Wednesday 5 June 2013

'New law needed' after collapse of care home neglect case

'New law needed' after collapse of care home neglect case

A silhouette image of a woman passing a cup of tea to an elderly lady.Just 170 prosecutions for wilful neglect of the elderly were brought last year.

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The collapse of Britain's biggest investigation into elderly care home neglect has prompted calls for a reform of the law.
Former care minister, Paul Burstow wants a new offence of corporate neglect to make it easier to hold those running bad care homes to account.
He is to table an amendment to the government's Care Bill which is currently going through parliament.
Care Minister Norman Lamb says he is considering the issue.
Mr Burstow - who stepped down in last September's reshuffle - said he was determined to ensure the government created the new law following the end of Operation Jasmine.

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Paul Burstow
We need companies that provide care to realise it's not just about their profits. It's ultimately about the dignity of the people they are looking after”
Paul BurstowMP
Police launched the operation seven-and-a-half years ago following concerns over the death of more than 60 care home residents in six homes in Wales. The investigation by Gwent Police cost £11.6 million and amassed more than 12 tonnes of evidence.
Among the alleged victims were elderly people who became severely malnourished or dehydrated, or who died because of infected pressure sores.
But despite exhaustive inquiries, the CPS said there was not enough evidence to charge key figures - including one of the care home owners Dr Prana Das - with gross negligence manslaughter or wilful neglect.
Later attempts to bring the care home boss to trial for lesser charges under health and safety legislation failed in March when he was deemed unfit to stand trial after suffering head injuries in a burglary.
Mr Burstow said that under the current legal framework often the only option left open to police was to try to prosecute individual carers with wilful neglect. He argues that a new law should be introduced to make it easier for police to hold owners to account instead.
He said: "We need a new criminal offence of corporate neglect which should take its lesson from the legislation on corporate manslaughter.
"We also need companies that provide care to realise it's not just about their profits, but it's ultimately about the dignity of the people they are looking after."

Find out more

An elderly lady's hand on a walking stick.
Listen to the full report on File on 4 on BBC Radio 4 on Tuesday, 4 June at 20:00 BST and Sunday, 9 June at 17:00 BST.
The call is being backed by Labour MP for Blaenau Gwent, Nick Smith who recently challenged David Cameron to ensure the law in this area was fit-for-purpose.
The BBC asked care minister Norman Lamb whether he would consider creating a law of corporate neglect.
In a statement, Mr Lamb said he was considering the issue - but stopped short of agreeing to a change in the criminal law.
"When I first took on this job in September, I identified a clear gap in the regulatory framework - one which I'm determined will be addressed.
"This summer, we will announce proposals to address the gap in the law on effective corporate accountability," he said.
Figures seen by Radio 4's File on 4 programme show that while English social services investigated more than 25,000 allegations of elderly neglect last year, just 170 criminal prosecutions for neglect were brought before the courts.
The Care Bill had its second reading in the House of Lords in May.
Listen to the full report on File on 4 on BBC Radio 4 on Tuesday, 4 June at 20:00 GMT and Sunday, 9 June at 17:00 BST. Listen again via the Radio 4 website or the File on 4 download.

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Saturday 1 June 2013

Monitoring the use of the Mental Capacity Act Deprivation of Liberty Safeguards in 2011/12

Monitoring the use of the Mental
Capacity Act Deprivation of
Liberty Safeguards in 2011/12


