savage Brown’s free care

Labour peers savage Brown’s free care plan

Sam Lister, Health Editor and Philip Webster, Political Editor

A key plank of Gordon Brown’s re-election strategy was condemned by members of his own party yesterday as irresponsible, unaffordable and based on a myth.

The Prime Minister’s plan to offer free care at home to the elderly, outlined yesterday in the last Queen’s Speech before the general election, was compared to “an admiral firing an Exocet into his own flagship”.

Lord Lipsey, a former member of the Royal Commission on Long-Term Care, also accused the Government of peddling a “pernicious myth” that people are better cared for in their own homes than in a nursing home.

The measure, aimed at 400,000 of the neediest people, amounted to a “demolition job on the national budget”, he said, as the Government would be forced to cover unnecessary claims made by the better-off. He said that it threatened to undo current work on building a system to help the elderly and those most in need of care.

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  human rights in old age
• nhs / abuse of elderly

“I’m not looking forward to the night of the next general election but, if the result goes as I expect, one of the consolations will be that one of the most irresponsible acts to be put forward by a prime minister in the recent history of this country will be swept away with his government,” he added.

Lord Warner, a former health minister, described the care Bill as totally misjudged. “There has been no proper impact assessment, and no data to show how this would work,” he said. “There’s a big question mark as to whether there’s even actually a Bill ready.”

Other peers are known to oppose a Bill that many see as a last-minute, back-of-the-envelope proposal. Mr Brown, criticised by the Conservatives for what they said was a blatantly electoral programme of 15 Bills, faced more attacks from his own side. Charles Clarke, the former Home Secretary, said that the Prime Minister’s attempts to impose political dividing lines was “neither the best way to govern the country nor the best way for Labour to win in 2010”.

David Cameron said that the “biggest omission of all” was the failure to mention MPs’ expenses or the report by Sir Christopher Kelly, the chairman of the Committee on Standards in Public Life. Sir Christopher joined in the criticism, issuing a statement pointing out that party leaders had agreed that his recommendations should be implemented in full. It was disappointing, he said, that the speech failed to address the remit, powers and independence of the new body being established to regulate expenses.

A Downing Street spokesman said: “We are not standing in the way of any of Kelly’s recommendations. Everything related to sweeping away the old, discredited expenses system . . . can and should be implemented without further legislation.”

The criticisms of the care Bill were echoed by health economists. Niall Dickson, of the King’s Fund, said: “These latest proposals seem to have been hastily put together and appear to cut across the options set out in the Government’s own Green Paper.”

rights in care

National Minimum Standards - Your Rights

24 June 2009

Find out about the minimum standards care services have to meet and what you have a right to expect.

The following guidance is from the Care Quality Commission (CQC), the regulatory body for care homes in England.

The Government has set national minimum standards for care services. The standards set out the quality of care, service and facilities you should expect from your care provider.

These are just some of the issues the national minimum standards cover:

• you have a right to be treated politely and with dignity

• you have a right to privacy for yourself, and your relatives and friends when they visit

• you have a right to deal with your own finances and spend your money in the way you choose

• you have a right to eat food that is prepared in line with your faith, and to worship when and where you want to

• you have a right to choose the food that you eat and be given the time and space to relax and enjoy your meal

• you have a right to get up in the mornings and go to bed at night when you choose

• you have a right to complain if you are not happy with the care you get.

The national minimum standards enforceable by law but are important guidelines to help providers, inspectors and people who use services to judge the standard of service.

They are designed to make sure everyone understands what's expected and so services can be measured against the same standards.

Age Concern is also calling for

Health

Elderly care 'needs radical overhaul'

Elderly people should not pay for health and social care, says Age Concern



Radio 5Live on Age Concern's report
Britain's growing elderly population need a cheaper, more equal and more open system of long-term care, according to charity Age Concern.
In its final submission to the Royal Commission on Long Term Care, Age Concern calls for a radical overhaul of the existing system, including:


new locally based community care authorities to administer long-term care
a state-funded scheme which allows the young to save for possible future care costs
free health and social services care for all elderly people.
Sally Greengross, Age Concern England's director general, said: "If the services of the future are to support the growing older population, the Royal Commission must look closely at the experience of the past and resist the temptation to patch up and paper over the cracks in the current system."



