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	TX: 20.05.09 - Care Homes PRESENTER: JULIAN WORRICKER
	Downloaded from www.bbc.co.uk/radio4 THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT. BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH FOR ITS COMPLETE ACCURACY. TX: 19.05.09 - Call You and Yours PRESENTER: JULIAN WORRICKER WORRICKER Hello, good afternoon. On today's programme we're focusing on a dilemma we'd rather not face but many of us may well do so - how do you go about choosing a care home for a relative who can no longer look after themselves? And once the choice has been made what have your experiences been like? And if you haven't been happy have you felt able to complain and see improvements as a result? As the elderly population grows it's also a pressing concern for the government. In recent weeks extra money has been announced for the care sector to try and fill a growing number of vacancies. The aim is to raise the standards and the status of care work by funding apprenticeships for young unemployed people and a national graduate trainee scheme. But will an initiate like that make a difference? 03700 100 444 is the number to call with your experiences of care homes. Calls will cost the same as those to 01 or 02 numbers. To e-mail the address is bbc.co.uk/radio4//youandyours or you can text the word YOU and your message to 63399 and that will cost you around 15 pence. I'll be joined by various guests throughout the programme but let's go first to the phones and our first caller is Mary in Dunstable in Bedfordshire, Mary good afternoon. MARY Good afternoon. WORRICKER What would you like to say on this? MARY Well I'd like to say that - I'll give you a brief background. I was a health visitor and a district nurse and I nursed for 60 years so I've got vast experience. I was looking after my husband who has Parkinson's Disease and he was 88 at this time, last year, and I collapsed - I didn't realise that I had got so run down looking after him - and he was pretty hale and hearty. Well I called in social services and they recommended a rest home and he went in and it was an absolute nightmare. I mean they - on one instance he lay on the floor from 2 o'clock in the morning till 7 - and this is a highly intelligent man, he knew exactly what he was talking about - on this urine soaked carpet that was absolutely ghastly. They expected him to wash and dress himself - a man of 88 with Parkinson's Disease - and the whole treatment was absolutely terrible. He was turned from a very vigorous man that I'd taken on holiday for three weeks in Malta just a few weeks before to a shivering wreck. WORRICKER I don't doubt that you raised a lot of issues when this happened, what was the reaction? MARY I did. Well I wrote to them and what I got was - I won't give you the name of the company - but I got a letter back which was nothing more than a whitewash of the situation and they said that the situation had been resolved. Well obviously it hadn't been resolved - he'd gone from a 42 waist trousers to a 36 in about six weeks. He was so terrified he was asking me for money to get himself home on the bus, this place was at the top of a steep hill and he knew the area - we'd lived there for 20 years - he knew it very well and he had to cross a busy road to get on the bus and eventually I had him out for a weekend and he just - I just couldn't take him back, he was too frightened. WORRICKER We're going to talk later on in the programme about the whole complaints process, which we will get into. Initially we're talking more about the process of actually making that initial choice of care home ... do you ... MARY Well we don't have much choice ... WORRICKER Well that was the point I was going to raise yeah... MARY ... you went. WORRICKER Yeah, so you didn't really feel you had the choice partly because of the time situation? MARY Well I wasn't well enough to be honest with you to go around homes and have a look at them and I knew the homes in the area fairly well - I was running sheltered housing at the time so I knew the area and I thought well that home I've known something of and people from my home had gone into there and it was good but by this time under totally new management. WORRICKER Mary we appreciate the call, thank you very much for coming on the programme. Janet's in Staffordshire, Janet good afternoon. JANET Good afternoon. WORRICKER Yes, what's your experience here? JANET Well my mum was in a care home, a very small care home, registered for 12 people but unfortunately it was a listed building and they weren't able to make the adaptations they needed in order to attract people who perhaps had more vulnerable needs, so essentially it closed and it was a shame because it had a family environment and it was just a very nice place to be. Trying to find my mum another care home was a nightmare and I went on to the CSCI - Commission of Social Care Inspection - website and looked at the inspection reports of the homes round about and mentioned this particular home that wasn't too far from me to a district nurse and she said oh no, no don't send your mum there it's dreadful and they don't spend time with them, they just feed and water them. And this inspection report was really quite glowing and this district nurse then said try this other place, which I did and I was happy with and my mum now lives there. And so my point really is that it isn't sufficient just to do an inspection of a place, it doesn't tell you what it feels like to live there. And I thought when I was going through that process how useful it would have been to have almost like a Trip Advisor type service where family and people that actually live in these care homes could refer to so that they know how it feels to live there, not just read an inspection report. Even if you know that the inspection report's available to read, which not everybody does, it just doesn't tell you a thing. WORRICKER Well we are going to talk to somebody a little bit later on in the programme, Janet, who has set up a website which broadly goes down the route that you have described. So stay tuned to listen to her because she will be joining us fairly shortly. But thank you very much for coming on the programme. With me throughout the hour is Amanda Sherlock, who's the deputy director of operations for the Care Quality Commission, which is the independent regulator of health and social care in England, it regulates health and adult social care services whether provided by the NHS, local authorities, private companies or voluntary organisations. Amanda, good afternoon. SHERLOCK Good afternoon. WORRICKER How do you make your judgements about particular homes? SHERLOCK