Purpose of the Safeguards
The Safeguards came into effect in 2009. They are part of a legal
framework set out in the Mental Capacity Act 2005 (MCA). The MCA
is a very important mechanism for protecting the rights of people who
do not have the ability (mental capacity) to make certain decisions for
themselves. It provides guidance to people who need to make decisions
on behalf of someone else. It sets out the principles that should guide
such decisions, including the need to act in the person’s best interests
and to achieve the desired outcome in ways that put the least restriction
on the person’s rights and freedom of action.
The Mental Capacity Act is primarily concerned with people who have
mental disabilities. The Safeguards are particularly relevant for those with
severe learning disabilities, dementia, or people who have brain injuries.
The Mental Health Act focuses on people who have mental illnesses. In
practice, the same person may be covered by both Acts, depending on
individual circumstances.
The reason the Safeguards were introduced was to address the problem
that arises if a person does not have the mental capacity to make an
informed decision about care or treatment. This problem was brought
to light in the late 1990s by the case of Mr L and became known as
‘the Bournewood Gap’. 1The reason the Safeguards were introduced
The case of Mr L
Mr L was profoundly mentally disabled and
unable to consent to medical treatment.
He was admitted to hospital by a psychiatrist
without the use of the Mental Health Act, as he
was thought to be fully in agreement with this
course of action.
His carers challenged this admission because of the
restrictions on his liberty that were applied to him
once in hospital and because Mr L did not have the
capacity to disagree with the restrictions. The reality
was that he was not free to leave.
The case went to the European Court of Human
Rights, which agreed that Mr L had been deprived
of his liberty within the meaning of Article 5 of the
European Convention on Human Rights.2
The ‘gap’ that was identified was in the lack of
safeguards for the admission and detention of people
who appeared to agree but in fact lacked the capacity
to consent or disagree.
There were no stated grounds for such action, no
statement of purpose, no limits of time or treatment
and no requirement for continuing clinical assessment.
It was this gap that the Deprivation of Liberty
Safeguards were designed to address.
1 HL v United Kingdom (2005) 40 EHRR 761
2 Article 5(1) Everyone has the right to liberty and security of person. No one shall be deprived of his liberty save in the following cases and in accordance with a
procedure prescribed by law:… (e) the lawful detention… of persons of unsound mind.
4 Monitoring the use of the Mental Capacity Act Deprivation of Liberty Safeguards in 2011/12
There have been high profile failures in health and social care, which
include deprivation of liberty. The Winterbourne View Serious Case Review
highlighted the unlawful nature of restrictions imposed on people with
learning disabilities in that service. It found that individual patient records
gave rise to concerns because they did not accurately reflect the person’s
legal status under the Mental Health Act (MHA); nor did they give any
indication as to whether the Safeguards had been considered.3
The decisions of the courts continue to develop mental capacity law, the
meaning of ‘deprivation of liberty’ and practice. The health and social care
system is currently changing. NHS primary care trusts will be abolished
in April 2013, when local authorities will assume responsibilities as
supervisory bodies for hospitals as well as for care homes.
How the Safeguards work in practice
The Safeguards must be considered in care homes and hospitals when the
restrictions on a person’s freedom, imposed in their best interests, may
mean that they are deprived of their liberty. In addition to protecting the
person’s rights, the Safeguards can provide reassurance to staff that they
are acting appropriately within the framework of the MCA, in a way that is
proportionate to the risk of harm to the person. The following
two examples illustrate this point.
Case study
Mrs A, care home resident
Mrs A has severe dementia and lives in a care
home. She makes persistent and purposeful
attempts to leave the home.
Staff are concerned for her safety if she was to leave,
but also concerned not to restrict her rights and
freedom any more than the minimum necessary for
her safety.
The care home (managing authority) decides to ask
the local social services authority (supervisory body)
to consider whether Mrs A should be ‘detained’
in the care home under the Deprivation of Liberty
Safeguards.
The local authority carries out a series of independent
assessments (looking at the person’s best interests
and medical needs and including the person’s family)
and notes that Mrs A’s medication is not being
administered correctly – which could be exacerbating
her anxiety.
The assessor recommends that the GP should review
the medication and look into an alternative medication
plan. The local authority agrees to authorise
deprivation of Mrs A’s liberty for a short period to
allow time for these aspects of the care plan to
be changed.

Monday 27 May 2013

Coffee addiction: Do people consume too much caffeine?

Coffee addiction: Do people consume too much caffeine?