Sally Greengross: long-term care needs a total overhaul
Although the Royal Commission, set up last December, is supposed to look at funding for long-term care, Age Concern says it should first define what the term covers.

It wants a new national definition of long-term care which clearly distinguishes between the cost of the nursing element of care homes and other 'hotel' costs, such as food, accommodation and cleaning.

This would ensure elderly people did not have to fund health costs and would make for smaller nursing home bills.

The charity says many elderly people in nursing homes now pay for health care which should be free on the NHS.

Age Concern also wants a national system for subsidising hotel charges.

Community care authorities

The charity is also proposing that new locally based community care authorities be set up.



Some old people fall between the health and social services nets
Currently, long-term care costs are split between health and social services departments.

Age Concern says this can be confusing for elderly people and can cause funding battles between departments, leading to delays in people getting the care they need.

For example, bathing services for the elderly can be defined as either a medical or a social need.

The government is due to set out its recipe for reducing the so-called "Berlin Wall" between health and social services on Wednesday.

National guidelines


Age Concern is also proposing national guidelines on charges for long-term care.

"There is quite a lot of disparity across the country. What you get access to and whether you pay for it depends on where you live," said a spokeswoman.

"Elderly people need to know what is available, what they can expect, what kind of financial support they can have and how much they will have to contribute," she added.

Age Concern is also calling for:


ring-fenced funding for long-term care
a system which takes into account every aspect of a person's ability to pay for long-term care
an annual independent review of care standards and costs
a review of benefits for the elderly, particularly those who are disabled
government to meet any shortfall between local and health authorities' resources and elderly people's needs.
Age Concern gives oral evidence to the Royal Commission on 24 September.

It has so far submitted nine papers to the commission, which is due to report its findings in December.

The politics of long-term care

UK Politics

The politics of long-term care

The report's plans could cost the state £800m

The government has yet to respond to the main recommendations of a major study into caring for the elderly.
Four months after the Royal Commission on Long-Term Care for the Elderly called for free nursing and personal care to be available for all, there is still silence from ministers.

The commission was set up by the government to look into the complex issue of who funds long-term care.

The motivation was concerns over Britain's ageing population.

Currently, the ratio of people of working age to people over 65 is 3.7 to one.

In the next 40 years that is likely to fall to two to one, meaning there is less tax money around for the government to fund long-term care.

Recommendations

The commission's key recommendations include:

That the costs of care for those individuals who need it should be split between living costs, housing costs and personal care
That personal care should be free and funded by general taxation
That elderly people should pay for housing and accommodation costs, but that payment should be subject to a means test
That the government should establish a National Care Commission to monitor trends in the nursing and residential care market, demography and spending, to represent elderly people, to encourage innovation, to ensure transparency and accountability in the system and to set national benchmarks for long-term care.
The commission also recommended that the value of a person's home should be disregarded for up to three months after admission to residential care.

It stated that quality of care needed to be improved so that it was more client-centred and that budgets should be shared between health, social services and other statutory bodies, but accessed by clients through a single point of contact.

The commission also made recommendations relating to carers and called for a national carer support package.

Selling homes

Under the current system, people who are in care homes run by the NHS are exempt from charges for nursing care, while those in other types of homes often have to contribute towards their care costs, based on means-testing.



The growing elderly population will need long-term care
People with between £10,000 and £16,000 in savings get some help from the state to pay for their care.

Those with under £10,000 get the maximum state support, but are still expected to use their savings to pay towards some of their care.

The commission recommends that level should be raised to £60,000.

Many elderly people have been forced to sell their homes to pay for long-term care.

Nursing organisations and charities campaigning for the elderly have long oppposed what they say is an arbitrary division between nursing and personal care.

The cost of funding the commission's proposals over funding personal care is thought to be about £220m a year.

Unveiling the commission's report in the House of Commons in March, Health Secretary Frank Dobson said the government would respond after an informed debate, but no formal response has yet been issued.

The Commons health select committee has criticised the government for its lack of response.