I think the callers have raised very interesting points about making appropriate choices that will meet the needs of the individual - their relative, person they care for - going into a care home. In terms of choice the information that we make available on our website encompasses the information from our inspection visit but also information that we glean from surveys of people who are resident in care homes, from district nurses, from general practitioners - from all of those that have an interest in the care and the quality of life of residents living in the care sector. So we do take into account what it's like to live in a home, it isn't a tick box exercise our inspection visit, it's about having a conversation with residents so that we really get a feel for what the quality of service is like. WORRICKER And you have what is a visible ratings system don't you? SHERLOCK We do, yes. WORRICKER How does that work exactly? SHERLOCK From our inspection findings and from a whole range of information that comes into us, as a commission, including notifications of any serious incidents, for example, any complaints from members of the public or from people using services, we pull all that information together and our inspectors and assessors make a professional judgement on what that information and evidence, if you like, tells us about both compliance with regulation that's very important for safety and dignity but also what the experience of living in that care setting was like. WORRICKER And how often are you able to update that because one of the problems that has already arisen via the e-mails that I've been reading and was perhaps touched upon again by the callers a moment ago is that an individual experience can change from one week to the next depending on which staff are on and which staff are off and a whole array of other considerations. Realistically you cannot do that can you? SHERLOCK We try very, very hard to make our inspection findings as contemporary as possible so that they reflect what's happening. There are circumstances, such as a change in manager, that we know from our experience can have a detrimental effect on the quality of service. So if we saw changes of manager, if we saw an increase in complaints, if we had concerns raised by the public we would go out and we would do an inspection regardless of whether or not that was in our schedule. So we have the ability to do both booked inspections but also a random inspection if we have concerns. WORRICKER And if you do either of those inspections and you aren't happy what do you then do? SHERLOCK There are a number of avenues that we can take. If we have real concerns our largest power is to take an immediate cancellation where we would go to a magistrates court and seek cancellation of registration if our concerns were so extreme. WORRICKER Which would effectively close down a home? SHERLOCK Yes it would and that's something that we don't do lightly because again that is an individual's home, it would only be in extreme circumstances, but we do have that power. What's more likely to happen is that we would request an action plan from a provider and from a manager that we would monitor and if that action plan wasn't delivered to drive up standards we would then issue what's called a statutory requirement notice that is a legal requirement that the provider does comply. And that can then lead if there isn't compliance to prosecution or again cancellation. But what we are focused on is improving the day-to-day environment and day-to-day experience. WORRICKER Just one last observation on this before we go back to the phones and e-mails as well. All that sounds very convincing, in which case why do we still hear stories like our first caller? SHERLOCK Well unfortunately where you have human beings involved, it isn't a science, it's as much an art as a science - caring - where we see good quality care, where we see people who have the appropriate attitude and respect the dignity and rights of individuals in care homes then you will see good quality effective care. And there is far more good quality care than there is poor quality care. What we need to be fed back to us, as the Care Quality Commission, is people's individual's experiences and we will act on those experiences if they don't meet standards. WORRICKER Okay well that's a fairly clear invitation. Amanda Sherlock is with me then throughout the programme. Let's go to the phone in room, because I know a lot of calls have been coming in and e-mails as well and Henrietta Harrison is there, what do you have Henrietta? HARRISON Yeah that's right the phone-in lines have been really busy this morning. We've also had lots of e-mails, people e-mailing in with their experiences of care homes. Very few, unfortunately, have been positive and we've heard some really sad stories this morning. Elaine says the so-called care of her father was at best a national tragedy and at worst a national disgrace. She says her dad went into a nursing home when he was nine stone and at the end he was just five stone. She claims he was not properly hydrated and says she didn't get a proper explanation from staff for extensive bruising. Another listener also e-mailed us about the care of her late father. She thinks her dad, who was blind, contracted scabies from a member of staff and says it was her who had to wash her father on the day he died. Now she doesn't want to be named as she says she doesn't want any repercussions. And Julian that's a common theme - most people who have e-mailed us say they're too scared to complain in case residents are punished as a result. As I said most people we've spoken to have had bad experiences but Nathalie Adams is the care manager of the Old Vicarage Care Home in Dorset. She says: "I've worked there for 10 years now and we've been rated excellent in our care provision." And she adds she feels very fortunate to work in such a lovely home. 03700 100 444 is the number to call with your experiences of care homes. To e-mail the address is bbc.co.uk/radio4/youandyours. WORRICKER Henrietta, thank you very much for the moment. Alison Shields is on the line, she's phoning from Windsor. Alison, good afternoon. SHIELDS Good afternoon. WORRICKER What would you like to say? SHIELDS Basically I sort of feel as if we've covered both ends of the spectrum because my father was in two different homes and we had completely different experiences with both. The original home that he went to - because my mother's health started to deteriorate, she'd been looking after him for nine years with Alzheimer's - the original home he went in was a residential home and he had an allocated carer, which was wonderful, she