As well as this blog, I keep another occasional blog recording our tribulations with our daughter's care agency. Other parents, I fear, will recognise a story of unprofessionalism and lack of integrity in a care organisation that is only exceptional in that it is unexceptional.
I have decided to republish the posting on this blog, to give it the widest currency. Tonight, carers arrived with a clearly prepared speech that assisting our daughter to make transitions from chair to wheelchair to stair lift to toilet was an illegal manouevre. The carers clearly also had no alternative plan by which her care should be delivered. We instructed them to leave and dealt ourselves with our daughter's very great distress. We do not ourselves expect to get to sleep very early. There can be no starker contrast between the practices of conductive education and the often out-dated thinking of 'moving and handling' so-called experts in care companies.
The republished posting follows.
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An All Party Group of MPs on Dementia has called for training in dementia for all staff working with clients with dementia in care homes.
The point that interests me is "training": firstly, that up to now training has not been thought necessary and secondly that, at last, a group of MPs have recognised the need. Speaking on "You and Yours" on Monday 28th April, Jeremy Wright MP, the Chair of the Group pointed out that currently the only training that was mandatory on companies employing staff in care homes was for fire regulations and for moving and handling. He emphasised the importance the All Party Group placed on training in dementia for such staff.
Let us assume that those staff delivering care to clients with dementia living in their own homes should also be trained. Let us also assume that training should not just apply in the case of clients with dementia but also to those serving clients with other conditions, such as cerebral palsy, say. Let us further assume that, as the All Part Group of MPs seem to have done, that it is in fact not possible to deliver appropriate care without such training.
Let us finally assume that as part of the training in cerebral palsy for those who work with clients with cerebral palsy, that training will bring about an understanding of the importance of maintaining and, if possible, enhancing, independent mobility (a) as essential for the lifelong mental and emotional, as much as the physical, wellbeing of the client and (b) that anything less, anything which promotes or tends to promote, a reduction in physical mobility, or unnecessary dependence on carers, is a form of abuse of the client and of the client's human right to a full life.
Now consider this.
1. Carers who arrive consistently and
persistently 10 minutes late in the morning, so that the 30 minutes
allocated to our daughter is reduced to 20 minutes, for showering,
dressing and coming downstairs on the stairlift - leaving no time for
careful and managed transitions from chair to lift, lift to chair; no
time for our daughter to properly participate herself positively in
managing her independent mobility skills;
2. Carers who now find that "assisted mobility" has become something more akin to "lifting".
But do not leap immediately to blame the carers. Ask yourself what the care company, Supporta, should do. Ask yourself the quality assurance question: How does the care company know with certainty that they are delivering a quality assured service appropriate to the client's needs? The answer, of course, is that they don't. Not only do they not train their staff in working with clients with cerebral palsy (for whom patient time is often essential to success); not only do they not provide the specialist training for their staff in the assisted mobility with people with cerebral palsy, they actually have no way of knowing that their staff are cutting by a third (cutting 10 minutes off 30 minutes) the time allocated for an appropriate service. Of course, one might say "Why would they bother to find out?" when they get paid under their contract with the Council anyway.
And then what happens?
"Moving and handling", suddenly becomes an issue for somebody.
What does Supporta do?
1. Shortly after 9.30pm last Friday night, we ring Mission Control at Supporta to enquire when to
expect carers who should have arrived by 9.00pm or Mission Control
should have called us by 9.15pm to advise us of the delay. Justina,
for she is the voice of Mission Control, says "While you are on the
phone ...." a moving and handling expert will be coming on Tuesday
morning to assess the situation. My wife points out that this cannot
happen (a) because he is male and a stranger, and cannot be permitted
to see my daughter undressed, getting dressed and use handrails to
assist the process and (b) because his visit needs to be part of a
proper process shared with the client (our daughter) of which she has
been properly informed and been able to contribute.
