Tales of The Un-Inspected

Care Home 37

By Eileen Chubb

( This report is the Copyright of Eileen Chubb)

Dear Mr Brown,

I have looked at the inspection history of…………………………..Care Home 37, these are my findings.

Inspection report dated 19^th to 22^nd of February 2008.

The report states, that this inspection is being carried out as the result of serious concerns being brought to the attention of the authorities by relatives and healthcare professionals, as the concerns are very serious a pharmacist inspector has been involved in the inspection.

My Comments, I note that relatives and healthcare professionals raising concerns results in an investigation which includes a drug audit.

The report states, The homes recruitment practices must be more robust, when staff do not declare any criminal convictions in their job application and it later transpires they have a conviction the manager must assess the persons integrity before they start work, also references should be checked to ensure their authenticity.

My Comments, Recruitment practices need to be more robust, I do not think they are robust at all, when you consider this home has firstly employed people who have turned out to have had criminal convictions, secondly not questioned the staff when they were made aware of this and thirdly has not checked references. The inspector thinks the remedy for this is that the manager should have assessed the staffs integrity when this came to light, I think that people who give false references and lie about criminal convictions are highly unlikely to have integrity and the last person who should be judging integrity is a manager who employed such staff in the first place.

The report states that the company audits on the conduct of the home must be provided to the inspectors.

My Comments, I am not surprised these reports have gone missing, because when it turns out there are major failings in a care home the company reports will show everything was fine. A care company should never be expected to give an accurate assessment of themselves. Monthly reports are a cursory tick list and only a fool would place any trust in their credibility.

The Report states that care plans were poor, for one resident the entire information included her name and weight on admission, moving and handling was poorly completed or not completed at all, which GP residents were registered with was missing in some cases.

My Comments, The report lists a catalogue of negligence that went unnoticed by the authorities and the company which owns the home until concerns were raised. I know this is often the case and when relatives or staff raise concerns directly with the authorities this should ring alarm bells that something is very wrong.

The report states that medication practices within the home put residents at risk, A GP reported the home for not administrating medication he had prescribed to two residents who had to be admitted to hospital as a result.

Controlled drugs were not securely stored and could not be audited as staff did not keep the correct records, The records used by the company did not demonstrate medication had been given as prescribed, some records were electronic and could not be shown to us at all, some of the MAR sheets were handwritten and what was given was not clear, a resident said staff had tried to give him medication he was not prescribed, some residents had medications in their room, staff had made no record of most of the medication in the home, records of medication disposed of had been kept.

My Comments, This is the new improved medication procedure that keeps people safe? at least that is what the Department for Health would have the public believe. The reality is that vulnerable elderly people can be denied the medication they need to stay alive. I have seen first hand elderly people given lethal doses of Anti-psychotic drugs obtained from illegal stockpiles, drugs of residents who had died. I have seen the system that an abuser is able to exploit, I have also seen the suffering that is inflicted as a result. This has gone on for years and thousands of elderly people have suffered and died. How many more need to die before you act?

The Report states that there was insufficient records to show how or if the manager had investigated the one complaint recorded as received.

My Comments, Why is this manager even expected to have paperwork to show how he investigated a complaint? Two Anonymous complaints and one concern were made by those with relatives in the home relating to staff and medication were made to the CSCI as were reports from staff in the home who raised concerns about medication. It is extremely likely these concerns were raised with the homes management first. However when a Doctor raises concerns it warrants an inspection.

The reports states the whistle-blowing and protection of vulnerable adults policies of the organisation keep residents safe, action is required by the company and home manager to remind staff about their responsibilities to report abuse.

My Comments, The staff who reported their concerns outside the home did so because either they felt unable to blow the whistle within the home, or they did blow the whistle but no one listened. It is a slap in the face for those decent brave staff who risked raising concerns with an inspection authority that thinks this care company is blameless and its staff who should be reminded of their responsibilities. That is what The Public Interest Disclosure Act protects, the abusive company with all the right bits of paper.

The Home is graded zero Star Poor.Inspection report dated July 2008.

Five Months Later.

The report states that whilst relatives made critical comments about the care, positive comments were made also.

My Comments, Only the positive comments have been listed.

The report states some medications were checked and gaps found, this means staff are not always signing for medication they have given, when doses varied there was not enough guidance on what should be given.

Relatives raised concerns on the surveys about medication but there was not enough information to uphold this issue.