On Thursday, the government responded to the select committee's report on long-term care, saying it backed many of its findings.

However, it was once again silent over the committee's comments on the Long-Term Care Commission.

Charities have also been critical of the delay.

They have welcomed the commission's proposals, but some organisations are disappointed that it did not endorse concerns about a "demographic timebomb".

Paul Burstow elderly person

5 http://www.richimag.co.uk/hrioa/ elderly person living in a care home is likely to receive four times as many prescription items as a person living in their own home. As many as 1 in 5 admissions to hospital are linked to inappropriate drug therapy.
2.6 Particularly at risk are elderly people with dementia. Behaviour such as wandering, poor self-care, restlessness, impaired memory, depression without psychosis, uncooperativeness and agitation that is not dangerous, are common features of the disease. There are no medical reasons for prescribing antipsychotics in such cases. Managing challenging behaviour without trained staff is no excuse for reliance on chemical solutions. Until more trained staff are in post, there will continue to be calls for even more use of antipsychotic medication, to the detriment of the patients well-being.
2.7 In December 2001, following direction by the Labour Government, the National Institute of Clinical Excellence were set to issue guidance concerning the cost and clinical effectiveness of atypical antipsychotic medication for people with schizophrenia. This guidance has now been postponed until March 2002.1 Older people that do not suffer from schizophrenia have been left out. The National Service Framework for Older People and the National Minimum Standards published in March 2001 are steps in the right direction. But they will fail to deliver change for older people unless there is rigorous monitoring and enforcement, yet there are scant resources to do this. Furthermore, international evidence suggests annual reviews of prescribing to older people are inadequate, and that harm can be done to an older person in far less time than a year.
2.8 Successive studies have demonstrated the need for a step-change in the way medication is used in the care of the elderly. The chemical management of older people is a scandal. It denies older people their dignity, and robs them of a better quality of life. Pressure on care providers is not an excuse for inappropriate use of medication. GPs and care home managers should be jointly accountable for safeguarding the interests of the vulnerable elderly people in their care.
Recommendations
2.9 The Department of Health must commission urgent quantitative and qualitative research into the extent and reasons for the overuse of antipsychotic medication in different care settings.
2.10 The National Institute for Clinical Excellence must prepare and publish guidance on the use of antipsychotic drugs and non-drug alternatives in the care of older people. This would include the development of a model for drug list revisions in care homes, to automatically evaluate drug lists according to a quality indicator, and keep track of the drug lists and changes made to that list. The quality indicator should also serve as guidelines for prescribers.
2.11 Review the National Service Framework and National Minimum Standards for care homes to ensure that the standard on medication, (standard 9), provides for prescribing reviews at least every three months. All prescribing decisions must be clearly documented with the reasons for the use of the medication set out in full. By evaluating the Scottish

Long Term Carers

Flexible Working Practices for Long Term Carers
Speech by Paul Burstow MP delivered to Speech to the Sutton & Merton PCT Carers and Employment Conference, The Holiday Inn, Sutton on Thu 15th Jun 2006

Every minute of every day four new carers start caring.

It could happen to any one of us, overnight. Three in five of us will become carers at some point in our lives. For many caring responsibilities will come during their working lives. And that's the challenge.

Taking on caring responsibilities should not force the carer to give up work. Doing so can set in motion a chain of events that ends up with the carer suffering from poorer health and poorer wealth.

The research evidence is compelling: caring can have a serious effect on both the psychological and physiological health.

For many carers of working age the consequences of giving up work can be huge. Quite apart from the compelling social reasons for more flexible employment practices there is also a powerful economic case.

Our economy is estimated to need a further 2.5 million people in the workforce over the next eight years. Currently there are 3 million carers in employment, but there are 4 million of working age.

One in five people have given up work to care. Once a carer has given up work it is harder to get back into work. The longer they are out of the workforce the less likely they are ever to return and more likely to be dependent on income support.

That is why I co-sponsored and helped to pilot onto the statute book the Carers (Equal Opportunities) Act 2004 and before that the Carers and Disabled Children Act.

