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When Is A Care Plan Not a Care Plan?

December 13, 2014

Rather unexpectedly, I felt that today might be a good day to reintroduce an occasional feature of this blog – the Saturday Riddle. Previous riddles have been tongue in cheek affairs but this one is deadly serious, prompted by one of the most upsetting news stories of the year:

The Riddle is:

Q: When is a care plan not a care plan?

A: When it’s a guideline.

Yesterday, on Radio Oxford, the formidable Phil Gayle interviewed Phil Aubrey Harris who is Southern Health’s director of social care. The interview focused on the inquest findings the day before into the death of Nico Reed, a young man who died in 2012 in one of Southern Health’s supported living services. Nico’s care plan stated that he needed 20 minute observations as several physical issues he had could put his life in danger. On the day of Nico’s death, there was one support worker attending to 4 severely disabled people and the records showed that there had been a gap of between 45 minutes to an hour between Nico’s observations. Mr Aubrey Harris repeatedly talked about “with hindsight” but Mr Gayle stuck to his guns and continually pointed out that hindsight wasn’t needed – the care plan was quite clear. It was at this point, that the Sloven man threw in the audacious idea that a “care plan is just a guide”.

A care plan is just a guide????????????

No it isn’t Mr Aubrey Harris. A care plan, done well, should be a very clear statement of the care someone needs. And when specific figures are quoted in a care plan, they are there for a reason. Someone has decided that an exact time needs to be given to the specific issue that the plan is addressing.

You might accuse Mr Aubrey Harris of wriggling. You might say that he is covering his organisation’s arse. I might say that he is perpetuating the abuse that led to Nico’s death. A company commissioned and paid an awful lot of money to provide care reveals once again that their reputation comes kilometres before the needs of their “customers” and the feelings of the people left bereaved.

Where does this “guidelines” bollocks end? Supposing you have been assessed as needing 24 hour care and that is subsequently written into your care plan. The commissioning service will pay the provider for providing 24 hour care. But in your world, this is just a guideline and you decide the person can be supported on 16 hours care per day. They are left alone for the other 8 hours. Too off the wall? For me, it’s the logical progression of providers deciding that an assessed care plan is open to flexibility.

I’m being kind. The statement from Mr Aubrey Harris has nothing to do with flexibility. It is about cutting costs by cutting corners. They put in a tender to win the contract and obviously set their profit margins too low (for their board). The tender was accepted and then someone must have nudged them and told them that the shareholders won’t be too chuffed to get such a poor reward. I suspect the viral quality team got together to decide how they could turn this problematic situation around. And inevitably, the end user carries the can.

I’m struggling to get my head around the implications of “guidelinegate”. In all the discussions about #LBBill, I’ve always assumed that, although the care providers make huge profits at the expense of our family members, they were at least providing the care they were commissioned to provide. Now that idea has gone of out of the window. Everything can change when in the hands of greedy providers and care plans aren’t worth the paper they’re written on.

The commissioners mustn’t get off lightly either. Do they just sign the contract, hand over the dosh and then retire into the night? Imagine I commission a window cleaner to do upstairs and downstairs of my house at £20 a time. The window cleaner sees this contract as just a guide, cuts costs by not having a ladder and just cleans the downstairs windows. I would see it as my job as his commissioner to whomp his backside and would probably cancel our contract on the spot.

Another galling aspect of all this is that if the boot was on the other foot, there is no way that families would be able to get away with providing such awful care and going against written care plans. When Steven was in the Unit, I’m not sure if he had a care plan – I certainly wasn’t part of drawing up one. He had umpteen “behaviour management plans” and a big part of the council’s case in court is that they didn’t believe I would follow these behaviour plans. I would have been castigated if I’d suggested that these meticulous positive behaviour plans were just a guideline. But then families are not part of the gang.

There is so much else about the coroner’s verdict that chills to the bone. Southern Health took an executive decision that Nico’s family would not be told the nature of his death for over a year. In fact, even then, they found out by accident – not through the candour or humanity of the provider.