was brilliant, she knew all the things he needed. Unfortunately she then went on holiday, when that happened he wasn't allocated to anybody else, it was just done between all the others and somehow he went without food and water for something like three or four days and the irony was that when we visited him we would leave at mealtimes so as not to disturb him, so we didn't actually realise that this was happening until we went along and actually demanded a doctor be called, it was actually at the weekend, and the staff said they weren't supposed to call the doctor at the weekend until Monday morning when the management came back. But we absolutely insisted and he was hospitalised, they said it was going to be touch and go but happily he did actually recover. We told the social services in the hospital all about the incident but unfortunately it didn't seem to be taken up and we never had any feedback about it and just because there was so much going on we didn't actually manage to sort of follow that one up. But the happy ending is that when we then found a new home for him, after he came out of hospital, it was just completely the opposite. And I have to say that the care he gave him there was second to none. WORRICKER And how did you find that one? SHIELDS When he was in hospital there was actually an organisation in there which gave us a list, which was provided to us free of charge because he'd been in hospital, but I understand that that's normally charged for - about £200 or so - but in fact in the beginning we did the internet for the first place, checking out all the different inspections and all the inspections had been brilliant and yet when we actually went along the first place obviously fell far short of what we'd been led to believe. WORRICKER Alison, thank you for the call. Just on that, Amanda Sherlock, people don't pay to access your information presumably do they? SHERLOCK Absolutely not, no, our website cqc.org.uk contains inspection reports on all the registered care services and you can key in through either postcode or location or the kind of care setting that you want to access and that information is available free of charge. WORRICKER And you've heard a few people say they've been to a website like yours but what they've read doesn't match what they then experience. If people come back to you and tell you that what do you do about it? SHERLOCK We would then review our inspection findings, we may go out and do a further inspection report to clarify the information deficit or where people have told us that information is inaccurate. But all of our inspection reports go through quite rigorous quality assurance before they're published on the website but we're always keen to hear people's individual experiences. WORRICKER Okay well one couple who were dismayed by the problems that they had researching suitable homes for a relative are Mark and Helen Sadler and they've now set up their own website to try and make things easier for people. The aim has been to collect as much comparative information about different homes as possible to let people come up with a shortlist of homes that they think are worth a visit. Well Helen Sadler joins us from our studio in Swindon. Helen, good afternoon. SADLER Good afternoon. WORRICKER What was so difficult about looking for a home in the first place? SADLER Well a couple of years ago my self and my husband were involved with finding a care home for a relative and we naively thought that actually a lot of information would be available to us. We were given a list of addresses and phone numbers but actually we didn't really know where to start, we didn't have time to visit every single home on the list. And for us it was like trying to buying a home without ever seeing estate agents' details, we really needed - felt like we needed more information about the homes and more support and more guidance, frankly, about how to find one, how to choose one and how to pay for one. WORRICKER I mean what specifically was lacking because you've heard Amanda Sherlock in the studio with me from the Care Quality Commission outlining the detailed reports that appear on their website and the fact that they're updated regularly, so what is lacking in your mind? SADLER Well for us one of the main things was the lack of photographs. In deciding how - which homes to visit we felt very strongly that you needed to get a sense of place and yes we read the reports but very often you needed a few more details about what was available in the homes, whether homes would accept pets - all the sort of minute details to help you decide which ones to view. WORRICKER And the kinds of activities that might be laid on for residents as well presumably? SADLER Exactly, the kinds of activities and just - as I think one of your callers said earlier - the general feel of a home is hard to get across in a report. And I suppose from our point of view, our website - yourcarehome.co.uk - is trying to say view more homes, here is the information to help you choose which homes to view. WORRICKER And where do you get your information from now? SADLER We ask the care homes, the care homes come on our site and they essentially give us the equivalent of estate agents' details with up to nine photographs and as I said all the details of local amenities, facilities at the care home and then when you're actually searching for a care home you can put in your country or your postcode but you can also search for specific details - I need a care home for dementia, I need a care home that will let me have respite care, even down to I'd like a care home with a garden - any of those things. WORRICKER Now you're not inspecting these homes in the way that, for example, the Care Quality Commission is, so where should people be going for the most reliable information or is perhaps the best advice to look at yours and at theirs? SADLER I think certainly have a look at ours, we do link to the reports from CSCI and the Quality Care Commission. But I suppose our battle cry is to - the best viewer of a care home is yourself, you're the one who knows your relative - mum, dad - you're going to have a much better idea than anybody about whether a home is right for you. And yes homes are - can be viewed in terms of what facilities they've got but at the end of the day what makes a good home is the people inside it. And you can only really discover what that's like by visiting them. WORRICKER Helen, stay there. I mean that is sound advice Amanda Sherlock isn't it, if you're going to take a relative to a home and they are going to live there for a significant period of time you've got to go there as that relative and frankly be a bit