The Carer Act 2004 extended the rights of carers pacing new duties on local authorities to take account of carer's wishes to work or undertake training when undertaking a carers assessment. But that is only part of the picture. Flexible working practices are essential to retain carers in the workforce.

Flexible because one size does not fit all, carers need different levels of support at different times. Any thing from access to a phone to check on a person, to leaving and start times that fit around hospital appointments.

Without this flexibility the pressure and stress on the carers can become unbearable, making them ill, driving them from the workplace.

A loss to the business in terms of knowledge, experience and training.

A loss to the economy in taxes, extra benefit payments.

Research suggests that employers who introduce more flexible working benefit. For example, a 26 per cent reduction in stress related absences.

So we have the Carers (Equal Opportunities) Act promoting a positive duty on local Councils facilitating carers working. But what about employers? Currently before Parliament is another Bill shortly to become an Act, the Work and Families Bill.

Clause 12 of the Bill extends the right to request flexible working beyond the Employment Relations Act 1999. It does not mandate employers to concede this but it does require proper consideration.

Clause 12 amends the Employment Rights Act and provides a power to make regulations. The question is what the regulations will say and in particular how carers are defined. The Government has consulted on two definitions. First, is a narrow definition restricting the provisions of the Act to 'close relatives' such as husbands, wives, someone living with you, father, mother, son, daughter - including in laws. Second is a 'near relative' definition which includes everyone in the first definition but adds grandparents, brothers, sisters, aunts and uncles.

I think good relation must be simple to implement - that means it should be easily understood. It makes sense to use an established definition of carers. To opt for a narrower 'close relative' definition would draw an arbitrary distinction that would lead to confusion and resentment in the workplace. Why should someone caring for their grandparents or a brother or a sister be treated differently?

I hope that the Government responds positively to the consultation and gets the definition right.

This new right comes into effect from April 2007. There is already plenty of good practice out these: flexible starting and finishing times; compressed working hours; annualised working hours; job sharing or part-time working; homeworking; term-time working.

To conclude we all owe a huge debt to carers; their contribution as carers has been estimated at £57 billion a year. Without them our health and social services would be unable to cope. But words are not enough. Providing carers with the opportunity to work makes good business sense. I hope today's conference proves a useful catalyst to encourage employers and carers alike

Human rights law 'fails elderly'

Human rights law 'fails elderly'

Elderly people need better protection, the charity said
Human rights legislation is failing some vulnerable older people, according to charity Help the Aged.
The charity said gaps in the law left older people exposed to mistreatment which cannot be fully investigated or dealt with under the Human Rights Act.

It said that while statutory services were covered under the Act, the majority of care - which is contracted to the private sector - is not.

It urged the government to push forward with its planned equality bill.


The bill, included in the 2005 Queen's Speech, will establish a Commission for Equality and Human Rights, among other aims.

Champion needed

Help the Aged said such a body would have powers to champion older people's rights and could better protect them from abuse and neglect from carers.

The charity said the majority of older people's services - including more than 90% of care home places and nearly 70% of domiciliary care hours - are contracted out to the private sector, which is not covered under the Act.

In a report titled Rights at Risk - Older People and Human Rights, it said "thousands of older people [were given]... little protection in law if abuse takes place".

The charity identified "institutional cultures" which breach human rights and cites major delays in providing essential services, and limited services with little choice.

'Revulsion and anger'

Lack of hygiene, the use of inappropriate restraints, both chemical and physical, and restricted access to food and water have been reported to it as existing in some health and care settings.

Senior policy advisor Tessa Harding: "High-profile and widely publicised cases of elder abuse and neglect rightly provoke revulsion and anger.

"Unless strong new laws are introduced to give older people specific protection against breaches in their human rights, the sorts of cases seen [recently] will continue to be treated only as a matter of poor standards."

She said a commission was needed to "deliver firm, clear messages about older people's human rights to all providers of health and care services".

Care home residents 'drugged and tagged'

Care home residents 'drugged and tagged'


Severe staff shortages face many care homes

Care home residents are being subjected to widespread abuse because they fall outside mainstream society, a charity for older people has claimed.
Counsel and Care said some nursing staff admitted "indiscriminate" use of electronic tags to restrain elderly people against their will, and the use of sedative drugs to control "troublesome" residents.

