As a doctor, I long ago vowed I’d rather die than go into a care home

THE Mail’s exposé of the crisis in our care homes made for grim reading yesterday. But while I am horrified at what has been uncovered — that as many as four in ten such homes are not fit for purpose, leaving some 70,000 residents at risk — I am, sadly, not surprised.

I was a medical student, working in a nursing home for people with dementia, when I first encountered the abuse meted out by some staff to patients.

Residents would be locked into bathrooms, tied into chairs and commodes, and repeatedly left lying in their own excrement. They were verbally accosted by carers using some of the most offensive language I have ever heard.

These residents were profoundly impaired and unable to articulate what was happening to them. So when an inspection failed to uncover what was going on, I reported the home to the local authority. Several staff were sacked — but only after one of their colleagues came forward to corroborate what I’d witnessed.

That was back in the early 2000s, and one would have hoped for — no, expected — improvement, especially after highprofile scandals such as Winterbourne View in Gloucestershire, Orchid View in West Sussex, and some other homes.

The Mail’s findings suggest otherwise, with reports of violence, bullying, inappropriate behaviour and inadequate treatment. Even more alarmingly, suggests a rapid deterioration in the quality of care.

Vulnerable

Last month, the Care Quality Commission (CQC), the independent regulator of health and social care, reported that since October 2014, 20 per cent of homes were failing its inspections. Yesterday, we discovered that this year alone, 38 per cent of homes failed.

So why do things seem to be getting worse — and is the CQC up to the task of enforcing the highest standards for the most vulnerable in society?

Over the years in which I have provided medical cover in care homes, I’ve been a fierce critic of the CQC. It’s been toothless and inept in identifying and tackling abuse and neglect.

Its inspections have focused on easily monitored, quantifiable criteria such as how medicines are stored, what infection control procedures are in place, how complaints are dealt with, and how many ‘ sharps bins’ there are in clinical areas.

Yes, these might be important, but they assess a very narrow aspect of care.

In effect they are an audit of the bureaucracy in a care home; how well it is playing the game; jumping through the right hoops. That’s very different from assessing the experience of the residents and patients.

But since October 2014 that approach has changed; rather being judged ‘ compliant’ or ‘non- compliant’, homes are being subjected to far greater scrutiny by the CQC. As a result, it is uncovering problems that were previously — tragically — going unnoticed.

Another factor behind the findings is the crisis hitting social care. A growing and ageing population, with ever more complex medical conditions, means services are under increasing strain.

We don’t have enough specialist NHS placements, so care homes are under pressure to take sicker patients, many with behavioural difficulties related to dementia. And local authority cuts to social care budgets mean that running a care home is far less lucrative than it was.

Owners, including the big providers such as Bupa, HC- One and Four Seasons Health Care, have been reducing staff or increasing numbers of residents to keep profit margins healthy. Staff are overstretched and the care they deliver has deteriorated.

What particularly concerns me are the so-called ‘granny farms’ that are springing up — large nursing homes housing dozens of residents — as a cheap way of delivering care in a cash- strapped sector. In reality this means dehumanised and disjointed care.

It’s no surprise that the CQC report shows that smaller services designed to care for fewer people were rated better than larger services.

Dignity

This is not to make excuses for anyone — neither the CQC, nor those homes that have failed. The Mail’s revelations shame us all. There are, of course, some excellent care homes in this country and some truly outstanding carers who deserve proper recognition for the job they do.

However, given my experiences over the years, I decided long ago that I’d rather die than end up in one.

The loss of dignity, the neglect caused by indifference and apathy that comes with a workforce that is understaffed, under- paid and untrained — well, sometimes it was too much to bear.

And I can only imagine the distress of those whose elderly loved ones are in care or likely to need it in the near future when they read about the failings in the system. Such a decision is not made easily.

I’ve seen children and spouses racked with guilt at the prospect of putting a family member in care. Invariably, they feel they’ve let that person down and abandoned them just at the point they needed them the most.

As a society we face a huge challenge in caring for an ageing population. It is crucial that we have the right safeguards in place. We need a culture change in care homes and, to bring it about, must have stronger legislation.

Given what we know now about the extent of the problem, the criminal prosecution of just five homes in two years by the CQC is insufficient.

Care home owners must be held personally responsible for poor care and properly punitive fines — or imprisonment — imposed more widely. Firing a few members of staff and then reopening under a new name isn’t good enough.

Minimum qualifications with mandatory professional development for carers must be introduced, as well as a professional governing body, just as nurses and doctors have, to regulate care workers.

This will have the additional benefit of elevating care work- ing to a profession and show carers — who do an incredibly physically tough and emotionally demanding job — that they are valued and the work they do is considered skilled and important.

Until this happens, the old and infirm will, shamefully, continue to suffer.

I am often asked by the relatives of elderly patients how to find a good home. It’s not easy, but unannounced visits to prospective homes as well as talking to residents about how they feel about the place is a good indicator.

Neglect

Many recent cases of abuse have been caught out, not by CQC inspections, but by covert surveillance by family members. It’s a desperately sorry state of affairs, but CCTV cameras in the rooms of all vulnerable people would be another way of clamping down on abuse and neglect — until the Government responds to the crisis.

There is, of course, a far bigger question. We need to think long and hard — and start soon — about how we are going to fund social care.

The reality is that quality care is not cheap. So who is going to pay for it? Can we expect the taxpayer to foot an ever-increasing bill?

I fully support this newspaper’s call for a Royal Commission to explore how we should pay for social care ( and the NHS) in the challenging years ahead.

At the very least the weakest among us should have an expectation of compassionate care that protects their dignity. And the fact that we — the fifth largest economy in the world — are failing to provide it on such a scale is intolerable.