My Comments, Relatives raised concerns but they are not upheld as the inspection survey form they were given to record concerns did not allow them to give sufficient information in order to have those concerns addressed by the inspectors who gave them the forms.

The Report states the home manager is now registered as they successfully passed the, Fit persons, Process.

My Comments, The fit persons process is not fit in that case.

The report states two staff files are checked and the recruitment process is robust.

My Comments, If you read the opening paragraph as a member of the public you could be forgiven for assuming that the recruitment process was robust and read no further. However the final paragraph states that the files did not document why employment references were not pursued instead of accepting character references.

The report states, two members of staff were asked about handovers taking place, one staff member said they always did, one staff member said the never did.

My Comments, The positive evidence was preferred by the inspector. Who graded the section it fell under as good.

The Home is graded 1 STAR Adequate.Inspection dated 11^th of June 2009.

( 11 Months Later )

The report states, Medication practices have now improved.

My Comments, No drugs are checked the finding is based on the home having robust procedures for medication, the same robust procedures in place when the drugs put residents at risk.

The report states that people are now cared for as there care plans record all their needs.

My Comments four care plans checked, all praised except the final one which recorded a residents needs had significantly altered and the care plan did not record this.

The report states that people can be confident that any concerns they have will be listened to and acted upon.

My Comments, The above statement would be true but for the fact that the Care Quality Commission had been contacted by members of the public who raised concerns about the home, four of these concerns were referred back to the home to investigate, two of the complaints were safeguarding issues and what they were or what happened is not mentioned. The inspectors felt the issues would be best investigated by the home in spite of the complainants coming to them.

Tales Of The Un-inspected

Home Number 36.

By Eileen ChubbC.S.C.I Inspection report dated 2^nd and 3^rd of June 2008.

The report states that there have been improvements in medication management, now medications are being accurately administered in accordance with what is prescribed, there are some medications that are not been recorded as received by the home.

My Comments, There has obviously been an on-going problem with medication but what the problem was is not mentioned, I looked back at the previous inspection report and found that the medication problems included not recording medication, medication being given that did not tally with what was prescribed. That is more than a shortfall it is a criminal offence. There is a clear pattern emerging of making excuses for this home rather than dealing with the issues. No pharmacy inspection is recommended, it is graded adequate and left until the next inspection.

The home is graded 1 Star Adequate.CSCI Inspection dated 9^th of February 2009.

(8 months later)

The report states, the home assured the inspector that surveys had been sent out to relatives, staff, residents and healthcare professionals but notes only one came back.

My Comments, every year for three years these surveys have been sent out but none came back, there is clearly something wrong, this should be followed up by checking who was allegedly sent them, however it is just noted.

The report states, since the last inspection 4 random inspections have been carried out, a statutory notice was issued in relation to medication management and the home is considered to have addressed the issues. There have been 12 complaints and five adult safeguarding issues.

My Comments, this information should be disclosed in full, it is barely touched upon other than saying the home was complying, yet out of 48 residents with multiply medications the stocks of only three medications were checked and were deemed sufficient evidence to presume all medication was in order.

The report states the home has filled in all the paperwork needed to ensure residents are safe.

My Comments, All the paperwork has the right words written, weather that is the truth is another thing, the inspector has the sense to check the residents weights, the paperwork was not accurate but the inspector has not the sense to see that if one lot of paperwork was not reflecting the truth, the rest could be the same. The action taken? It was discussed with the homes manager how important recording weight was when drastic weight loss is discovered to have occurred.

( This report is the Copyright of Eileen Chubb)

Tales Of The Un-Inspected.

Care Home 35, A Report By Eileen Chubb.

( Copyright of Eileen Chubb )

Dear Mr Brown,

I have recently looked at the inspection history for home number 35, whose identity is disclosed to you in order for you to act.

………………………………………………………………………These are my findings,

The CSCI Inspection report dated 28^th Feb and 4^th of March 2008 states the following,

1. Prior to the inspection relatives surveys were sent out but only one was returned, residents spoken to during the inspection were positive.

My Comments, The fact that only one survey was returned is an indication to me that this is not a home where people feel they can say too much, the fact that residents spoken to were positive is not enough as often people feel they will suffer retaliation if they say anything negative.

2. The report states that medication procedures are not being followed by staff, that medication records are not accurate, considerable amounts of medication signed for as given were found to be still in the home, records of medication destroyed or returned had not been completed. The management told the inspector last time that the home had liaised with The Nursing and Midwifery Council on training for the nurses in the home but nothing had improved. This has been an on-going requirement for three inspections.