Alison Clarke, co-author of the report Showing Restraint, told BBC News Online such treatment would not be tolerated for any other social group.

Counsel and Care has demanded new rules to govern the management of care homes and league tables to "name and shame" those mistreating residents.

Underpaid

According to the report the line between restraint and abuse is constantly crossed by overworked and underpaid nursing staff.



In some areas, if a big supermarket opens, half the staff disappear because they can get better pay

Alison Clarke
During a series of more than 50 seminars with care home workers, Counsel and Care also heard of residents being deprived of walking frames and rails placed around their beds to control movement.

Ms Clarke said: "You could say that putting someone in a bed with cot sides so they can't get out is assault, it's imprisoning them.

"It would be considered assault if it was done to you or me, but if it's done to an 80-year-old with dementia it's considered ordinary."

Staff shortages

Ms Clarke said some 500,000 elderly Britons live in care homes, but there are currently no national guidelines enforcing a minimum standard of care.



Substituting chemical management for good care denies older people their dignity

Paul Burstow
Lib Dem MP
Counsel and Care hopes that will change when a new National Care Standards Commission to regulate the industry begins work in April.

It said staff shortages are one of the biggest causes of the misuse of restraint, and called for better training and pay for care home staff.

Ms Clarke said: "There's a real problem in some areas with staff shortages. It's seen as a low status occupation, but it's very hard work and pay is often very low.

"In some areas, if a big supermarket opens, half the staff disappear because they can get better pay."

Calling for league tables showing the number of restraints used, the charity said similar close monitoring of homes in the US had led to better care for residents.

'Unacceptable'

The findings of the report were backed by the charity Action on Elder Abuse, which estimates that one in 20 older people are abused - many of them in care homes.

Its chairman, Peter Westland, said: "We are concerned about the level of denial that such abuse exists. The time has come for people to acknowledge the existence of this serious issue."

Liberal Democrat spokesman for older people, Paul Burstow, said the methods of restraint discovered were "unacceptable."

He said: "The over-medication of older people is a scandal. Substituting chemical management for good care denies older people their dignity."

Mr Burstow said the public needed reliable information about the quality of care in care homes.

The Counsel and Care report is published in the Nursing Times.

Thousands of old people 'drugged'

Thousands of old people 'drugged'


The Lib Dems want tighter checks on care homes
More than 22,000 elderly people in nursing homes are being given powerful sedatives for no medical reason, it has been claimed.
A report by the Liberal Democrats suggests residents who do not need these drugs are being kept sedated to make life easier for staff.

Its health spokesman Paul Burstow said the situation may be even worse in residential homes.

"Quite simply the over medication of older people is abuse," he said.

The report's figures are based on a review of British and international studies in this area and information released to parliament.

Under sedation

It is the Lib Dems' second report on the issue. According to Keep Taking the Medicine 2, up to 22,233 elderly nursing home residents are being given powerful anti-psychotics without medical grounds.

It suggests that another 32,000 elderly people in residential homes may also be at risk.

I find these figures very surprising

Spokeswoman,
National Care Homes Association
The report points to an increase in community prescriptions for antipsychotic drugs - up 6.2% between 1999 and 2002, an increase of 129,000 prescriptions.

It also shows that two out of three GP practices have missed a government target to introduce six-month reviews of medication for all over 75s. These reviews were supposed to have been up and running since April.

Mr Burstow called for tougher action to tackle the problem. He wants tighter checks on care homes and a new criminal offence of neglect of a vulnerable adult.

"Despite mounting evidence that older people are the victims of a chemical cosh in care homes, minister's have failed to get a grip on the problem.

"With serious shortages of specialist staff and little chance of attracting more, the evidence is that care homes are turning to chemical cocktails to make residents easier to manage," he said.

"It can result in death and it denies older people their dignity."

'Homes checked'

The Department of Health said care homes were required to keep "meticulous" drug records on every resident.

"If an inspector from the National Care Standards Commission finds evidence of over-prescription or maladministration of drugs, they have a duty to report such evidence to the police and the professional bodies of those involved for further action," a spokeswoman said.