2. On Monday
midday, the moving and handling expert himself rings and identifies
himself as from the Primary Care Trust. A long conversation (20
minutes and maybe more) ensues in which he says that he is calling
because Justina (Supporta Mission Control) has said that 'we did not
understand' what we had to do. (Try to imagine how condescending and
patronising we find this simple statement). The M&H expert is
informed that (a) he should first arrange to visit the programme our
daughter attends during the daytime where he can observe positive
practice in what our daughter can do, before making an appointment to
see her at home; (b) he might consider doing so on a weekend morning
rather than a week day morning, when there is less pressure on her time
to be up and out. (He says he does not work weekends; the carers do and
we do with our daughter, so we rather think that is his problem and not
the client's problem.) And (c) that we cannot permit a male and a
stranger to undertake this assessment. Somewhere in this conversation
the M&H expert, who is somewhat ambiguous when it comes to his
point of view, when, of course, his point of view should be entirely
neutral and independent, says some thing to the effect that if we
refuse a moving and handling assessment the care company, Supporta,
might withdraw care services altogether. It is difficult to see how
this comment might reasonably arise in a professional conversation,
based in good practice, a conversation simply about how an appointment
might be arranged, taking into account the needs and wishes of the
client as well as of the M&H expert and Supporta. (We did not at
that moment know what his relationship is with Supporta, nor precisely
who the M&H expert is employed by, nor the process by which he is
involved, whether it is a statutory or voluntary/contractual process.
ie in a very ordinary sense, we do not know, at the time the
conversation takes place, who this man is, who is requiring and
expecting to visit our daughter the next morning.)
3. Monday
afternoon, about 4.00pm, Supporta's own moving and handling expert,
Rosie, telephones. She asks if she can "... just pop round ...." in the
morning when the carers attend and the PCT M&H expert will be doing
his assessment. She is told that this assessment is being re-arranged
with the PCT M&H expert. She refuses to accept this statement and
her manner on the telephone is harrassing and threatening. We
immediately seek to report these phone calls to our daughter's social
worker but she is off work.
4. On Tuesday, the Social Services duty
officer leaves messages and we finally get to speak to her about
5.00pm. She kindly comes out of a meeting to do so.
We point out
that this travesty of process has completely by-passed the client, not
taken into account her needs or wishes nor her interests but has been
driven solely by and for Supporta; that this is wholly and totally
unacceptable in a 'Valuing People' service; that Sheffield Social
Services should not tolerate such poor practice from a contracted
organisation. It then transpires that someone, Chris Webster of the
family that formally owned Hallam Health Care and who stayed on as
manager after it was taken over by Supporta at the turn of the year and
who never came back to us on any of the issues we were discussing with
HHC last autumn and who knows that HHC/Supporta owes our daughter £200
for a pair of glasses broken by one of the carers at least as long ago
as last November, that Chris Webster, had rung Social Services
to complain that we had "cancelled an appointment". Isn't "an
appointment" a mutually agreed thing not one imposed? And it turned
out that the moving and handling issue had been raised by Supporta with
Social Services last week, without any thought to when and how the
client was to be involved or her wishes and needs taken into account;
and it turned out the PCT M&H expert was involved because a
"referral" had been made by Supporta, without the client's wishes etc
etc again, and without the client being informed.
Has anybody at Supporta read "Valuing People" never mind acted on it? Has anybody at Supporta read "A Good Life", Sheffield's draft strategy for people with learning disabilities? Does anybody at Supporta have any understanding of what "Valuing People" and "A Good Life"mean for best practice in their company?
Does anyone at Supporta seriously think that a ""While you are on the phone ..." at 9.30pm on a Friday night and a 'can I just pop in ... phone call on Monday, that gets unpleasant when the caller does not get the simple compliance she obviously expects, are exemplar ways in which to go about best practice? Will Sheffield Social Services remind them of their duty to their clients under the law and under their contract?
I told the Social Services Duty Officer that this would be posted on the internet. This is it.
