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Relatives of elderly residents in care homes are throwing the spotlight on such places thanks to “freedom of information”.
They are using the freedom of information act (FOIA) to unearth secrets about care homes and evidence of poor standards.
All public bodies – including the commission for social care inspection (CSCI), which regulates care homes, as well as children’s homes and other social services – are subject to FOIA.
The FOIA Centre helps people who want to dig out information about care homes. Relatives often want to find out more about a care home where their loved one is being neglected or even abused. People also turn to the FOIA Centre to find information to help them choose a home.
Several exemptions under FOIA can prevent people from obtaining information they want, but most exemptions are not absolute, so public bodies must weigh whether the public interest favours disclosure. In general, reports on complaints about specific homes should be available under FOIA.
Through FOIA, relatives made an astonishing discovery after making complaints about Lynde House nursing home, in Twickenham, south west London, owned by Westminster Health Care (WHC), whose chief executive at the time was Dr Chai Patel, one of the businessmen embroiled in the “cash-for-honours” affair. Patel was also then a government advisor on care for elderly people.
He made an estimated £8 million fortune after selling his stake in WHC, which was later bought by Barchester Healthcare, one of Britain’s biggest care home operators. Patel is also chief executive of the Priory group, which includes the London rehabilitation clinic favoured by celebrities.
Patel has a remarkably close relationship with the Blair government. He was one of the Labour donors nominated for a peerage, although the appointments commission objected to his nomination.
He is one of the trustees of the Blairite think tank, the institute for public policy research.
In 2003, the Priory group was awarded a £3 million contract by the ministry of defence (MoD) to provide all of its in-patient mental health-care services. According to the Priory group, this was the first time that a national long-term mental health contract was given to an independent service provider by any government agency.
Although the Priory is best known for helping celebrities overcome addictions, much of its work comes from NHS referrals for psychiatric illnesses.
Another illustration of the closeness between Patel and Blair was how the businessman arranged for the prime minister’s daughter to be treated at the Priory in 2004 when she suffered a break down, leading her father to come close to resigning.
In 2001, the Sunday Express published an ex-pose on standards at Lynde House and two other WHC homes.
Patel rejected the criticisms, saying that many were “out of context, many more are inaccurate or simply wrong.”
However, following relatives’ complaints, the area health authority commissioned Mary McLaren, an external professional advisor, to investigate Lynde House.
While the investigation is understood to have been completed by January 2002 and although complainants received findings on their specific complaints the following March, the overall report was not published for another five months. Relatives suspected that WHC tried to intimidate the health authority into not publishing the report.
Freedom of information proved that they were right.
A letter, disclosed under FOIA, shows that WHC’s solicitors threatened to sue the south west London health authority and McLaren, personally, if the report were published.
The letter, dated 15 August 2002, about the in-tended publication of the report that had already been amended following objections raised by WHC, says: “Much of what is comprised within the report is defamatory.”
“We must put you on notice as to the potential ec-onomic loss that our clients may suffer if this document is published in the way that is proposed. Our clients have produced detailed information in rebuttal and we put you on notice that they reserve the right to take action against both the health authority and Mary McLaren personally for damages for libel and for negligent mis-statement.”
This kind of report, published by a public body such as a health authority, is usually protected from a libel claim by “privilege”.
However, WHC’s solicitors argued that privilege did not apply because the health authority no longer had regulatory responsibility for the care home even though its predecessor, the Kingston and Richmond health authority, commissioned the report as part of its duties as the registration body.
The letter also demanded that, if publication went ahead, WHC be given notice so that it could seek an injunction to block it.
Despite the threat, the report was published that month, and WHC never began proceedings over it. Soon after, Patel stepped down as a government advisor, but denied that he was forced to resign.
The report made a series of damning findings about Lynde House, saying that it “allowed insufficient levels of staff to operate on occasions,” and, “allowed inadequately trained staff to undertake the care tasks and procedures required.”
The home “allowed nursing staff to continue to undertake poor practice, ie wound care, record keeping, drug administration, ear syringing, and moving and handling,” and, “allowed unacceptable levels of maintenance of hoists, wheelchairs and other equipment, which put the safety of residents at risk.”
In addition, it “did not ensure that all residents had access to a call bell at all times.”
It also criticised Kingston and Richmond health authority for failures while it was the home’s regulator.
The south west London health authority apologis-ed for the failures of its predecessor body.
Lynde House made no apology, however, and in-stead rebutted every criticism.
A spokeswoman for Barchester Healthcare, which bought WHC in 2004, said: “When Barchester took over Westminster, there was a period in which they had to really bring up the standard of a lot of Westminster homes to a standard that they think is appropriate.”
Following the McLaren report, Dr Vincent Cable, Liberal Democrat MP for Twickenham, introduced an adjournment debate in the house of commons on care homes for elderly people.