"We are aware of concerns about the overuse of antipsychotics for older people, particularly those in care homes.

"Since March 2001, as part of the National Service Framework for older people, doctors, pharmacists and other health care professionals have been implementing a medicines management programme where medication is regularly reviewed to ensure that people receive the right medication."

However, the National Care Homes Association dismissed the claims.

"I find these figures very surprising," a spokeswoman told BBC News Online.

"Care homes don't prescribe drugs. Doctors prescribe drugs. If the Lib Dems are saying these drugs are being prescribed for no clinical reason and just to make the life of care home staff easier then it is doctors that need to be called to account."

Human rights law 'fails elderly'

Human rights law 'fails elderly'

Elderly people need better protection, the charity said
Human rights legislation is failing some vulnerable older people, according to charity Help the Aged.
The charity said gaps in the law left older people exposed to mistreatment which cannot be fully investigated or dealt with under the Human Rights Act.

It said that while statutory services were covered under the Act, the majority of care - which is contracted to the private sector - is not.

It urged the government to push forward with its planned equality bill.


The bill, included in the 2005 Queen's Speech, will establish a Commission for Equality and Human Rights, among other aims.

Champion needed

Help the Aged said such a body would have powers to champion older people's rights and could better protect them from abuse and neglect from carers.

The charity said the majority of older people's services - including more than 90% of care home places and nearly 70% of domiciliary care hours - are contracted out to the private sector, which is not covered under the Act.

In a report titled Rights at Risk - Older People and Human Rights, it said "thousands of older people [were given]... little protection in law if abuse takes place".

The charity identified "institutional cultures" which breach human rights and cites major delays in providing essential services, and limited services with little choice.

'Revulsion and anger'

Lack of hygiene, the use of inappropriate restraints, both chemical and physical, and restricted access to food and water have been reported to it as existing in some health and care settings.

Senior policy advisor Tessa Harding: "High-profile and widely publicised cases of elder abuse and neglect rightly provoke revulsion and anger.

"Unless strong new laws are introduced to give older people specific protection against breaches in their human rights, the sorts of cases seen [recently] will continue to be treated only as a matter of poor standards."

She said a commission was needed to "deliver firm, clear messages about older people's human rights to all providers of health and care services".

Why care home drug errors happen

Why care home drug errors happen

By Hannah Goff
BBC News health reporter


When inspectors said thousands of care home residents were being given the wrong medication - the image of a grotty, poorly run nursing home reared its stereotypical head.
How could something so simple as giving a patient their daily dose of tablets be going so wrong, so many times over?


There is concern about over-use of sedatives on elderly patients

But according to care professionals, management of residents' medication is one of the most complex areas of running a nursing home.

And unless fail-safe practices are adhered to, the results can be very damaging to both the resident and the care worker.


Adrian Webb, who runs a specialist mental health unit for elderly mentally ill people in central Manchester, says the main problem is that there are so many people in the chain.

An ordinary patient would take their GPs' prescription to the pharmacist and then, presumably, take the medication in the advised dose.

Each stage of the process there is potential for error.

Adrian Webb

In the case of a care or nursing home resident, there are so many more people inputting into the system.

The prescription might be written by a GP or consultant.

The pharmacist then has to make it up, then it will go to the staff in the home for storage and then a number of different people may be involved in the issuing the medication to patients.

Mr Webb, who is a registered nurse and oversees the distribution of drugs in the Victoria Park Nursing Home, says: "At each stage of the process there is potential for error.

"It has been known for prescriptions to come from doctors that are incorrect.

"But it's very easy for someone to type 100 instead of 10, for example."

Spotting errors

In the Victoria Park Nursing Home, which he runs with his wife, he checks every prescription that arrives from the doctor and pharmacist for errors.

And because he is a registered nurse, he has some knowledge of the kind of doses that ought to be expected and the drugs that are used.

He recalls one instance of receiving a batch of drugs which came from the pharmacist in the wrong dose.

The only way he knew it was incorrect was because he happened to know the higher dose pills were a different colour.

Here, it was his nursing experience which allowed him to spot the error.

