Exploiting the Elderly A brief account of neglect and death in the uk health services
by Patrick Cooper-Duffy
This is a brief account of neglect and death in the uk health services of the elderly.I deal with a recent case that of VioletTownsend and with some of the financial and politicalimplications. I show some of the historical legacy and thedifficulties faced by reforming nurses egCharge Nurse GrahamPink and medics eg Dr Rita Pal.For a good overview of some ofthe issues I recommend reading Professor Mike Brogden Geronticide-killing the elderly.

Violet Townsend was moved from the home where she had
lived for eight years when it raised its fees to £463 a week.Gloucestershire social services moved a woman of 88 from her nursing home to save the council £12 a day. Her doctor warned the council that her life expectancy would be "considerably reduced" if she was moved. He was ignored. She died five days after leaving her old home 1

This information was carried in much greater depth by the
BBC.There had been widespread opposition by her family and
indeed the care home.The decision was taken by the
Department of S social Services against medical advice.
One of her relatives said: "Her doctor said she should not be moved on account of her health but the DHSS thought differently and she had to go." 2

The circumstances,the names ,the actors change but a
common story is a picture of routine neglect ,ill
treatment. 3.

History
A brief historical overview of the services in the uk might be relevant At the end of the second world war an amalgamation of the muncipal,voluntary hospitals and private took place to form the NHS. A variety of treatments remain available by state charitable and private means.A review of those services took place under the Royal Commission into elderly care. Basically that those services would be free which theyare now in Scotland and Wales but not in England. A four tier system of care 1. Community 2, Care Home 3. Nursing Home4.Hosptal care.

The provision for services are paid for via national insurance and taxation. Those services of nursing are in theory to be provided free but the system is complex. Hospital base services are deemed to be free and some community services may be. But in principle those services of community, care and nursing are provided by a mixture of Local government and private companies. Local government receiving a grant from central government but also with the power to raise local taxes or community charge.

This well publicised death of Violet Townsend comes at a time when a health Ombudsman has recently found that elderly
people have been incorrectly charged for treatment that were
entitled too freely.They are infect owed money by the State.
4

Modern workhouses

From history we know that the workhouse was an
administrative means of killing off the poor and elderly. Are we any better with the the warehousing of the elderly through the residential and nursing home care services?

This is an area that is little discussed, and the marginalization of ethnic minorities is ignored. One of the issues that is covered up is the 30,000 people sent to nursing homes, even though they warranted free health care under the National Health Service. This is both unfair and unlawful.

Add to this injustice the removal of psychiatric, social and
rehabilitative services. Then they merely provide warehousing spaces for the young who have become physically disabled by car and work accidents. The same is true for head injury victims, stroke victims, the learning disabled, and among the fragile or demented elderly. What is going to happen? 5.
But this institutional or systematic abuse of the elderly is not new. Some of which is documented from 1967.6,
A disturbing indictment of seven hospitals by doctors, nurses and patients, revealing conditions of neglect
and incidents of ill-treatment and brutality.There were
Parliamentary debates and eventually to the appointment of
seven 'independent committees of enquiry' to look into the
allegations concerning the seven hospitals and an Ombudsmen
were finally set up by the National Health Service
Reorganisation Act 1973 6.
Even where nurses and medical staff blow the whistle the
abuses continue almost unabated. Not only in the NHS but
through the private care home industry.7Infact the death of a lord in a private health institutiont prompted legislation to better regulate the private health care industry by his wife who happened to sit in the house of Lords 8.
It could be argued that ill treatment and neglect remain unchanged this was the treatment of charge nurse G Pink9and indeed extended to the ill treatment and abuse of Dr Rita Pal10.

Its my contention that many misconceptions exist concerning
the care of the elderly in the UK and in turn the manipulation of public opinion for example. A misconception is that much of the care is private? However 80 % of the patients or residents are funded from taxation.Yet when many of the beds were cut the greatest number came from the local authority services. Creating an opportunity for the private sector to profit from the bed losses. Some of the
home owners may even move the use of their property from
bed and breakfast to elderly care depending on profit. When
some additional money £45 million became available for the
most part it was diverted into the pockets of the home owners.

Much has been made of bed blocking a figure is given of 4000
by elderly residents but little is done of the 40,000 that are forced into elderly care homes each year incorrectly. Norindeed is there much comment or action of the 100,000 stroke patients each year.Inspite of a Royal Commission on elderly care little has been done.

Exploitation of the Elderly. 2The care in the community improvement programme has been ditched. To add insult to injury it has been recently found that many elderly people have been charged incorrectly. After much hot air in the 1970s it could be argued that elderly care has notmoved further an inch. Is the truth that no body cares very
much?

The role of labour is little considered.The ill health and
the stress of working these services Against a background of routine bullying,threats,silencing and intimidation.There needs to better information and
stratergies.Some of this is now provided at Bully on Line.I do not see how care for the elderly can be improved with out
better attention to the needs of the humans providing that
care. A strong denial mechanism is at work and Tim
Fields (Bully in Sight) is to be thanked along with others for bringing this into public discussion12

I would suggest that Whistleblowing legislation has not
improved the situation. Indeed the whistblowers are as ill
treated and isolated as ever.This is a world wide problem and those seeking change need to know what they are up againstand indeed survive.13

New thinking and new organisations are needed.Part of the solution may be new trade union bodies coupled with social justice movements.There needs to be a move for Democracy in health care, coupled with a Free flow of information and Open press. Reformers may have to give up their belief in the justice in the system and find new ways about bringing social change.


References
1. Socialist worker Friday 21st 2003
2, Wednesday, 12 February, 2003, 21:12 GMT BBC News on line
3. Questions of care a review of Mrs Usable Louis (kit) Keen written by her son Peter
Keen Dec 1995
Liz Dolman Sunday Telegraph The Ombudsman report is just what the Dr ordered Feb.
23rd 2003
5. NEWS & LETTERS, March 2002
6. Sans everythingSans Everything, a collection of essays and articles published in 1967
7.Westminster Health Care(Health chief backs Sunday Express probe into misery at
nursing home April 14th 002
8Reader Digest Jan 001
9 Graham Pink see ethics in health care www.Freedomtocare.org
10Dr Rita Pal www.medical neglect org.
11Cary L. Cooper and Naomi Swanson, Workplace violence in the health sector -
State of the Art, ILO, WHO, ICN and PSI 2002. ISBN 92-2-113237-4; Vittorio
di Martino, Workplace violence in the health sector - Country case studies
(Brazil, Bulgaria, Lebanon, Portugal, South Africa, Thailand, and an
additional Australian study), Synthesis report, ILO, WHO, ICN and PSI 2002.
ISBN 92-2-113441-5.
12.Tim Fields Bully in Sight ISBN 0952912 www.successunlimited.co.uk
13.B Martin The Whistleblowers Handbook ISBN 0-85881-167-7