of a nuisance to make sure that you've picked the right one? SHERLOCK Absolutely, I'm completely in agreement. The best way to understand whether a home can meet your relatives' needs is to go and to visit, to ask questions, if staff are evasive that should start to ring alarm bells, don't accept being fobbed off, keep asking question, look under the carpets, look at the skirting boards, check at mealtimes, just understand what it's like to live in that care home. WORRICKER Marilyn Childs is on the phone from near Bristol, Marilyn good afternoon. Hello Marilyn. CHILDS Hello. WORRICKER Hi, yes you're on air, what would you like to say? CHILDS Well three and a half years ago my parents asked me to look for somewhere for them to stay. My dad was nearly blind and my mum is very confused. We visited five homes, they were all personally recommended, either by the GP or the health visitor or by friends who had been in a similar situation. The one we chose, when we went in it was warm in every sense - there was a lovely rapport of the staff, there was reciprocal joking and laughing going on with the residents and the residents themselves were happy to talk with us - that was such a contrast with the other four where ... WORRICKER Well that's interesting, so this one really stood out for you did it? CHILDS Absolutely, absolutely. WORRICKER What was your dilemma about the other four, what was your doubt when you went into those? CHILDS The others, one particularly just felt as though everything was being done to a price, the bare minimum was being done to tick all the boxes. Others, well the one they went to it was the only place where obviously we were paying two fees but it was the only place where we were offered two rooms for the two fees. And what was suggested was that we make one their double bedroom and they use the other as their private sitting room, which of course was really precious because they were a married couple. WORRICKER Absolutely and you look back now and think that you made a good choice? CHILDS Oh absolutely, absolutely, they're being cared for really well. The other thing that was really important was that it was in a situation where you could actually take them out very easily to do nice things, it's in a position where the back of the home backs on to a park and the front on to a seaside front. And so you could actually walk out with my parents, or indeed with a wheelchair, without any difficulty. And we feel that if there's going to be long term care and if you're going to be visiting time after time after time to be able to do something really special with the person you're visiting, rather than sit there looking at their four walls, is very important. WORRICKER Yeah very important. Marilyn, thank you very much, thank you very much for coming on the line. Now the care home industry is dominated by four big companies - Four Seasons and Southern Cross are the biggest and are run with mainly local authority funded places. BUPA and Barchester Healthcare are the other main companies, they have more of a mix with more privately funded places. Tim Hammond is the managing director of Barchester Healthcare and is on the line. Tim, good afternoon. HAMMOND Good afternoon. WORRICKER How do you strike the balance between running a business and therefore making a profit but also providing good care? HAMMOND It's actually surprisingly simple because it all fits together. We work on the basis that if we've caught happy staff, well led, well trained, well supported by the managers, we will be able to deliver excellent care and if we can deliver excellent care then we know that reputation will build and as the programme probably illustrates very well reputation does spread far and wide in the care home - care home sector and indeed in terms of other services that we provide. So we strongly believe that our financial soundness, if you like, is as a result of the fact that we deliver very good care and we do that by looking after own people. WORRICKER And are you financially sound because one or two of your competitors look a little bit shaky in that department at the moment? HAMMOND Well yes obviously I don't really want to talk about any issues that maybe at any other companies but we certainly find a very close relationship between financial soundness and the soundness of the care that's being provided and that's for a very simple reason. We can afford to invest in the services that we offer. So, for example, staff training is probably one of, if not the most important, aspect in all this. At Barchester last year over a thousand of our people did some form of vocational qualification or apprenticeship. So that's a big, big stream of activity in our organisation that we spend millions of pounds on every year, we also spend a huge amount on upkeeping our buildings, we believe passionately in gardens and having outstanding gardens. We spend more on food than I believe the two companies you mentioned and others. We can afford to invest but in the process of investing it has to deliver the care and the outcomes that the people using our services are looking for. WORRICKER Indeed, I mean I've read some of the appraisals that your homes have and they are very glowing. I mean I've got the Commission for Social Care inspection details in front of me here and clearly you come out of that very well, so I'm not about to give a hard time on it. But I just wonder, going back to where I began, there is still a profit element, there are still the shareholders to bear in mind and at some point they have to take precedence don't they? HAMMOND Well I honestly don't see a conflict, I think everything fits together and if I could use an analogy from another industry who were in the news earlier today - Marks and Spencer. Marks and Spencer make profits but I think many people over 125 years would say they've delivered some excellent quality product at the same time. WORRICKER And there are no cost pressures at the moment because of the pressures on local authorities, who of course fund some of those who you are looking after, or indeed the pressures that individuals are facing because their private funds are not going as far as they hoped they would? HAMMOND There are some very serious cost pressures, I think the industry is at a very, very difficult point at the moment. I think the challenge for both the people who are funding their own care through decline in the values of their houses or the values of their shares is one issue. The other issue, which is even bigger, is the issues to do with government funding. As you probably know there's a green paper due out next month and all three political parties strongly believe that the current