But in a care home, where the administering of medicine is not carried out by a nurse, it is questionable whether a mistake such as that would have been noticed.

'Do not disturb'

"If you have not trained as a nurse are you really going to have the confidence to challenge the doctor or pharmacist about his prescription?," asks Mr Webb.

He also says the fact that a nurse could potentially lose his or her job over a medication error tends to focus the mind.

But Laura, a care assistant in the North West, who has worked in three homes for the elderly and one for people with learning disabilities over the past four years, says medication issues are taken extremely seriously indeed.

She said she spent the majority of her breaks drinking her coffee in front of a poster detailing what to do if a drug error occurs.

There are sheets for everybody coming into the home whether they are there for long or short term care and careful records of what medication is distributed, she says.

"The team leader is responsible for handing out the medication.

"There's a sign on the trolleys saying do not disturb while giving out medication and they are not disturbed," she said.

It's using the so-called chemical cosh instead of more skilled techniques to look after someone

Clive Evers
Alzheimer's Society

As in Mr Webb's nursing home, Miss Bates says the person giving out medication is focussed on that job and is not allowed to run off and answer a phone, for example.

But director of information at the Alzheimer's Society, Clive Evers argues the high turnover of staff and their limited training can been the odds are stacked against good practice.

"The workforce is very under-resourced and under-recognised. There is very limited training of staff.

"This is a workforce that would not be allowed to operate with children but they are allowed to work with adults in this way."

With up to 70% of people in care homes suffering from some form dementia, one might expect staff to have training in how to deal with their symptoms.


Care staff say drugs are closely monitored

But guidelines have only recently been adopted by the watchdog, the Commission for Social Care Inspection.

One of the other key worries in care homes is the over-use of anti-psychotic drugs and sedatives.

Over-medication is something that Mr Webb fights against in his nursing home for elderly patients with challenging behaviour.

Patients can take months to get over the heavy sedatives they are given during a visit to hospital, he says.

Good working relationships with GPs and consultants however allows his staff a certain level of control over what the patient is given.

"We give the minimum amount that is needed and it is reviewed regularly.

"We favour as little medication as possible to allow people to be themselves. The more medication people are on - the more problems they have."

But according to Mr Evers, not all homes have even this limited control over what their residents are prescribed.

"Neuroleptics (drugs) are used to limit behaviour that the care workers are not trained to deal with.

"It's using the so-called chemical cosh instead of more skilled techniques to look after someone. And unfortunately we know that this is still happening."

victims of drug errors,

There are more than 20,000 care homes in the UK
Elderly people living in care homes are being put at risk because of sub-standard systems for handing out medicine, according to a report.

University of London researchers found seven in 10 residents were victims of drug errors, having carried out half-day snapshot inspections of 55 homes.

They blamed inadequate information, over-worked staff, poor teamwork and often complex courses of medication.

The government said a review was focusing on medication "weaknesses".

Nurses are part of some of the workforces in specialist units caring for people with severe problems, such as late stage dementia.

This is just one of the many flaws in the current care system which can have a huge impact on the quality of life for many older people

Andrew Harrop, of Age Concern and Help the Aged
But the majority of teams working in more than 20,000 care homes across the UK do not include people with clinical training.

Instead, they rely on pharmacists and GPs signing-off repeat prescription requests without any or little face-to-face contact with residents.

The report, published in the journal Quality and Safety in Health Care, said the system meant vulnerable residents were put at risk.

During the inspections, which took place in the mornings when two-thirds of the daily drug courses would be taken, researchers gathered data on 256 residents.

In total, mistakes were made in 178 cases with many the victims of more than one error.

The most common mistakes involved wrong dosages, insufficient monitoring of residents after medication had been taken and people being given the drug at the wrong time.

But rather than blaming the care home staff, the researchers said they were often not given enough training or information about handing out medication.

The report said part of the problem was that care home residents were increasingly being given complex courses of medication - each resident was taking eight different pills on average a day.

Lead researcher Professor Nick Barber said: "It is a cause for concern. Residents are usually taking a cocktail of medicines and are more susceptible to drug side-effects as a consequences of ageing.

