Is It Becoming Illegal To Care?


Would somebody please care to develop this or add to? Thanks

Is it becoming illegal to care?

Consider the headlines- whistleblowers unsupported or there are false accusations against them, a couple in USA charged for daring to give feed to the homeless, homeless people moved from a New York street and also in the UK, mal-treatment of some people with mental illness UK, USA, Romania..

Reasons? Are they a threat? Is it against the affluent image of the town or country? Do politicians aiming for neoliberalism – “each responsible for themselves”- urge us to harbour mal-feelings towards the so called “non contributors?”

The number of “non contributors” in all countries, is increasing due to the increasing wealth of the businessmen who pull the puppet strings of politicians.

Remember the street children killed in Brazil (amnesty 2013) ,shot in a hail of gunfire by the police. These were the real people. So much more worth than police and politicians.

Link to history- does caring actually exist naturally or is it an aim to survive?

Suggested reading- Huxley  A Brave New World, Golding W Lord Of The Flies

Suggested viewing Soylent Green


Zero Hours


Regulatory Sham

The NHS Ombudsman is nothing but a diversionary tactic, the function of which is to syphon complaints made by patients and their relatives from NHS trusts. The Trust management is ‘free’ of the case, and likely to remain so, for it is rather like sending an average 13 year old to sit a degree level exam – they will not possibly be prepared for it. The Ombudsman (more accurate if called Ambushman) will close a case if the smallest of details are not submitted, and if the slightest inference is given that legal action is being considered, which, of course, could mean the Trust paying compensation.
Do not approach the Ombudsman when the Trust advises it. This is only a delaying tactic which gives them time to destroy medical records and rewrite medical notes. Their allies in this subterfuge are the the GMC, which treat Complaints from NHS managers about locum doctors speedily, in contrast to those made against those in permanent posts within the Trust.
A GMC representative commented on ‘doctors from abroad'(more likely to be locums) under a FOI request:
‘There is no evidence that the GMC persistently discriminates against black and ethnic minority doctors. Research commissioned by the GMC and carried out by Economic and Social Research Council’s Public Service Programmeconcluded that doctors from abroad, irrespective of their ethnicity, were more likely to come before the GMC but that in cases involving UK qualified doctors there was no link between ethnicity and outcome’.
Trusts have enormous influence with the GMC and NMC. If a Trust states it has ‘no problems’ with a doctor or nurse, the GMC and NMC will be unlikely to take the case forward. This protectionism is at the very heart of RCN proposals for nurse revalidation, which give a nurse’s employer the power to ‘validate’ the continuing competency of the nurse. It is a win-win situation for the Trust. Be a good nurse (i.e. compliant and non-complaining) and we will say we have ‘no problems’ with you – case against you dismissed! It is the same with doctors on a permanent Trust contract – safe from complaints by individuals. In contrast, the GMC and NMC act propitiously when a Trust makes a complaint.
What is the true nature of a Foundation Trust? They can generate up to half of their income privately, using half their beds and staff for that purpose. They can enter joint ventures with  corporations to ‘hive off’ or franchise services to the private sector. A foundation trust can be closed if it fails to generate enough income, regardless of local need. This only describes what Foundation Trusts do, and the consequences of failure to do it profitably, so it does not answer the question in the way that Marcus Aurelius suggested – ask not what someone or thing does, its true nature is revealed by what need it serves. By this dictum, Foundation Trusts are the means by which political neocons make a profit by selling State assets to their business friends. Parliamentarians are heavily involved as investors in Foundation Trust ‘joint ventures’, and receive political donations from the same joint venture ‘bandits’.
Adding to the unholy alliance of health care regulators, the  CQC has a primary function of registering more than 22,000 health and social care providers: As Allyson Pollock summarised in the Guardian (June, 2014), ‘Central to the government’s NHS reforms is the concept of a well-regulated market. Behind the CQC controversy is an assumption that if a commercially run hospital is failing it has simply not been well enough regulated. But experience from the US shows that effective regulation of large healthcare corporations is impossible: we cannot afford it, or get the data necessary to carry it out. That is why the NHS had direct management in the first place’.
The GMC, NMC, RCN, and CQC are all complicit in covering up the abject failure of the ‘marketisation’ of the NHS, that is, failure to patients, not to their ‘fingers-in-the-pie’ political masters.

lenin nightingale 2014


Doctor and Nurse Ostrich

A study of 350 Florida nursing homes, conducted between 2000 and 2007, published in the Journal of Health Care Finance, showed that nursing homes run by private equity groups have more deficiencies and fewer registered nurses than other for-profit facilities. Private equity-run homes had a 9% higher pressure sore risk, and  had a (probably related) 29% lower registered nurse hours per-patient, per-day.