system of fees is an unfair one and needs to be changed but unfortunately that hasn't mapped yet into any kind of clear action and we're hoping that next month there might be some greater clarity on that. WORRICKER And just one last question to you because it will point towards what we're going to discuss in the next half of the programme. If one of your members of staff decides they've seen something they would rather not have seen and decides to complain about it, in other words blows the whistle, what's your attitude towards them? HAMMOND Our attitude is positive, we're glad that they've pointed it out because on the very rare occasion this happens then we want to know about it. We have a confidential hotline, if you like, that goes straight through to a guy on our senior team, called Jim Marr, who is our director of quality in care, who's not involved in the direct running of the homes. You can leave your name or you can not leave your name, entirely up to you, but 24 hours a day you can ring this number. But the other point I want to make on that is it is a rare occurrence because it's so important to get the right culture in the homes. People have to trust each other and you may have seen the Sunday Times do this best companies to work for and a couple of months ago we were voted by our own staff in an anonymous confidential survey as one of the top 20 companies to work for in this country, across all sectors, we were the only care company in that top 20. And we were top 20 on, for example, there was one of the many answers they have to agree or disagree with, one of the ones we were in the top 20 on was this organisation runs on sound moral principles. WORRICKER Okay, we must leave it there Tim, thank you very much for coming on the programme, Tim Hammond. It's 12.31, you're listening to Call You and Yours on BBC Radio 4 with me Julian Worricker and still to come more of your calls on the quality of Britain's care homes. Specifically in the second half of the programme, as I hinted a moment ago, we're going to turn our attention to the complaints mechanism. If you are unhappy with the way your relative is treated what can you do? And what ideas do you have more broadly for improving the service? WORLD AT ONE TRAIL You're listening to Call You and Yours where we're discussing your experiences of Britain's care homes. Now we've talked so far about the difficult choices some of you have made before selecting a home for a close relative and about some of the experiences you've had as a result. Inevitably some of those haven't been good and in some cases they have been deeply disturbing. Well on yesterday's programme we heard from Eileen Chubb, a carer who left her job 10 years ago, after she says managers ignored her complaints that a colleague was abusing residents. She and several colleagues failed to bring a case of constructive dismissal. Well she set up the charity Compassion in Care, which carries out anonymous inspections of care homes and publishes them on its website. CHUBB I saw people stripped of every human right, left in corners whimpering like animals, left without food and drink. I saw people spat at, kicked, have their fingers bent backwards until they screamed. But the most frightening thing for me is there were so many people that accept it and says oh well that's okay, it's not so bad, you know you have to learn to turn a blind eye to these things. WORRICKER So people knew it was happening and did nothing about it? CHUBB They did nothing, no. I went to the management of the home and they told me that I shouldn't speak to anyone else and that they needed to collect evidence and it went on and on, it was only six months later that I found out six other carers were also going to the management and they were all told not to speak to anyone about it. There was more than enough evidence. All of the allegations were subsequently upheld by social services. WORRICKER So what eventually happened to you? CHUBB What eventually happened to me is I found that because I'd blown the whistle I was basically marked as somebody that was a trouble maker. WORRICKER And was the same true for the other six people that you referred to? CHUBB Yes the same is true. They all moved from the area because basically they couldn't find work. WORRICKER Because you wanted to stay in the care sector presumably but you just couldn't find work within that vicinity. CHUBB I absolutely - it's the best job in the whole world. Everyday that you work in care what you give you get a hundred times back. WORRICKER Eileen Chubb, talking about what happened to her and her charity Compassion in Care. Let's go back to Henrietta Harrison in the phone-in room with some more of your views there, Henrietta. HARRISON Hi, yeah. Actually a lot of the people getting in touch with us they're usually telling us about the experience of finding care or nursing homes for their parents. But we're also getting some members of staff getting in touch. One caller, who didn't want to go on air, works in a care home and says the experience is like a battery farm for the elderly. Now also Trish, who e-mailed us, has worked in a care home for two years but says she found it a fairly brutalising experience. She says some residents are bullied by staff and even carers with the qualification NVQ 3 in social care do not look after residents properly. Now this is backed up by an e-mail from an NVQ assessor for the health and social care qualification who got in touch. He says: "This qualification is for the most part worth nothing." He says he has four to six months to get someone through the NVQ level 2 process and is put under constant pressure to get someone through regardless of ability. Now unfortunately none of these people want to speak out. Another woman's e-mail starts: "I need to be anonymous." She goes on to say: "My mother has been in residential nursing care for four years in two different homes. Our experience is that staff have very little understanding of her advanced dementia," and says care staff do not have a reasonable command of English. Now there have been quite a few e-mails and calls from relatives who say there is poor care for people with dementia or Alzheimer's. Now if you'd like to share your experience of care homes the phone number is 03700 100 444 or the e-mail is bbc.co.uk/radio4/youandyours. WORRICKER Henrietta, thank you very much. Let's go straight back to the phones because Vivienne Philips is on the line from Cornwall, Vivienne, good afternoon. PHILIPS Good afternoon. WORRICKER I think you wanted to raise this issue of complaining and what happens if you do. PHILIPS Yes I do. My husband suffered dementia, which mean he had strokes. He