Action on Elder Abuse

1
Action on Elder Abuse
2
Action on Elder AbuseAnnual Conference - 2007

• Getting Better Together
• Perspectives from the Health and Parliamentary
  Ombudsman Service

3
Health Service Ombudsman Objectives

• To contribute to improvements in public services
  by being influential and sharing our knowledge
  and expertise
• To deliver a high quality complaints handling
  service

4
Why Change to Functional Teams?

• To be better able to respond to people
• To be more authoritative and knowledgeable
• To be better able to identify themes and make
  connections

5
Focus for Today

• What is the nature of our evidence?
• What does it say about the healthcare provided to
  older people?
• Where does the complaints system fit?
• Working together for service improvement
• Resources.

6
What is the Nature of our Evidence?

• It is drawn from investigations that are
• Independent
• Impartial
• Private
• Inquisitorial (not adversarial)
• Free

7
What can the Health Service Ombudsman investigate?

• Complaints about
• Strategic Health Authorities
• Primary Care Trusts and Primary Care
  Practitioners
• NHS Trusts, including Foundation Trusts
• Services provided by the independent sector but
  commissioned by the NHS
• The Healthcare Commission
• The Mental Health Act Commission
• NICE and a range of other bodies.

8
What can the Health Service Ombudsman Investigate?

• Properly made complaints
• Not employment, commercial or contractual matters
• Not complaints where alternative remedy is
  possible or has been secured
• Usually cases under one year old

9
How Do We Reach Findings?

• Examine records
• Interview individuals
• Consider prevailing policy, standards and
  guidance
• Take clinical advice about reasonable standards
  of care and treatment
• Apply the Principles of Good Administration

10
Health Care and Older PeopleWhat do our
Complaints Tell Us?

• Health Service Complaints in 2006 07 (Very
  Approximate!)
• 1,100 complaints
• 110 about services to older people (380 with
  Continuing Care)
• 56 upheld overall
• 60 of cases involving older people upheld

11
What are our complaints about?

• Hospital Care
• Communications
• Record Keeping
• Monitoring
• Nutrition Hydration
• Dignity privacy
• Medication
• Assessments and
• discharge arrangements
• Mental health issues
• End of life care

• Primary and Community Care
• Nursing Homes
• (Same issues as for
• Hospitals)
• Few about GPs and community nursing services
• Application of Vulnerable
• Adult Policies
• Continuing Care Redress

12
Who Complains?

• Carers predominate spouses and children
• More men than women
• And who doesnt
• People from minority ethnic groups

13
Example 1 - Basic Care urgent admission

• Case
• Fell
• Admitted to gynae ward
• 4 months in hospital
• Became confused
• Fell again
• Lost weight
• Discharged to nursing
• home

• Findings
• Urgent care systems
• lacking
• No care plan
• Over use of sedation
• Failure to, observe
• monitor and record
• Lack of clinical skills and
• oversight

14
Example 2 Basic Care Planned Admission

• Case
• Hip joint revision
• Many other problems
• DNR agreement
• disregarded
• Lack of blankets
• No response to call bell
• Poor pain control and
• medication management

• Findings
• Failure to plan
• Failures in basic nursing
• care and management
• Poor medical care
• Resuscitation mishandled

15
Example 3 End of Life Care

• Case
• End stage cancer
• Left alone to manage DV
• Fell
• Inadequate care of
• pressure areas
• Visiting restricted

• Findings
• Appropriateness of care
• setting
• Lack of care planning
• Nursing skills
• Communication and
• attitudes

16
Example 4 Listening to Patients and Carers

• Case
• Admitted for assessment
• related to dementia,
• Decided to discharge to
• nursing home that patient
• disliked,
• Carried on, despite sons
• protests.

• Findings
• No evidence of patient and
• carers views being taken
• into account,
• No explanation given about
• possible transfer later,
• Carer and patient left in
• distress.

17
Example 5 Poor Discharge and Transfer

• Case
• Multi system issues
• Hastily arranged discharge
• to community hospital
• Inappropriate rehabilitation
• No end of life care

• Findings
• Inadequate clinical
• handover
• Lack of assessment and
• care plan
• Poor observation
• Poor communication
• with the family

18
What do our Complaints say about Elder Abuse?

• Types of Abuse (No Secrets)
• Physical abuse
• Sexual Abuse
• Psychological abuse
• Financial Abuse
• Neglect and Acts of
• Omission
• Discriminatory Abuse
• Intentional/unintentional

• Ignoring medical or
• physical care needs,
• failure to provide access
• to healthservices, with-
• holding the necessities of
• life such as medication,
• adequate nutrition and
• heating
• Unintentional

19
Policy Matters..?

• Essence of Care (2001)
• Getting the basics right
• hygiene, nutrition, pressure ulcers, continence,
  privacy dignity, record keeping, continence,
  communication)

• NSF for Older People (2001)
• Tackling discrimination
• Individualised care and
• integrated services
• Management of age-related
• conditions

• Single Assessment Process (2001)
• Assessment of needs
• Person-centred care planning
• Co-ordination between
• different agencies

• NICE Guidance 2001 - 2005
• Pressure ulcers
• Pressure relieving devices
• Falls
• Nutrition support in adults
• Urinary incontinence
• Dementia

20
What Did We Recommend?

• Nothing new in most cases
• Already in policy and guidance
• Reflect and learn.
• A reflection from a Trust.
• Our staff were burnt out. It was a downward
  cycle, our reputation was dreadful we couldnt
  recruit.

21
Where Does the Complaints System Fit?

• Issues
• Lack of sign-posting
• Lack of listening and understanding
• Fragmented
• Quality of communication and explanation
• Time frames
• Remedy

22
Example 6 The Complaints Process

• Case
• Care in Nursing Home
• CPN input
• GP Care
• Care Co-ordinator

23
Example 6 Contd The Complaints Maze
24
Example 6 Contd

• Much writing, emailing and telephoning
• Many hours of time
• Systems start joined up and then split apart
• No overview until the end
• Took over three years to complete.
• Complainant fuelled by ongoing problems and
  failure to recognise that he only wanted things
  to be better.

25
Improvements to The Complaints System

• Informal liaison with NHS Organisations
• Stakeholder surveys
• Advice and guidance for complainants and
  organisations
• Staff development
• Regulatory Reform Order to allow LGO and HSO to
  investigate jointly
• Preparatory work for further realignment of
  health and social care complaints in 2009
• Voices in Action Network

26
How can the Health Service Ombudsman enable
service improvements?

• Through recommendations for remedy and redress
• Through good practice guidance Principles of
  Good Administration (and shortly, Principles of
  Redress)
• Build alliances and share information
• Providing reports to the Westminster Parliament
  about matters arising from cases

27
Resources

• www.ombudsman.org.uk
• Advice about making a complaint
• Speeches
• Reports
• Plans
• Case studies
• How to get involved

28
Thank you!

• ..And please keep in touch
• Valerie.Harrison_at_ombudsman.org.uk