Tea, coffee beans, energy drink, espresso maker, cans of energy drinks, coffee
US officials are investigating the safety of caffeine in snacks and energy drinks, worried about the "cumulative impact" of the stimulant - which is added to a growing number of products. Is our tea and coffee-fuelled society too dependent on the world's favourite drug?
The bubbling kettle, the aroma from the mug, the first bitter mouthful of the morning.
It's a ritual without which the working day would be, for millions of people, frankly horrifying.
Caffeine is, according to New Scientist, the planet's most popular "psychoactive drug." In the United States alone, more than 90% of adults are estimated to use it every day.
But now even the US - home of Coca-Cola, Starbucks and the 5-Hour Energy shot - is questioning the wisdom of adding it to everyday foodstuffs like waffles, sunflower seeds, trail mix and jelly beans.
In a statement, the Food and Drug Administration (FDA) highlighted the "unfortunate example" of Wrigley chewing gum producing packs of eight sticks which each contained as much caffeine as half a cup of coffee. Subsequently, Wrigley said it would "pause" production of the product.

How healthy is your coffee?

Coffee beans
"On the plus side, coffee is known to be packed full of antioxidants, which stop other molecules oxidising and producing free radicals.
"Women who drink two or more cups of coffee a day are less likely to get depressed, other research suggests.
"However previous studies have linked high caffeine intake to raised cholesterol and short-term high blood pressure."
The agency is also looking at highly-caffeinated energy drinks, and said it was concerned about the "cumulative impact" of adding stimulants to products.
According to the US Substance Abuse and Mental Health Services Administration, the number of people seeking emergency treatment after ingesting energy drinks doubled to more than 20,000 in 2011.
However, the energy drink industry says its products are safe and insists there is no proof of a link with any harmful reactions.
There have been documented cases of fatal overdoses caused by "caffeine toxicity", though these are very rare. Scientists at Johns Hopkins University, studying its addictive properties, found that withdrawal symptoms included tiredness, headaches, difficulty concentrating, muscle pain and nausea.
But there is far from any kind of scientific consensus that caffeine use is harmful. A recent study by the Harvard School of Public Health suggested that "coffee drinking doesn't have any serious detrimental health effects" and that drinking up to six cups a day was "not associated with increased risk of death from any cause".
In moderation, caffeine may have some positive effects. Research suggests it could be associated with a reduced risk of prostate cancer and breast cancer. A recent study linked drinking coffee and tea with a lower risk of type two diabetes.
As a result, the FDA has pledged to "determine what is a safe level" of caffeine use.
The agency's move has been welcomed by those who fear caffeine is already encroaching too much into our daily lives - often in products where it may not be expected.
"Many people just aren't aware of how much caffeine they are taking," says Lynn Goldman, dean of the George Washington University School of Public Health and Health Services.
As a result, she says, they could unwittingly create problems for themselves with insomnia, indigestion, or their blood pressure.
It's especially worrying for parents, who can find it hard to regulate their children's intake.
BeverageCaffeine (mg)Quantity
Coffee
77-150
6oz/170g
Tea
40-80
5oz/142g
Coca-Cola
34.5
12oz/340g
Pepsi
38
12oz/340g
Red Bull
80
8.3oz/235g
But challenging the hegemony of caffeine may be a difficult task on a planet that consumes 120,000 tonnes of the substance per annum.
In Finland, the world's most caffeinated country, the average adult consumes 400mg of the drug every day - equivalent to four or five cups of coffee a day, and equal to the maximum daily limit recommended by the UK Food Standards Agency.
"We think that, when used in moderation, caffeine doesn't pose a risk," says Sanna Kiuru, a senior officer at Evira, the Finnish food safety authority. "It's mainly adults who drink coffee, not children. For us the levels are quite moderate."
Even buzz-loving Finns have been troubled by the rise of stealth stimulants, however.