was unable to do anything for himself and I would visit the home and find him - his hands covered in excreta - I'm sorry to mention this at lunchtime - and in a generally dishevelled dirty state - unwashed, unshaven. This is a man who fought through the war, who was a gentleman and served 46 years for the government and I thought it was despicable that he should be left in this state when I wasn't able to look after him. I fought the home for his better care but there was only one girl on the wing for 13 people of similar state to my husband, either with Alzheimer's or dementia, with an occasional lunchtime float which meant they couldn't feed themselves and ones in worse condition than my husband would get my attention. Anyway I took this on and on and on and in the end I had to go to an interview in which social services - a woman - appeared, two from the home and two psychiatric nurses. And the social services turned round when I explained the state I would find my husband in regularly - and I went in other day - said to me - what did you expect - and I said to her I did not expect to find my husband in this state. I think to be asked that was appalling. Every inch of the way, even when my husband was home and I was trying to get an occasional respite, I had to fight on with social services. And as for finding a home it's a lottery, it depends on your postcode and your county and it depends whether or not you're fully self funding - we were only part self funding and that limits your choice of home completely, in fact there may not be a choice. WORRICKER And just to complete the story, were you able to go beyond the person who said what do you expect and get anything more satisfactory by way of an answer? PHILIPS No because I felt they ganged up on me - five to one - and the scenario was put to me well what do you want to do, find another home? Well it had taken me quite a long time, more than a year, to get that far, I'd seen the area manager of the home a couple of times, the first time he was incredibly sympathetic, the next time he was rather bored with me and then we had this final meeting and it was left to me - you either stick with it or you move him. And it would have been - I mean he was deteriorating all the time, obviously keep having TIAs and it would have been criminal to have moved him. WORRICKER Well I appreciate you coming on the line and telling the story Vivienne. Amanda Sherlock, clearly that should not happen. If somebody from social services turns around and says what do you expect what should happen to them? SHERLOCK I would expect their manager, the director of adult social services, that has ultimate responsibility for the quality of services in a county or in a town to take a very firm line with that individual. It's not acceptable to say what do you expect. Actually what we should all expect is that basic standards of hygiene, of dignity, of safety are met regardless of whether it's self funded or part funded and regardless of fee levels - there is a basic expectation of dignity and respect that we should be providing to all of our older people in care homes. WORRICKER But how does anyone above the group of people who sat in that room, that Vivienne experienced, how does anyone above that actually know that that conversation has ever taken place and that somebody has sat there and said what do you expect? SHERLOCK Well there are various mechanisms, if it was a case conference then they should actually be minuted and noted and I would be expecting managers of services to be doing audits and reading through those minutes so that they have a view of what's happening with front line staff. I would also expect that if the lady had made a complaint through to social services that that was thoroughly investigated and appropriate action taken. Or in the last instance if the lady found that she wasn't get appropriate resolution through working with the provider and working with social services to contact the Care Quality Commission and for us to review and work with the provider to try and reconcile what are clearly conflicting views on the quality of service. WORRICKER So if you'd been contacted in that situation you could have acted upon it in a constructive fashion could you? SHERLOCK Yes. WORRICKER To the extent of going as far as you alluded to at the start of our conversation that if the home was bad enough something - something serious would have to happen to it? SHERLOCK Yes absolutely. WORRICKER Okay. Mary Toll in Ludlow good afternoon. TOLL Good afternoon. WORRICKER What's your experience here? TOLL My mother used to live on her own and she had a fall at home, went into hospital and we needed to find a nursing home for her. We did this using the system and looking at all the various grades, going visiting the nursing homes that were available in the area. And she went in there, she was in there for six months and she fell again and she fell because nobody was in the room - they used to take her into a common room - nobody was in the room, she wasn't given a bell, she felt she could get to the toilet, which she couldn't because she can't walk, and she fell. She ended up back in hospital for another four months. My family and I felt that we couldn't return her to the original nursing home. We had to make a complaint, we felt that it was only fair to make a complaint. It was so long, so laborious, we felt that we weren't being heard, that nothing - no action was constructively being taken, that we decided just to back off because it was more important to look after my mother and her needs. We found a second home, it was listed as a grade A, we had to wait two further weeks - we had to keep my mother in hospital for a further two weeks until a vacancy became available. She's in there, it's got a lot of good points - after listening to some of your speakers this afternoon it's got some very, very good points - but it doesn't do the basics of making sure that she drinks plenty of fluid because she has a urinary infection, a constant urinary infection, and they don't toilet her. They are two things that we pointed out were very important to us when she went into the second home. My sister attends all of their meetings, we go to all of their fundraising events and yet we are - my sister spends more time trying to get these things - make things happen than she does - she's more stressed over the way that my mother's looked after than the actual - you know the system. WORRICKER And do you feel you're making any progress on that specific issue? TOLL No, no and you are so worried that your parent is going to have a backlash from you complaining and asking for these things to be put right that you