My Comments, The medication practices in this home have been an on-going requirement since 2005, three years of recommendations ignored. The report states that enforcement action will be taken, but that is not something a care provider fears as it is rarely taken and usually only when the media become involved. The fact is this home is dream for anyone wanting to steal drugs in order to sell them, as no one can account for what is missing as no one knows what should be there in the first place. There is an ingrained culture of drug abuse in this home, weather it be to hide criminal theft of drugs, or in order to keep residents quite or because they simply do not care if residents get pain relief or life saving drugs like insulin. Whatever the reason the culture is ingrained in the home and in the company that owns the home, as the company has carried out all the required audits and done nothing. They know what is going on and by their inaction are complicit. This situation can have lethal consequences for the elderly residents and every day it continues is a day too long, it has continued for three years at this point.

3. The report states that two residents were asked about staff, one said they were the best, the other resident said some staff were better than others, the reports states two other residents said the staff were great and lists the two comments.

My Comments, I notice the two positive comments are given prominence by highlighting them in italics and placing quotation marks on each so they stand out from the text. The negative comment however is left to merge with the text and this speaks volumes to me as to the attitude that is taken when concerns are raised, what is of concern is the attitude of the inspection authority who are supposed to be ensuring the people in that home are safe. The matter of the staff that are reported be, not so good, is not pursued by inspector. It is surely an indication that staff could be abusive, that it could be noted and not considered worthy of investigation says it all.

4. Feedback about the food did vary, the highlights all the positive comments.

My Comments, Again all positive comments are highlighted, but what about negative comments? These are not included at all other than it being mentioned some residents were dissatisfied.

5. The report states that a resident had developed pressure sores and a complaint was made directly to the authorities about lack of care.

My Comments, Relatives rarely make complaints outside the home without repeated efforts within the home to get issues addressed in my experience. This says complaints are either not being recorded correctly, or they are treated with contempt. An examination of this relatives records proved the complaint to be true, the sores had developed and no specialist medical assistance was not sought and the care plan said the resident should be turned four hourly, however this was not done. As a result of this complaint the care plans of two residents were checked on this inspection and found to be in order as far as medical assistance was now being sought, but not acted upon. It is of grave concern that people can get pressure sores which are totally avoidable but even after these sores have developed nothing is done to prevent them getting worse. Bed sores can be fatal.

6. Care plans also revealed food and fluid charts not maintained, residents at risk not weighed, falls not maintained.

My Comments, This company has all the right paperwork but that means nothing, if there is no care given then blank pages sometimes result.

7. The report states there have been four adult protection investigations undertaken in the home, three allegations about poor standards of care and the fourth arose during the inspection, a resident screaming for help whilst being attended to by a carer was heard by a nurse, the resident was found to have facial bruising, the incident was reported to relevant authorities and the carer suspended pending investigations. The other matters were partially upheld and one was not upheld.

My Comments, Firstly the allegations about poor care, there is evidently a prior history of poor care and yet allegations of such are only partially upheld and even the partial bit upheld is about communication between the home and relatives driven to complain.

7. The report states, The manager is well qualified and experienced to run the home and has been in the home a number of years, management is graded good.

My Comments, the medication practices that put residents at risk have gone on for years and the manager in charge during this time is supposed to be good, I wonder what would warrant a grade of bad.

The home is graded 1 Star, Adequate.CSCI Inspection report 23^rd of July 2008.

1. The reports mentions that three other inspections have taken place, two by a pharmacist and one regarding a complaint.

My Comments, These other reports have been kept from public view but it mentions that the first pharmacist found the medication practices that had resulted in statutory notices had now been complied with. Sounds good until you get to the second pharmist who says there are now more concerns about the medication and as a result a warning letter has been sent to the care home company. However the original concerns and the new concerns look suspicially similar. It seems if a company or home has not complied with requirements for years is suddenly found to have complied than no action is required, however four weeks later a pharmacist finds new concerns than the whole process can begin again which buys time for an inspection that has no inclination to prosecute care providers, especially the ones that are big companies. There is four weeks between the two pharmacists reports. If only as much thought and effort was put into protecting the residents.

2. The report states the home uses an effective organisational wide system for monitoring the wellbeing of residents.

My Comments, If it has failed in this home than it can fail in all their homes, it is a tick list.