"We have been concerned about the rise in caffeine in different foods," says Kiuru. Highly-caffeinated energy drinks in Finland are obliged to carry warning labels - a practice that will be extended across the EU from 2014.
For most caffeine consumers, its chief benefit is that, by stimulating alertness, it helps you get more done.
This is a trait that makes it unusual among recreational substances, says Stephen Braun, author of Buzz: The Science and Lore of Alcohol and Caffeine.
Coffee-drinkers chart
"Its appeal is that it helps us earn more money," he adds.
"What makes it different from other drugs is that it's used as a productivity tool - not for pleasure, like cannabis, or as a relaxant, like alcohol."
Perhaps the closest analogy is with coca leaves, chewed by labourers to give them extra energy in countries like Peru and Bolivia.
It's no coincidence, Braun believes, that caffeine's popularity boomed in Europe at the dawn of the industrial revolution, when the race for ever-increased productivity accelerated.
Many of history's creative minds have also been associated with some truly epic feats of caffeine consumption.
According to one biographer, the French novelist and playwright Balzac drank as many as 50 cups of coffee a day. "Were it not for coffee one could not write, which is to say one could not live," he once insisted.
For seven years, the film-maker David Lynch ate at the same Los Angeles diner every day, drinking up to seven sweetened cups of coffee "with lots of sugar" in one sitting, which he said would guarantee that"lots of ideas" arrived.
Ludwig van Beethoven was said to have painstakingly counted out exactly 60 coffee beans per cup when he brewed coffee.
Perhaps the most well-publicised recent tales of caffeine excess featured the somewhat less critically revered singer Robbie Williams, whoreportedly consumed 36 double espressos and 20 cans of Red Bull a day.
It is the routine task itself, as much as the stimulant properties of caffeine, that makes the process so significant, Mason Currey, author of Daily Rituals: How Artists Work.
"A lot of artists use the process of making the coffee as a gateway to the creative process," he adds.
"You need to get into the right mindset to do that sort of work, and the preparation ritual provides a focus."
Cup of teaDoes the very ritual of preparing caffeinated drinks help minds focus?
But attempts to clamp down on the spread of the substance have historically proved futile.
In 1911, the US government sued the Coca-Cola Company, on the basis that the caffeine in its drink was "injurious to health", but Coca-Cola prevailed in the courts.
One problem with attempting to regulate the substance, says Braun, is that it affects everyone in differently - people's varying physiologies and metabolisms making it impossible to prescribe a "safe" limit that works for everyone.
"Ultimately, you have to become your own scientist - there isn't an alternative to careful self-experimentation," he says.
Most people are likely to have ascertained by adulthood how much, or little, tea or coffee they can tolerate at a time.
But critics say this doesn't apply to energy drinks and caffeinated foodstuffs, whose effects are arguably more difficult to judge.
However profitable these products may prove for their manufacturers though, Currey suspects they well never acquire the mystique of coffee and tea.
"There's something that's not quite as special and evocative about them," he says.
"Buying an 5-Hour Energy drink from the 7-Eleven [convenience store] doesn't have the ambience of brewing a cup of coffee. I can't imagine future biographers of great artists and writers describing this stuff in the same way."
Additional reporting by Mark Bosworth in Helsinki

Thursday 16 May 2013

A&E must change or face collapse, NHS warned


A&E must change or face collapse, NHS warned


Patients waiting to see a doctorPressures have been growing on A&E units for a number of years

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Urgent changes must be made to the way A&E units are run - or the system could collapse, doctors and managers say.
Both the College of Emergency Medicine and Foundation Trust Network have put forward proposals to overhaul the system.
Funding and staffing have been highlighted as key issues.
Health Secretary Jeremy Hunt said it was "very tough out there" and ministers would deal with it by "better joining up" health and social care.
The warnings come as fears grow over whether the NHS can continue to cope with rising demand.