keep constantly - you're constantly backing off and it's so frustrating. WORRICKER Mary, thank you very much. Amanda Sherlock if that happens, again, are you able to step in, if there is a backlash, because there is a fear out there isn't there that if you are a - what's seen as a - troublesome relative, that you interfere too much, you ask too many questions that your relative will be the one who ultimately suffers? SHERLOCK It's difficult to get the balance right between your expectation - absolute expectation - of the quality and safety of care being provided and from having unrealistic expectations that unfortunately in the minority of cases we do find that complaints or consequences absolute unrealistic expectations, so it's getting that balance right. If you are finding that there are problems with unresolved complaints then do come through to the Care Quality Commission and we will work with the provider, we will work with relatives, and service users to try and find resolution. WORRICKER And what's your attitude to whistle blowers within staff? SHERLOCK There is an absolute legal responsibility that we follow appropriate process to whistle blowing. We would follow that process, we take any complaints or concerns that come through to the Care Quality Commission equally seriously, we would respect anonymity and we would use that information in our regulatory activity. WORRICKER Well let's turn our attention to future changes and possible improvements in the service being provided to those in care. In the budget the government announced a new plan, funded with £75 million, for 50,000 long term unemployed young people to be helped into social care apprenticeships - how much difference can that realistically make? And the Care Services Minister Phil Hope says he also wants to lure experienced graduates, managers and leaders from the private sector into the social care sector. Jennifer Barnard manages the graduate training scheme for the National Skills Council, good afternoon to you. BARNARD Good afternoon. WORRICKER How much difference do you say this will make? BARNARD It's got to make a difference hasn't it. Just listening to the stories of people who have been disappointed, if not made really anxious and fearful, about the standards of their care. We are all determined that it can only get better. And bringing young people in with energy and the right support and training and bringing in people who can bring a different eye to managing services, bring good standards in, keep staff motivated, keep an eye on everything, make sure that the customer services are absolutely 100% right is what we all want to happen. WORRICKER Nobody's going to argue with trying to give young people work but is it right to aim it solely at young people when perhaps people with more life experience might be better suited to this sort of work we're talking about here? BARNARD We've got a million and a half people in the workforce and your listeners can't see me but I'm certainly at the more mature end of it and we need a good balance between those who are very experienced and those who are coming in and learning. And having the mix, actually older people do appreciate, they do tell us that they like to have younger people around, as well as people of a similar age or people the age of their own families. WORRICKER How do you change people's view of the job and the status of the job? BARNARD We're doing everything we can to try and do that. I've worked in just about every job in social care from being a social care worker to being a social worker and to looking after services and now to running the graduate trainee scheme and other things and it is so rewarding, it's so wonderful to be able to work alongside people and their families to make a difference or to get it right in terms of how they choose a career that we're doing a number of things. Firstly, making sure that young people understand what the options are, and we've talked a little bit about that. But the latest idea is to bring in graduates from any discipline, say come and have a really worthwhile 12 months in social care, find out what it's about, with a variety of employers - the statutory sector, the private sector, the voluntary sector, perhaps in services themselves, perhaps more in the thinky tanky end of it - see what it's like, come and try it and then tell your friends. WORRICKER But they won't be very well paid while they're doing it will they? BARNARD The bursary scheme is pretty generous, we're actually providing a bursary of £20,000 for the 12 months experience because it is a serious learning experience we expect people to have. And social care workers are not generously paid, no, that is a problem and I think it's been acknowledged, including by the government in its latest workforce strategy that more thinking needs to be done about that. And employers who support the skills academy will also say that the levels of pay that they receive for placing people is also putting a strain on their ability to deliver a good service. But we can't let those things stop us being human beings and delivering a really excellent service to other human beings in a way that respects their dignity and their wishes. WORRICKER Okay you've prompted some calls. Jo's in Newport, Jo good afternoon. JO Oh hello. I think most of the points have been covered while listening to the programme but I am a carer in Newport itself and [indistinct word] again to young people I think yes young people are absolutely invaluable in the care environment. There are young people working in the home I work in and the elderly seem drawn to them and they find them exceptionally good. WORRICKER When people talk to you about what you do, particularly if they have reservations about doing it themselves, what do you say to them? JO Well I think if I was younger I don't think I'd come into it, I think we do such a broad based job, we've considered residential care but ultimately the job is seeing to people's basic needs and I think you have to have a certain amount of [indistinct word] even at the level as I do as a carer, I still think you have to have a great empathy with people. It's no good encouraging graduates to come in if there is no tendency well generally care for people. WORRICKER Jennifer Barnard, do you want to pick up on that point? BARNARD Oh I 100% agree and believe me we're going to be very tough when it comes to the selection stage about the empathy bit. We're not interested in people in social care who haven't got deep concern and a deep feeling of understanding about the needs of other people and a deep curiosity too because you can't possibly know about everybody's life experiences and