3. The report states, the home has good paperwork listing all the needs of residents.

My Comments, It looks very good until you examine its contents. If you do not dwell on the fact there are no safeguards to ensure residents get their medication and not someone else’s, that if you are diabetic you are likely to be in real trouble if you expect nursing care. This company has previous on this issue in another home so its company wide monitoring system would not appear to be working.

4. Dressings have not been changed causing risk of infection, fluid charts not maintained, there has been another complaint about pressure sores.

My Comments, if you do not get fluid you die, after your mouth has split and your screaming in pain whilst your organs fail, but you die. This seems obvious to most people of course but this is a care home inspection and matters of life and death result in requirements and statutory notices that go on for years and no one really wants to think about the consequences for those reliant on this inspection process.

5. The report states, There were no discrepancies found in the medication this inspection. However we did not count any medication.

My Comments, When you know a care home has a history of appalling medication practices and you go into do an inspection, you do not count the medication. It amounts to a see no evil policy after all if a home is repeatedly ignoring the law, the last thing an inspector wants is to call it to account.

6. The report states residents dignity was not protected and recites numerous incidents such as staff not asking the resident before subjecting them to the indignity of stripping them and exposing their private parts to public scrutiny.

My Comments, When peoples right to life is not respected then why does the inspector seem surprised when their dignity is treated in the same way? Going back to the companies national monitoring system, this company was the first to be prosecuted when one of its staff took photographs of a defenceless elderly women who had Alzheimer’s, naked to the waist and held up by both arms and distributed the images on the web. The report also says that the manager who is considered good, has disclosed personal information to the inspectors about a residents family and all because one of the family had made a complaint about care. Another member of the staff was heard discussing a resident that had complained as manipulative and they would never be happy with the home. Hardly surprising.

7. The company has a clearly defined complaints policy.

My Comments, The Manager decides what is a complaint and what should be written down, investigates those that are and finds themselves guilty of things like communication when the complaint was about poor care.

New C.Q.C Inspection report dated 7^th and 8^th of May 2009

1.The Report states, The company and manager check the medication at regular intervals and all is well now with robust systems, one medication we checked was not right.

My Comments, The manager says so is hardly any basis to presume all is robust, yet in spite of the previous history and the few sample checks showing things are still not correct. This home is now graded as meeting medication standards. Drugs disposed of are placed in a bin and a record is made of what is taken away. The only check is the outside of the bin has a code, what is written on the returns sheet is not checked against the contents of the bin.

2. The report states a significant number of residents of the home are quite poorly but they had paperwork such as life maps and a range of other tools.

My Comments, Its hardly surprising so many of the residents are ill, the report states all the impressive care plan paperwork in place to make sure their needs are met but has failed to check on one crucial thing, if you are bed bound and ill it is not the bits of paper in the care plan that will bring you a drink it’s a real person in the form of staff. Despite the high number of dependent residents being noted, no increase of staffing has taken place, furthermore the possibility is not even considered at all.

3. The report notes a relative is satisfied with the care of her relative or the investigation of her complaint, safeguarding issues are still being logged as complaints. The home records well compliments about care.

My Comments, I bet the home records complements better than complaints, for years this home has received complaints, for years relatives have gone to the authorities and still there are indications that there are unsuitable staff in the home and nothing is done.

To Those It Should Concern.

An open letter to The Prime Minister.

(This report is the copyright of Eileen Chubb)

Dear Mr Brown,

This Charity has been running a campaign called, Tales of The Un-inspected, for some time, this involves going into care homes under-cover and reporting what we see. Full reports of our work to date can be found on our web site.

We have decided to expand this campaign further, by choosing a care home at random and looking at the inspection reports for a three year period.

We have to date been informing CQC of our findings but no action has been taken, therefore the responsibility has passed to you.

Care Home Number 33, …………………………………………………………………………………………

I have listed below what was noted in the CSCI Inspection report for this home dated April 2008,

1. The heating has been constantly breaking down for several years and it has been reported to the company that owns the home.

2. Relatives say there are not enough staff, the inspector notes that staff are rushing around, and residents left in a back lounge unattended for hours at a time.

3. The report notes that five residents have developed pressure sores since entering the home and that a nurse visiting the home found the treatment plan she put in place had not been carried out.

4. The report notes that staff are lifting residents in a dangerous manner and bedrail risk assessments have not been carried out.