Private equity groups target ‘underperforming chains’, which they buy with bank loans secured with the money of private investors. The new management company receive a management fee (often 20% per anum), and the private investors receive a high fixed return, both irregardless of profit or loss, and both guaranteed contractually. The ‘real money’, however, is to be made by making the acquired asset more attractive to future investors, who will buy it at a much higher price than the private equity group paid, enabling the equity group to clear its debts and make a substantial profit. Private equity groups are ‘turnabout artists’, engaged in a form of gambling. They maximise care home profits by such means as employing lower grades of nurses, and more certified nursing assistants to undertake traditional registered nurse tasks. They also tend to employ more foreign nurses, whose raison d’etre, understandable, is to send money ‘back home’, rather than to disobey their ‘master’s voice’. They tend to be compliant, live-on-the-premises slaves, disabused by all.

What possible relevance is this to the NHS?, asks Doctor and Nurse Ostrich.

The answer is that ‘underperforming’ NHS hospitals will be acquired by private equity trusts, and the services they offer will be split, rather like an auctioneer who splits a collection into seperate lots, hoping to maximise profits, with services being outsourced to other investors, who will operate ‘in the community’, taking advantage of any reduced rate, out of town, business park offer the local council dangles in front of them. Anyone doubting this has only to consider the American experience of private equity acquisition in the health care market, and understand that this is the exact model  being gradually imposed on the NHS.

Examples of this ‘splitting the lot’ abound: Private equity companies aggressively invest in a number of lucrative areas of health care in America. Hospitals – where they buy not-for-profit chains and turn them into for-profit systems, which is the ‘name of the game’ – making them saleable assets, not public health sector services. Specialist Services – such as anaesthesiology and radiology – where private equity is investing in management companies that employ a network of hospital specialists. The largest ‘hospital specialist’ company in America is financed by AEA Investors, founded in 1968 to make investments on behalf of S.G. Warburg & Co., as well as the Rockefeller, Mellon, and Harriman families. Surgery Centres – which provide ‘significant cost benefits’ of relocating  inpatient  services in the community. Healthcare Technology Systems – a very large area of investment, because of the perceived need to create ‘efficiencies’ made necessary by projected (56% lower) government reimbursements. Such companies also manage ‘claims processing’, ‘data mining’, and ‘medical records’ systems. Chronic Disease Centres – speciality pharmacies with device and drug technologies are seen has a lucrative way forward in providing ‘customised therapies’ for asthma and diabetes. Cancer Care Centres – a vast amount of equity money is being invested in oncology services. Outpatient cancer care centres provide radiation therapy, chemotherapy and PET/CT imaging. Hospices – private equity firms view these as sure-winners, which is underpinned by an ageing population. A Baff Industry study in 2011 showed 10 hospice transactions in the first quarter of that year. The ‘unholy’ combination of hospice care and the profit motive was shown in a court case brought by the American government, which alleged that a company  ‘through its reckless business practices, admitted and retained individuals who were not eligible to receive Medicare hospice benefits, because it was financially lucrative’

In its complaint, the government describes a corporate culture in which AseraCare employees were given heavy incentives to enroll and retain hospice patients – even if they don’t qualify – because hospice providers are paid per patient per day. Top performers were rewarded with prizes like massage chairs, while those who didn’t meet patient admission goals were disciplined

But in addition to problematic certifications, the original Alabama case also claims that Golden Living games the Medicare system and maximizes profits by misclassifying patients and funneling the same patients through its various health care services. This corporate initiative is referred to internally by staffers as “synergy,” court documents said.