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Warnings don't come more serious than this”
Shadow health secretary Andy Burnham
Last week both ministers and the NHS regulator admitted the problems were a cause for concern.
A&E attendances have risen by 50% in a decade and this winter the NHS in England started missing its four-hour waiting time target.
Pressures have been noted in other parts of the UK too.
The review by the College of Emergency Medicine - based on feedback from more than half the A&E units in the UK - said the scale of the challenge was the biggest for a decade.
It said there were shortages in both middle-grade and senior doctors. As well as highlighting the workforce problem, the college also said more needed to be done to reduce unnecessary attendances.
It believes between 15% and 30% of patients do not need A&E care and instead could be treated in non-emergency settings.
Meanwhile, the Foundation Trust Network (FTN) highlighted the funding system in England which penalises A&E units seeing a rise in patients.
Funding concerns
Under rules designed to encourage the system to reduce A&E admissions, hospitals are only paid 30% of the normal fee for an emergency admission when the numbers rise above the levels that were seen in 2008-9.
But with the NHS failing to curb the rise in patients, that is costing some hospitals millions of pounds a year.
FTN chief executive Chris Hopson said: "Unless we can change the funding structure, the A&E system is going to fall over. We simply cannot carry on."

Why are A&E units getting busier?
Across the NHS more patients are being seen, but the upward trend is perhaps the greatest in A&E.
It is often said that the lack of out-of-hours GP care is the cause of rising demands on A&E.
That is certainly true. Since 2004 GPs have been able to opt out of providing night and weekend cover, leaving it to agencies to provide care.
A lack of confidence in the service has meant patients have to turn to A&E when they have not always needed emergency care.
This has been further compounded in recent months with the roll-out of the new 111 non-emergency phone line. Hospitals have reported rises in patients either because they cannot get through to 111 or have got poor advice and been told to go to their local A&E for trivial reasons.
But this does not tell the full story. The ageing population means there has been a rise in long-term conditions - about £7 in every £10 spent goes on patients with problems such as dementia and heart disease for which there is no cure.
When services are working properly in the community these patients can keep their conditions under control. But when that system fails - as it does too often - they can have crises and inevitably they end up at A&E.
He said the last winter was "very, very difficult" although with the weather now improving there were signs the system was stabilising.
But he added: "Unless we can make some really significant changes over the next six months I think it's pretty clear the system is in danger of falling over next winter."
NHS England has already agreed to plough some of the money it saves through these rules back into the system to support the most troubled A&E units in the short-term.
It has also ordered a review of emergency and urgent care, led by medical director Sir Bruce Keogh. The findings are expected to be published soon.
Shadow health secretary Andy Burnham said: "Warnings don't come any more serious than this.

Jeremy Hunt: "It's too difficult to access out of hours care"
"Too many hospitals around England are sailing dangerously close to the wind, operating way beyond safe bed occupancy levels."
He told BBC Radio 5 live the situation could be improved by "the full integration of health and social care - a national health and care service, if you like".
"As people get older, we've got to support them in their homes so they don't end up in hospital," he added.
"But we've also got to deal with the here and now and we can't have people waiting on trolleys in corridors and being treated in the back of ambulances.
"The government has got to get a grip on the situation and it's got to do it now."
Health Secretary Jeremy Hunt, meanwhile, told 5 live: "I've visited many, many A&E departments and staff are working extremely hard, you can see the lines on their eyes, people are very tired, they're obviously working hard, 24/7, and it's incredibly impressive what they're doing."
He said that, since the government came into power, the number of people using A&E had gone up by a million a year.
"There is that pressure and we have to do something about it," he said.
He admitted there was "a lack of joined-up thinking between health and social care system which we're sorting out".
He cited a care bill, set out in the Queen's Speech, which will introduce a cap on the cost of social care and give carers the legal right to support from their local council.
"That's also a very big problem because what you're finding in a typical hospital is maybe 100 beds are full of people who actually don't need to be in hospital but the doctors aren't able to discharge them into the social care system."
He said the government was putting £7.2bn into the social care system "to protect it against cuts".

A&Es under pressure

Figures for week ending 7 April 2013, to reflect period of higher demand during colder weather.
TrustA&E units% Patients seen in under 4 hours (target: 95%)
SOURCE: DEPARTMENT OF HEALTH

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