5.The reports notes that controlled drugs have gone missing in the past year the home was asked to complete drug audits.

6. There are 24 residents in the home who require assitance to eat, it was apparent at supper time that staff were struggling to give the required assitance.

7. The companys adult safeguarding policy does not meet guidelines putting residents at risk.

The CSCI inspection report dated March 2009, which notes the following,

8. Some of the requirements from the last inspection have not been complied with, for example in response to providing more staff, the company have permantly reduced staff numbers.

General issues.

Nurses asked to sign for controlled drugs being administer daily the day after and without witnessing the administration, ( Known in law by the term fraud )Staff working without references, POVA or CRB checks ( it leaves little in the way of protection but whats the worse that can happen to a company beyond the law?)Urine soaked carpets, Dirty generally, only one bathroom of three that’s usable, the company said they fixed it, curtains hanging of the hooks low wattage bulbs used making most areas dingy, some areas with no lights, Bed ridden residents left unattended so long that it got dark and no one came to switch on the light or close the windows so they we freezing cold.

Relatives asked to pay for basic equipment that should have been provided by the company including the means to keep their doors open ( So staff could see if they were dead or alive when they passed)The call bells removed from some rooms, residents clothes unkempt due to laundry staff being called to help with care, bathrooms dirty,

Threadbare sheets, not enough blankets for residents who were cold, identified risks not acted apon, turn charts not completed, fluid charts showing not enough fluids given, residents ungroomed, residents been moved in a dangerous manner,

Poor food slopped out in small portions, those residents who could get food to their mouths gulped it down as if hungry.

Large tins of baked beans in the storeroom, residents say too many baked beans, staff say the company has cut food budget. The fruit ration available for the home was a bowl containg two bananas and one orange.

2 of the 6 Vegetarians were catered for as the others were no longer able to express their needs due to dementia.

The two trolleys belonging to the housekeeper, one had paint chipped of and the other was held together by duck tape.

Insuffiecent aprons and gloves putting residents at risk of infection, ( Also food poinsoning as care staff handling food and food poisoning can be lethal to the elderly) The inspector was only aware of half the safeguarding referalls that had been made ( the home still not complied with safeguarding guidelines)Dangerous fittings a real danger to residents.

Handwashing gel no longer supplied by company.

Cleaning staff struggling to keep a lid on worst areas, hygien inspection said home needed cleaning.

The inspector in this case has done more than most in that she has listed what is wrong, the words wall and banging head occur.

REPORT ON HOME NUMBER 34.

By Eileen Chubb. ( COPYRIGHT APPLIES )

Dear Mr Brown,

I have looked at the inspection history for this home for the past four years and these are my findings,

Care Home……………………………………………………………. Referred to as home 34.

CSCI Inspection Report dated July 2007 notes the following,

1.There was a history of problems regarding medication practices in this home and that these were serious enough to warrant a pharmacists inspection.

My Comments, What the pharmacist found is not disclosed but a number of requirements were made to be met, however the medication standards are still considered to have been met as they are graded as such. The inspector relies on the assurances of the home manager that systems have been put in place to check for medication errors before they occur, the inspector considers these systems to be robust.

2. The report states that staff did not report an adult protection incident to the homes management for over four weeks. Complaints and protection is graded good.

My Comments, The fact that this could happen, go unreported for so long and still not affect how a home is graded is why abuse thrives.

3. Staffing is graded as adequate due to a staff reference discrepancy.

My Comments, the inspector notices that a staff file has no reference from their previous employer, a short while after the homes administrator tells the inspector the reference has been found and that is accepted, yet this reference is not produced its just the word of the administrator and it is accepted.

NEW CQC INSPECTION REPORT DATED 24^th of June 2009

4. This report notes that the inspection is being carried out due to the fact that controlled drugs have gone missing and that during the investigation into that the following was discovered,

That medication was not checked into the home, there was no way of auditing it correctly, it could not be checked what medication in what dose was being given to which resident, one of the two care plans checked had no record of medication being given, M.A.R sheets were missing, large amounts of medication being stored in unlocked areas, some medication had been ordered twice.