In some instances, Golden Living patients were admitted to hospice care, then discharged just before the date at which the patient would reach the Medicare payment cap. That individual is then placed in the company’s nursing home facilities until that Medicare cap is reached, before being admitted once again to its hospice care, according to court documents.

The lawsuit also contends that some hospice patients are recruited by staffers who troll public hospitals, tour public housing complexes or ride along with Meals-on-Wheels food deliveries.

“AseraCare employees are trained to market hospice services to these patients regardless of qualification and to admit these patients to hospice,” the Alabama complaint said, by “appealing to the needs of the patients and obfuscating the true nature of hospice care.” Corporate training materials remind staffers that “effective communication is the transfer of emotion, not information.”

Yes, they deal in death!  Wound Care Centres – these have seen a an influx of equity investment, again, on the sure-win situation of an ageing population. Goodbye GP practice nurse! Rehabilitation and Addiction Centres –  a huge market for the private equity investor, with chains of clinics and halfway houses being established. This is another sure-winner –  in times of ‘austerity’ and social security cutbacks, drug and alcohol addiction go up! Physical Therapy Centres – another good money-spinner! Doctors are instructed to refer patients to  ‘physical therapists’ rather than  to ‘costly’ surgery. Knees-up-mother-brown replace the knife! All physiotherapy services to be run ‘locally’ – i.e. within 10 to 50 miles! You’d need physio after getting there! Automation Initiatives –  Will your nurse avatar smile? Will you be able to chose between a ‘female’ and ‘male’ nurse avatar, or, indeed, request a gay nurse avatar? The suspicion is, to cut costs, all nurse avatars will be coffee coloured and be of ambiguous sexual orientation, unless, of course, you are a rich patient, a member of the UK government, or such like, when your avatar can be made to your specifications, and programmed to provide comforting ‘extra services’. Home Health – this is seen as a no-winner, with many companies competing for a tightly controlled reimbursement pot, necessitating employing carers at a low wage, to spend 15 minutes ‘caring’ for clients, an area ripe for abuse. Nursing Homes – now increasingly seen as a precarious long term investment, due to government cutbacks in reimbursements. The market value of private equity owned nursing home chains in America has fallen. If this scenario is followed in the UK, equity companies may ‘cut and run’, leaving the government to pick up the mess, which will be a big one, as debt-ridden private equity companies have been allowed to accrue 80% of the UK care home market.

There it is, I suggest – the fragmentary system of future care, the NHS being split into seperate lots by a speculator-friendly auctioneer, disguised as the UK government, in which patients travel to various privately owned clinics, which make drastic cost-cutting measures to operate within government cash parameters, staffed by less qualified and fewer personel, who will all work on zero hour contracts – the fate of Doctor and Nurse Ostrich. As for the poor patient with multiple needs, it is rumoured that the government will encourage the privatised rail companies to offer cut price rail tickets to ‘fascilitate inter care travel’.

It is not about efficiency, it is about naked avarice. When such privatisation was implemented in Sweden, the cost to the tax payer increased. The NHS can not simply be defined as ‘anything’ that is free at the point of entry. It was a special ‘something’ that defined the NHS, that ‘something’ being centred on hospitals that housed a full range of services, provided by an adequate number of fully trained staff, and which did not provide bloodsucking business interests with an incentive to destroy what generations had fought for. When that great lie is spoken that we can not afford to pay for the care of an ageing population, compare what the UK pay on health costs as a percentage of GDP to that of other ‘developed’ European countries, it is generally lower, and then ask why the UK spend vast amounts on killing people in the oil wars of its American masters. Uncomfortable reading for Doctor and Nurse Ostrich, who delude themselves that the NHS exists in a political vacuum.

lenin nightingale 2014




Zero Hours : From The Heart


Zero hours and non-payment of the minimum wage , by way of non-payment of travel time. Well that seems to sum up the majority of home care providers in the UK right now. Over the past year I have heard a lot of people talk about these subjects. Politicians, journalists, leading world thinkers.

Mainly zero hours as it would appear no one seems prepared to address national minimum wage laws. No one seems to have the answer.

