Monthly Archives: June 2017

Death, dosh and what the CQC knew

Posted on by
3

L1028442

An update to this post.

The CQC knew.

The ‘incident’ referred to here involves a man diagnosed with autism and epilepsy who drowned unsupervised in the bath in April 2016. He drowned. Alone, unsupervised in a bath.

cqc
The CQC re-inspected the ‘home’, found various failings and referred to Elric Eiffert’s death as an ‘incident’. They found inadequate, or no, risk assessments around epilepsy:
cqc1

They took no formal action despite identifying risks to life that ended in death.

Instead asking the provider to:

send us a report that says what action they are going to take.

Send us a report…

The CQC knew.

At the same time they knew LB drowned in a hospital bath three years before. A death that should have been, by then, high profile enough to make any provider or NHS Trust pay close attention to bathing risks for [‘”vulnerable”‘] people diagnosed with epilepsy.

The CQC knew.

At the same time they were conducting an investigation into the way in which NHS Trusts respond to unexpected deaths. The irony. The wanton, careless, unjoining of dots that demand to be joined. That scream to be joined. How much money is wasted on this shite? While people continue to lead impoverished lives or worse?

The CQC knew.

Today #7daysofaction launched a campaign focusing on the profit made from the incarceration of learning disabled people in assessment and treatment units.

Dosh or death. Death and dosh.

The CQC knew someone had drowned in the bath when they inspected that place on April 28 2016.

The Mystery of Loring Hall and the CQC

Posted on by
22

Ok. This is hugely important. And devastating. I’m going to go through it in some detail because it is so fucking important. And devastating.

Here’s the rub. In November 2015, the CQC inspect Loring Hall, a care home for up to 16 learning disabled adults, run by Oakfields Care. ‘Good’, ‘good’, ‘good’, ‘good’ and ‘good’ on all five domains inspected. A clean bill of health.

The CQC then received concerns around the management of risk to people living at Loring Hall.

On April 28 2016 they reinspect the home focusing on how safe and effective the service was. This produced a remarkably different picture to the November inspection. The re-inspection was conducted by an inspector and specialist advisor with epilepsy expertise. The key findings:

The inspection report reads eerily like the September 2013 inspection report of the unit LB died in. Medicines not stored properly, untrained staff and inadequate risk assessments…

Despite the list of failings identified during this new inspection (including a striking lack of training)…

… the CQC decided not issue any enforcement action:

A last bit of detail on the process of the April 2016 inspection:

On April 13 2016 Elric Eiffert drowned in the bath in Loring Hall. He was 34 and diagnosed with epilepsy and autism.

His family were told about his death on April 30 2016.

Just a few scrambled questions and comments (I can’t make much sense of any of this) largely for the CQC:elric 7

Our son drowned in a bath in a craphole unit, six years after another patient drowned in the same bath.

The first patient’s death was covered up until October 2015 when it was used as a nasty little ‘weapon’ at LB’s inquest.

Nearly three years after LB’s death (and after a Prevention of Future Deaths report was issued by the Coroner), Elric Eiffert  drowned in a bath in a craphole ‘care’ home that five months earlier had received a ‘good’ CQC rating.

No one should drown in a hospital or care home bath in the 21st century. Or die unsupervised of a seizure in a ‘care’ setting. LB, Elric, Edward Hartley, Danny Tozer and countless other people, would all be alive if they had received appropriate care.

This is beginning to look a tiny bit like state supported eugenics. And no one who should appears to give a fucking shit. Still.

Tribunal torture

Posted on by
5

This post builds on Five tribunals and a dress code. Sadly.  A few weeks ago I had a three hour (yes, three hour) interview with General Medical Council lawyers. This grilling (they warned me in advance it would be) involved a barrage of questions in tortuous, micro detail.

It was grim. Documentation (and this blog) had been mined for any inconsistencies.

As I’ve banged on before, staff have legal representation at these tribunals and these barristers can ask anything they want of witnesses. Witnesses (including bereaved families) are not allowed representation. During the interrogation, in a hotel meeting room in North Oxford, I scrawled this:

IMG_2704

I went home afterwards, instead of to the work meeting I was supposed to attend.

This morning the Nursing and Midwifery Council (NMC) called to update me on the six nursing tribunals due to be held this summer/autumn. A preliminary meeting was held last week apparently and the independent chair agreed to:

  1. Lump the tribunals together to make one long one hearing.
  2. Postpone this until May 2018.

Apparently the NMC opposed this delay but staff representatives disagreed with a possible January 2018 date.

So, another year and another tribunal to dread. The brutality of forcing us to revisit what happened for at least another 12 months.

We had no one at the meeting to draw to the chair’s attention the utter inhumanity intricately woven into this process.

We simply don’t count.