My Comments, Only two care plans checked and one with such a serious failing, yet no other care plans audited as a result. It would appear that the robust systems of two years earlier were not so robust after all, the whole thing is a shambles but what should not be forgotten is for over two years at best vulnerable people have been left in pain and distress without their prescribed medication and at worst could have been given medication not legally prescribed and there was not a single safeguard in place to protect them. This is post Dr Shipman and nothing has changed at all as lessons have not been learnt, the whole thing is treated like some minor event and as the home manager and staff have assured the inspector that a robust system is being put in place the home is graded as TWO STARS GOOD. The fact that the home had not met the requirements going back three years previously did not impact on their credibility at all. The inspector even commends them for their knowledge of the residents medical needs. I consider the fact that they knew what needs that were neglecting intentional negligence and certainly not something to be congratulated. Then it gets even worse.

C.Q.C INSPECTION REPORT DATED 27^th of August 2009. (Eight weeks later)4. What the report mentions, That serious concerns have arisen,

Residents left in their flats behind closed doors unkempt, uncared for, not fed, not weighed, lack of knowledge about medical needs, repeated falls, injuries not treated, medication not being correctly administered, relatives complaining, 2 of 3 requirements made last time not met.

My Comments, Everything that could be wrong is now suddenly wrong, the same staff and management that had so much knowledge of residents medical conditions just eight weeks ago now seem to be suffering from amnesia. It is noted that residents who needed help with basic care did not receive it, one resident had not been washed for so long or her room cleaned or even checked, the smell of neglect could be smelt in the corridors. People were found to have not been eating, getting food into their mouth with no one to help them resulted in drastic weight loss in many cases.

C.Q.C INSPECTION REPORT 19^th October 2009. (Eight Weeks Later)5. The Records did not demonstrate that action had been taken to address the issues, residents not given food supplements prescribed by Gps, food and fluid intakes not recorded, medical assistance not summed for repeated reports of chest pain.

My Comments, These are some of the concerns noted however of the 19 requirements made at the last inspection 7 are listed as not assessed on this occasion, the remainder have no evidence of being met but are unaccounted for, 4 new ones are made including the below,

The Home must ensure the proper provision for the health and welfare of the people living in the home and appropriate treatment is sought when concerns are identified to ensure people receive treatment without delay.

My Comments, obviously there is no hurry with the term without delay as the date the home has to comply by is 10^th of November 2010, over a year for people who have waited for protection for so long.

C.Q.C INSPECTION REPORT DATED 9^th of NOVEMBER 2009 (22 days later)6. The home has sorted out the medication, all of the outstanding statutory requirements not inspected.

My Comments, Now the home is assessed as meeting medication requirements it is graded as ZERO STARS POOR, what it will be next week is any ones guess but there is one certainty and that is the reality of the care and the star rating awarded for care will be at total odds.

Editorial By Eileen Chubb.

There has been a lot of fast exits recently, first there was Gerry Robinson saving dementia care homes. This two part series was a waste of time and achieved nothing. Mr Robinson comes at the problem from the angle that you can provide good care and make a profit but it soon becomes apparent that Mr Robinson is out of his depth. The care homes in part one of the series are given up on and in part two we are shown another care home. This home is shown what needs to change to provide good care but Mr Robinson fails to grasp that if one staff member takes a resident into the garden to paint the shed, the other twenty or so residents needing help will be left with one staff member to attend to all their needs, and that can not be done. The stark reality is that the official recommended staffing levels that homes comply with do not allow for decent care.

Mr Robinson was happy when treble the normal staff were on duty in these homes and decent care resulted, but that will not happen because of profit margins. This conflict was never dealt with and a picture of how easy it is to fix a home was the impression given. Than in the middle of filming before the home is “Fixed” it is inspected by CQC and is awarded a higher star rating, Mr Robinson is shocked at this! The programme ends with the homes closure and Mr Robinson walks away.

Baroness Young has also gone because the few inspections carried out by the new CQC turned out to be flawed to the extent the were a danger to public safety.

The Writer Martin Amis told the Sunday Times recently that he thinks there should be Euthanasia booths on street corners, well we already have them, the Hospitals and care homes from hell.

Finally Sir Michael Parkinson goes as dignity Guardian, You can be an excellent carer or the worst kind of abuser and still be a dignity guardian as just like in the care system no distinction is made between the good or the bad.

I have worked with the worst kind of abusers and know they would not hesitate to sign up to such a scheme as it provides cover. Sir Michael has been given a sticking plaster to fix a care system where there is no accountability and which is beyond the law. I have noted that many of the companies and care homes who have signed up to be a Dignity Guardian have continued to have elderly people abused or die for the want of care.