It also sets off enormous alarm bells about the realities of supported living. So popular at the moment but so at risk of being abused by both the commissioners and the providers. A prime vehicle for the cost cutters and the profit trouserers.

There has been lots of twitter discussion about the radio interview and for most people, it is clear that Mr Aubrey Harris is first and foremost a businessman and showed very little understanding of what he was being asked about. We shouldn’t be surprised. Care is big business. It’s not about care. Nico was a cost unit. A unit that could be trimmed to allow lucrative bonus schemes and money to go towards self nominated awards.

This is Care 2014.


From → Social Care

  1. My guess is that whatever was written – guidelines, care plan, pie in the sky lines was not written by the supporters doing the job, wasn’t written involving Nico’s family and was probably not worth the paper it was written on. A very sad, frustrating and ridiculous argument put up by Sloven which could be blown down by a fart in any Court! In my humble opinion.

  2. The whole terrible saga of Nico’s death, the aftermath, and now the verdict, have left me wanting to curl up in a ball in the corner, rocking and whimpering.
    I’m so relieved that you, Sara and others still have the strength to articulate specifics about the horror of all this; just now it’s beyond me to do anything but sit with the feelings and try to process them.

    Thank you.

  3. Shirley Buckley permalink

    inherent jurisdiction Court of Protection Sept 7 2007 Judgment Mr Justice Charles vice president In court “also when the case began there was not a care plan, other than one contained in a mass of material of a descriptive nature. That defect has happily been repaired over the period of the hearing” I have this care plan in front of me now, and it has nothing to do with Martin or reality.except to say “be guided by epilepsy protocols” This care plan was to cover Martin’s stay (sectioned or not) in a psychiatric unit run by (surprise The Ridgway Trust) From there he was moved to a residential care home in Cardiff (£2400 a week) where he remains under a court order. The epilepsy protocols have NEVER been in place, and there is no care plan. Three years ago commissioning queried the costs with the company that runs the home (surprise an investment company). They let this drop two years ago and have never followed it up. Here is the whole sad story in one paragraph. I finally got permission to publish this last July. Martin’s care fees are now in excess of £750,000 and the LA take $80 a week from him towards his care.

  4. Sally permalink

    Great post, awful, enraging story.Your window cleaner analogy is perfect. A “guideline?” What is a “guideline?” Answer:something they devoutly hope isn’t legally binding.Its something you “fall short of” and “learn lessons about”
    Imagine Mr Harris trying out this tripe in other settings.Would he tun up an hour late for a job interview, dentist’s appointment, flight? of course not. He knows in the real World you are expected to attend on time. Its only in the world of the vulnerable that you can say “just kidding!”

    I pray the next taxi driver who picks Mr Harris up drops him many miles from where he wants to go and says: “You did tell me your address, but I see that as a guideline.”
    I remember once waiting at home with my increasingly upset son for his case worker. No calls, no show. She drifted in over an hour late, by which time my son was distraught and hungry and we’d missed a favorite activity. Her answer? “Oh, the appointments are only an approximate time.” Nevertheless, had I not been in when she attended using the same excuse I’ d have been in awful trouble.

  5. Cathy H. permalink

    Everything in this post gives me chills. How can they be so uncaring, and say its a guideline.
    But worst, how can the coroner agree to hide his verdict for 1-year.
    That sickens me, and tells me that they only see us as figures on a spreadsheet.

  6. Lisa permalink

    This is all so absolutely fucking atrocious .
    Regarding care, does anyone know the best country to live in ? Or is this universal ?

  7. Trialia permalink

    I wish I could express real surprise about this. As someone living with visiting agency carers and being forced to plan my life around their & their office’s atrocious ideas about what “time-sensitive” means, I really can’t.

    A couple of nights ago I got a great one… bus driver dropped me off nearly a mile past my stop in the dark, cold & rain, despite my telling him where I needed to disembark, because the windows were so filthy I couldn’t see through them. I had a call from the office & told them about what had happened & that I’d be home as quickly as I could, probably 5 mins past my usual call time. I got home at that time, & the “carer” was nowhere to be seen.

