visit to identify the sorts of abuses that we are seeing coming
through our helpline, so I have concerns about that. I have concerns
also about other regulators as well. I am not convinced that the
Nursing and Midwifery Council is making the right decisions in
protecting people and giving the right messages out to the nursing
profession.
Q44 Dr Taylor: The presence of lay members
on the inspection team who in theory can go around and talk to
the patients/residents without anybody else with them, how important
is that because there is a fear that the CSCI may not take that
on?
Mr Fitzgerald: I think that would
move us more towards the point that Tessa was making which is
external advocacy. I think that is an important issue which needs
looking at. Personally I think that would help quite tremendously
in getting the views of an older person acknowledged and recognised
in what is taking place. I think it is quite possible you would
find out more about abuse than in the formal inspection process
we have got currently.
Q45 Dr Taylor: That would be more useful
than expecting them to use ICAS?
Mr Fitzgerald: That is a difficult
question. ICAS is still in the very early stages.
Ms Harding: I would say that I
think lay involvement is absolutely essential. What we should
be aiming to do is encourage open cultures. It is the closed culture,
the closed institution that breeds the potential for abuse, not
always abuse but at least the potential for abuse. The Audit Commission
issued a report a couple of months ago saying that the Human Rights
Act had made very little impact on public services and the way
public services conduct their business. We know that the Government
is about to set up a Commission for Equality and Human Rights
and is in the process of determining the powers and structure
and role of that Commission. It looks likely that the Commission
will have a role in promoting human rights. I think it is extremely
important that Commission should also have some powers of intervention
but certainly to educate and inform and to make human rights the
bedrock really of our health and social care services but it should
also to be able to intervene, to be able to undertake investigations
in areas where there is particular concern or to take test cases.
Mr Coe: The final point I want
to make is to okay what colleagues have said about the need for
independent advocacy. Whilst advocacy has developed enormously
over the last five years in particular it is still very ad hoc
in terms of its resourcing and in terms of its quality. I know
the Joint Committee on Incapacity legislation made some clear
recommendations about the development of advocacy and I would
really support those. I think there needs to be substantial investment
nationally, a network of high quality independent advocacy organisations
which I think would be more comprehensive than ICAS, as ICAS is
narrowly focused on the NHS complaints procedure, and I think
we need to have advocacy projects which have the right to go into
institutions to speak to people privately and to support them
right through the whole process which may not be a formal complaint
but may just be about supporting them to get their voices heard
about the quality of service. I think the presence of independent
advocacy has got a huge potential to have a real impact here because
it will deal with the whole spectrum that Gary started off by
talking about this morning.
Mrs Potter: I agree with that.
You have got to build up a relationship with someone before they
start telling you they are being abused anyway. Certainly someone
from an organisation spending a short time is not going to be
told things because elderly people are frightened of the comebacks.
You will not get an elderly person complaining about poor treatment
in a hospital because they are frightened they might have to go
back into hospital again. Certainly they are not going to tell
you what is happening in the home they are living in.
Chairman: Can I thank our witnesses.
I am sorry this session has been very, very brief. I think we
have had a taste of the key concerns you have expressed. Several
of you have mentioned coming back with further information. Over
and above that if there are issues you feel you would like to
add comments to arising from the session today, we shall be very
pleased to hear from you. Can I thank you for your help in this
inquiry.
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