"I think care homes need more help. Pharmacists and GPs should be taking more responsibility and visiting care homes more than they do."

Consequences

The researchers also collated information on the consequences of the mistakes.

Most were only minor, although one resident did suffer a thyroid complication.

Sheila Scott, of the National Care Association, agreed care homes needed help.

"Mistakes are always indefensible, but this is a problem we keep hearing about," she said.

"We need to face this challenge and find a solution. Staff working in care homes are not medically trained and yet they are being asked to look after people with more and more complex needs."

Andrew Harrop, of the newly merged Age Concern and Help the Aged charity, said the findings were "shocking".

"This is just one of the many flaws in the current care system which can have a huge impact on the quality of life for many older people."

The Department of Health said the government was aware of the issue and was now working with the regulator, the Care Quality Commission, which was carrying out a review of healthcare in care homes.

A spokeswoman added: "The review will take into account the findings of the research and will focus on strengthening weaknesses in the systems involving medication."

carehome cons

Charities warn of care home costs

Like most western countries, the UK has an ageing population

Charities say families with elderly relatives in local authority care homes in England are struggling to meet demands for top-up fees.

Age Concern and Help the Aged say councils are paying about £60 a week less than it takes to provide services, forcing families to meet the shortfall.
Care Services Minister Phil Hope told the BBC the situation was "distressing" and "shouldn't be happening".
But the Local Government Association said Westminster must increase funding.
'No limitless pot'
Age Concern and Help the Aged said some relatives were being asked to contribute several hundred pounds a month in top-up care fees.
"As local authority budgets come under tighter pressure, it's definitely something we anticipate getting worse unless government ministers get together with local authority leaders and thrash something out here," spokesman Patrick South told the BBC.
One relative, Jean Cutts, told the BBC about her struggle to pay nearly £300 a month for her 97-year-old mother's council-run home.
"It's hit us critically," she said. "Whatever money comes into the bank is drained out every month."

We have to radically change our system of care for the future Care Services Minister Phil Hope

The National Care Association, which represents care homes, said they were being asked to provide a far greater range of services because people with complex medical needs who would previously have been cared for in hospital were now looked after in the community.
And David Rogers, from the Local Government Association, said that this wider remit, combined with an ageing population, presented a huge challenge for councils who did not have a "limitless pot of money".
'National care service'
Mr Hope said half a billion pounds extra had been allocated to fund care and it was "up to local authorities to make sure that they meet the assessed care needs that an individual has".
However, he did acknowledge that "we have to radically change our system of care for the future".
To do this, he said, the government was proposing a national care service "where everybody no matter what their income will get some help with their care and support".
The top-up fees row comes as Health Secretary Andy Burnham is set to speak about the healthcare "timebomb" facing Britain's ageing population.
In a speech on Friday, he will say that the current system is "creaking at the seams and can't cope", and will call on public and health professionals to give their opinions on how it should be reformed.
The Department of Health has launched a public consultation exercise - the Big Care Debate - to get people's views on how care and support should be funded and provided in the future.
Care Services Minister Phil Hope said: "Local councils make decisions to best meet the needs of people living in their area.
"To help them do this, we have increased investment in local council services by 39% cent since 1997 and this will rise to 45% by 2010-11.
"We have also put £520 million into making services more tailored to individuals needs.
"More of us are living longer - life expectancy is going up and advances in medical science mean that people with a disability are living longer.
"This is worth celebrating but does mean we need to radically change the way care is provided and paid for.
"We need a system that is fair, simple and affordable for everyone and gives excellent care wherever we live and whatever our needs."

to brighten up my day

Bored and Lonely

Should I take a lover,should I have a fling,

should I get a toy boy, and all that this will bring.

I do need some excitement to brighten up my day

someone who will love me the good old-fashioned way,

someone I can lean on in times of stress

who will be complimentary when I get undressed

who'll tell me I'm a woman and handle me with care

buy me gifts and flowers and when I need him he'll be there.

I don't think I will bother

I think it's been too long

I think I've lost the art of love,I might do something wrong,

I couldn't face the embarasment of knowing where to look, so when I go to bed tonight

I think I'll take a book.

Janet Khan 2003