I’ve heard people talk statistics, budgets , profit margins and targets. But I see these problems from a different level – ground level. I have worked in homecare for almost 20 years and have seen a decline in the quality of care being provided, as huge private equity firms have been able to take control of the sector, and drive down the cost of care to almost unattainable levels. I have witnessed huge staff turnover caused by poor terms and conditions and also abuse and neglect of those receiving care as it has become acceptable to employ people with little or no experience to cope with the increasing demand.

When I talk zero hours and non-payment of travel time I talk about people I have met, people let down by our fundamentally broken system of care. Experienced staff forced to leave because they simply can’t afford to stay. Those receiving care accepting undignified substandard care and the lack of continuity that means they never know who is coming into their home to provide the most intimate personal care.

I could stand here and quote statistics and budgets but I can’t – I don’t understand them. What I do understand is people, what I do understand is care.

That is why I wanted to share an experience I had that I think sums up the problems within the current home care system. An experience that essentially continues to drive me.

I met a lovely man I’m going to call George. George had very complex needs and was unable to carry out even the simplest of tasks without support. I only met George occasionally, when his regular carer was off. They had been together a long time , George and his family were confident in her ability to provide him with quality care.

Suddenly George’s carer started losing hours , those hours being replaced by 15/20 minute calls , 10 -15 miles away. She was paying more for petrol than she was able to earn. The last time we spoke she was broken , struggling to provide for her family. Then she simply left.

Her crime and the reason she was being punished this way was that  she dared to challenge that organisation about the quality of care they were providing.

I started to pick up a few more calls at Georges house , immediately I was concerned about the quality of care being provided. There was no continuity – George had different carers daily. Often people didn’t turn up and on several occasions George was left in bed for up to 20 hours. Times they did arrive they often forgot to give him food , drinks, medication. And more often than not they would forget to open the blinds , turn the TV and heating on. George simply couldn’t do these things alone. I and Georges family repeatedly reported concerns. I begged them to give staff details of his needs, but nothing changed. I asked to be George’s carer but they said no !

I started to drive by George’s house about 10.30 every day, if the blinds were closed I would call the office explain I was aware of the problems in his house and could I just pop in and check on him. Usually he was sitting staring at the walls with no tv or heating on. Sometimes he hadn’t had any food or drinks, many times he had no medication. Each time I reported what I had found and begged them to make sure it didn’t happen again.

This continued for several weeks until I called in and requested to go in and check as I had done many times before. I was told no, I couldn’t go in and it was none of my business anymore. I felt the fight being kicked out of me- what more could I do?

Just a few weeks later someone called in sick and I was asked to cover a lunch call at George’s house. I arrived at the same time as his son. By now George’s family were so concerned at the quality of care being provided they had started to take it in turns to take time out of work around lunch time each day , just to make sure he had been cared for.

As we walked in to the house I was struck by how cold it was. It was January and there was snow outside , there was no heating on and all of the internal doors were wide open.

What I saw next will stay with me forever. George was sitting visibly shaking, he was wearing a t-shirt, his skin was grey from the cold. George was wet , a doubly incontinent man , staff had failed to provide him with a pad.

The blinds were shut, the TV was off and the lights were off. George hadn’t had anything to eat or drink , he hadn’t had any medication.

Cold, wet, hungry, alone in the dark – just waiting for someone to help.

I was angry, upset, annoyed , with the person who had left him to suffer like this, with the organisation who had failed to listen to my concerns, with the system of care that is so underfunded and undervalued this so called care has become accepted by many.

Mostly I was upset angry and annoyed with myself. I allowed that organisation to knock the fight out of me – essentially I allowed that situation to continue.

However guilty I may have felt and still feel , I know that wasn’t my fault.

There were 3 key point which lead to George’s suffering,

Zero hour contracts and their use by way of punishment and reward.

Unpaid travel time, Georges carer simply couldn’t afford to stay.

The lack of regulations for employing care staff which mean its acceptable to employ anyone to care for our most vulnerable.

I made a promise that day , I promised George and his family I was going to fight ot ensure this never happened again.

I only hope that by sharing my experience I can get the support of others to help me keep my promise.

Written by a home carer who wishes to remain anonymous.