He told parliament that he had received a series of complaints about Lynde House, saying: “Despite paying extremely large fees – typically, £30,000 a year – the residents had experiences such as sitting for very long periods, being unable to attract attention after ringing bells, sitting in their own waste and being unable to attract any nursing or care attention in an under-staffed environment.
“Perhaps most serious of all, was the climate of bullying that existed. Examples were given of old people in their 80’s or 90’s… being threatened with expulsion because they had complained about the problems associated with care in the home.”
“I was approached by a judge, who asked to meet me anonymously. Despite his senior position in pubic life, he was clearly a frightened man. He said that he wanted to tell me things that had happened in the home, but did not wish his name to be used. He was afraid that, if it were, there would be retaliation against his mother who was in her mid-90’s.”
Auriol Walters, 70, of Twickenham, whose late mother Irene Smith was at Lynde House, had all five of her specific areas of complaint – including repeated falls and bruising, poor personal care such as lack of bathing, and poor drug administration – upheld by McLaren.
“My mother was in her 90’s, and she had 28 falls while she was there for two-and-a-half years,” said Auriol. She leads the Lynde House relatives group, which has been using FOIA to unearth information.
The disclosure of the letter written by WHC’s solicitors confirmed her suspicions. And, although the final report was damning, she is seeking the earlier drafts under FOIA because she suspects that it was toned down under pressure.
Patel was referred to the fitness to practice panel at the general medical council (GMC) over several relatives’ allegations that he failed to investigate neglect at Lynde House properly. But it dropped the case after Patel won a high court application for a judicial review of the basis of the GMC charge against him of serious professional misconduct.
He later issued a statement, saying: “For over two years, Chai Patel has been the subject of nasty, personal and vicious attack. Documents that were flawed, unsubstantiated and prejudiced were cited as fact as part of the supposed case against him.”
The high court judge, Justice Collins, he said, had “recognised the potential for gross injustice.”
The FOIA Centre is currently helping the complain-ants seek information under open-access laws from the GMC about the conduct of their case.
Meanwhile, following its last unannounced inspect-ion in November, CSCI criticised Lynde House over staff training and competence. It ordered a series of improvements to be undertaken within four months.
The Barchester spokeswoman said that it had installed a new manager into Lynde House in September last year and that she has turned it round. “On the staff training issue, she addressed that very quickly by the end of the year.”
CSCI had indicated to the home that another unannounced inspection report due imminently is “incredibly positive”, she said. “It’s a good example of something that’s been turned around hugely.”
Former auxiliary nurse Andrea Wade decided to investigate a nursing home after her late mother caught scabies there.
Seven months after her mother, Doris Baxter, arrived in Beechwood care home in Northallerton, North Yorkshire, scabies broke out among residents and staff. Scabies is a contagious disease causing painful skin lesions.
Andrea, 62, of Thirsk, North Yorkshire, pressed unsuccessfully for her 88-year-old mother to go to hospital. She believes that the scabies was a major factor in her mother’s death five months later in 2003.
She complained to the regulator about poor standards of care at the home, with two of her complaints proven and another partly upheld. However, the regulator did not uphold three of her complaints, and said that the home provided appropriate treatment for her mother’s scabies.
Under FOIA, Andrea also obtained reports on other complaints, with identities of residents, relatives and staff removed.
Three district nurses lodged one complaint three years ago because they were being called out “on practically a daily basis” to deal with injuries resulting from accidents, residents fighting each other or a lack of supervisors.
The report fully upheld the four areas of their complaint, saying that the home had less than half the level of nurse staffing required.
Andrea said that her mother was moved to Beechwood from another care home, where she had been happy. “She repeatedly said she wanted out of Beechwood, the last time was a few weeks before she died. She said, ‘I don’t care where you take me or where you put me, but just get me out of here.’”
However, following its last unannounced inspection in March, CSCI said that Beechwood “provides a good standard of care.”
Care assistant Tania Busbridge turned to FOIA after she became a whistle blower on abuse of elderly residents at the home where she worked.
Tania, 62, and another full-time care assistant at Trelana in Bude, Cornwall, Sandy Waterman, blew the whistle in 2003 on two colleagues for repeatedly assaulting and mistreating residents.
Seven staff members, including two nurses, gave statements to the home’s manager alleging abuse.
But Tania, of Bodmin, Cornwall, said that the complaints were “swept under the carpet.” So, she and Sandy resigned and lodged an employment tribunal claim for constructive dismissal. They won.
The regulator, however, did not uphold the com-plaints about the home. So, Tania filed a FOIA request to find out more about what had happened with the complaints.
She found that the regulator privately criticised the home for the “speed” of its own investigation and for failing to report staff concerns.
The employment tribunal was more strident about the care home’s treatment of the complaints, saying: “It was, in our judgement, a very perfunctory investigation,” giving Tania and Sandy “the impression that their complaints had not been taken seriously.” Tania won £3,500 compensation, Sandy £2,482.
However, Trelana performed well in CSCI’s last unannounced inspection in November.
Another version of this article first appeared in the Daily Express.
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