    Office rang again, were told I was home & the woman barged her way in (she damn near broke the magnet on one of the communal doors despite my trying to tell her not to pull it), and was extremely rushed and rude to me when I was so chilled to the bone that I was struggling to speak at all and stammering hopelessly. She blamed me entirely for her sitting in her nice warm car for 10 minutes waiting for me whilst I was out in the rain fighting to get home as quickly as I could, and she wouldn’t let me explain although I tried. I couldn’t get her to do all that was necessary as I was still struggling to talk, and she rushed changing my clothes for bed so badly she nearly dislocated one of my ankles. As for medication prompt… isn’t the point of that meant to be that they remind me, not the other way about??? Of course she didn’t, and I missed them. It’s lucky none of my prompted meds are life-threatening if missed, isn’t it?

    Honestly, I shudder to think how badly the more vulnerable clients are treated, and I made a formal complaint that has only had the most trivial aspects upheld by my local council because the agency have no paperwork about the rest and the adult social care department seem bent on taking their word over mine on everything. I’m disabled, not stupid!

  8. Terrifying and disgusting. These are the issues that keep me awake at night more than anything else. We live in a society that supports a system based on hard profit not empathy for the most vulnerable. We are in danger of sleep walking into a terrifying future where greed alone will destroy us.(or are we there already?)

  9. Shirley Buckley permalink

    Yes Duncan and Mark we are there and we didn’t even sleep walk – we all knew it was happening and were powerless.

  10. Sally permalink

    Isn’t it a bit like this? People are valued in this society on the grounds of how much money they earn.The richer the person, the more worthy they are and the more entitled they are to preen.Next down are people not currently earning-such as the elderly-but who did once earn. At the bottom we come to the intellectually disabled, the autistic, the people who just cost money.Any little job they have (were the sheltered employment paces not closed) will be a drop in the ocean of money they will cost. For their whole lives.They don’t fit into the idea that everybody can and should earn money, that Government assistance should be time limited. Its so very easy to hand the job on to profit making agencies and wash ones hands.Their families, unless they are astoundingly rich, cannot pay for them as one does a child because they cost so much more for so many years.
    If the poor Nico had been a child left alone who had come to harm there would be a public outcry.A disabled person? Well, they’re worth less…

  11. Weary Mother permalink

    Re care plans: what accuracy and or value to they ever hold?

    Care plans can as good or as dangerous as the assessor decision. Speedily done assessments and care plans seen as a chore, put in a filing cabinet on day two and ignored.

    This years assessor simply ‘carrying out orders’ to reduce agreed critical needs of last year, down to substantial or even moderate (nil support) this time. The needs still the same or even more critical and the individual not miraculously cured in the space of a year. This year’s assessment same as last, but this years direct payments will only buy inexperienced cheapest dangerous support.

    All dictated by the values and or morals of the assessor/organisation.

    Not news……is just the world we live in.

  12. ParentCarer permalink

    Hi Mark, have you noticed anything different re the homes you pass on your way to work? They are are now being managed by the local authority due to provider failure. The place where Stephen goes to make pizza’s I think it is possibly going to be redundant sometime early next year, heard from a parent and so I queried it with th local authority.

    • I’ve changed my workplace, so haven’t been pass it for three weeks. I heard the same rumour about the day center. Steven hasn’t been there for ages – he woke up one Friday and announced he was having a disco and pub lunch on Fridays!

  13. Jayne knight permalink

    Probably in my darkest part of today the best thing that I have read. Yes I’m in. My mothers sister protested hugely many years ago about the treatment of inpatients, she’s looking after my mother, together again now. My aunt got struck off from a job she loved. Let’s make this a bloody reality for the people who have tried hard to change this system for a long time too. The decent, caring , honest ordinary person out there who hates the whole injustice of this.

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