you've really got to want to know [indistinct words]. WORRICKER Jo, thanks for the call. Isla Briggs is in Durham, Isla good afternoon. BRIGGS Good afternoon. WORRICKER Yeah what would you like to raise here? BRIGGS Yeah I just - going back to a previous point really - I feel that having a charity run care home is actually quite a positive thing. My mother-in-law is in a Christian care home, run by three local churches, so not only do the profits go back into the home but also they're more part of the community. There are volunteers coming in from the churches. She's not a Christian but you know it's a different face and someone else to be seen. WORRICKER And Amanda Sherlock presumably you are as empowered to examine and keep a close eye on those kinds of homes as you are those run in a more profit making capacity that we heard about earlier? SHERLOCK Absolutely, our expectations are the same regardless of whether it's charitable provision, local authority provision or private sector provision, we expect high standards of care. WORRICKER Isla thanks for that call. Pam Borlock in Oxfordshire, Pam good afternoon. BORLOCK Good afternoon. WORRICKER Yes, what would you like to say? BORLOCK I agree with everything that has been said so far in the programme about the serious of lack of care of elderly people in nursing homes but what really upset me when my stepmother was latterly in a nursing home, she died early this year, was that there seemed to be no guidance or any ruling on patient confidentiality. Her status was happily discussed with any seemed to be Tom, Dick or Harry or phoned up and enquired about her without asking whether they were members of family and therefore entitled to information. And in the last 10 days of my stepmother's life, when she was semi-conscious and quite restless in her bed and throwing off her clothes and bed linen and basically semi-naked that vague acquaintances and people who in her earlier days, when she was quite lucid, said that she didn't want to see were allowed to go to her room unaccompanied and just stand and look at her. And I did bring this up with the manageress of the home and sort of say you know surely you could say well she's not in a state to have visitors at the moment, she wouldn't know you were there and if you're going to do this why don't you just leave her out in the street for people to stare at her as they walk past. And I was really appalled by this. But there doesn't seem to - she was quite amazed when I brought up the subject of confidentiality and I wondered why in homes this isn't taken as strictly as it is covered in NHS hospitals where confidentiality is a very important part of a person's care. WORRICKER Well Pam let me put that to Amanda Sherlock. Is that regarded as seriously as it should be? SHERLOCK It should be regarded very seriously. It's about individuals' rights and dignity and certainly the next of kin or the service user themselves if they say they don't want people to have access to their bedroom then that should be absolutely respected. And the circumstances just described should not have happened. WORRICKER Let's go back to Henrietta Harrison for a final summing up from the phone-in room as regards what people have been saying to you Henrietta. HARRISON Yeah the phone lines and the You and Yours inbox have been really busy today. And there have been some shocking stories up and down the country but also some people who have e-mailed with positive experiences. As discussed many have said that smaller homes offer better care than larger homes but this is not reflected in the rating system according to many. The common complaint, as we've heard, is too few skilled staff, poor food and hygiene problems. Plenty of staff have got in touch with us, though practically all of them want to remain anonymous, like this one. "I managed a residential care home which I left because of the actions of the owners. CSCI and social services always told me that they were going to take action, including shutting it down, two years later they not only still run the three they have but have bought more." And finally and on a more happy note an e-mail from Lucy. She says: "My late father was brilliantly and compassionately cared for in the Orchards Care Home in Leicestershire. The home was on a low budget and the towels never matched but staff were utterly dedicated, in fact two carers came to the funeral." WORRICKER Thank you very much Henrietta. I'm reading this e-mail solution from somebody who's written in: "I'm a support worker myself, yes there are some staff who are there to collect the wages but there are many, many staff who do their best in the circumstances for a pittance of a wage and with no respect for employers, the community at large and sometimes residents and their families. Pay a decent wage, give good training, give respect to all involved and the right people just might come in to the caring profession and work well. At the moment staff are undervalued in every way." Let's look ahead, finally, with my two guests remaining in the studio. Jennifer, paint us a picture of five years from now. Do you argue that what has been announced in recent weeks is going to have made a significant difference by then? BARNARD It should have made a difference. We are so well aware of what needs to be done. We've got more resources to do it, we know how good training makes a difference, we know how good support and leadership makes a difference and we are opening ourselves up to working alongside people who need services so that they have more choices, more options, called personalisation in the jargon, including, if they wish to, putting their own support package together and staying at home, with care coming in. So we've jolly well got to make it work better and there is an awful lot of motivation amongst those of us who care deeply about social care to do that. WORRICKER And a brief final observation Amanda Sherlock, can you be optimistic about this sector given that more of us are living longer and will need more care in the future? SHERLOCK Yes I am optimistic. From next year there's a brand new registration system - very rigorous, very focused on what individuals should expect from the care sector - that will cover both health and social care and CQC will be holding those sectors to account. WORRICKER Okay. Thank you Amanda Sherlock for being part of today. Thanks to Helen Sadler, who joined us earlier, to Jennifer Barnard, who's still alongside me, and to Tim Hammond who was on the line as well. Back to the Transcripts homepage Back to the You and Yours homepage The BBC is not responsible for external websites

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