Published: 03/02/2005, Volume II4, No. 5941 Page 23

Linda Goldsmith on a multi-disciplinary failure in the care of older people

Our society has created an artificial division between nursing and social care that creates untold distress for older people. All too often, this increases their vulnerability by passing them around like parcels. There is a vast difference between dying in peace in a familiar place and dying in confused bewilderment among strangers.

In August 2004, my 95-year-old mother won an important victory in the Court of Appeal against a decision by Wandsworth Social Services to move her to a nursing home. The ruling made it clear that she should be enabled to live out the rest of her life with the 'maximum of dignity and the minimum of psychological harm'.

Mum has lived happily in her selfcontained flatlet in a residential care home for almost eight years. Her problems arose when she fell and was admitted to hospital in May 2003.

Two weeks later she had been successfully operated on and declared fit for discharge.

However her discharge was delayed by a physiotherapist concerned about how she would cope at home. I had no anxieties about attending the multidisciplinary ward meeting set up to discuss it; I thought the physiotherapist had simply misunderstood my mother's circumstances.

I offered to stay with her myself, or to fund any extra care she might need until we could accurately assess her. But my reassurances were not enough and my mum was detained in hospital for five months in an increasingly bewildered state. She simply could not understand why she was not allowed to go home.

I had to take legal action before her return to home was ordered by a High Court judge. Even so, Wandsworth and her care home managers made it conditional on my paying for 24-hour care during a seven-week period between court hearings.

This has taken the bulk of my retirement fund. And the nurses who cared for my mother saw in the first week or two that there were no tasks to be performed.

There was a failure to meet my mother's needs or to listen to my opinions. But decisions were made about my mum's life which had devastating consequences.

My mother's situation was prejudged. There was a failure to take sufficient account of her recent history of recovering from serious illness; her needs and best interests were not at the centre of the service.

The continuing care panel refused my request to attend their meeting. They ignored the guidance issued by their strategic health authority and made decisions without the required community care assessment.

The panel failed to keep notes of their meeting or inform me of their decision in writing.

Wandsworth had completely lost sight of their responsibility to weigh the information gathered, place it in context and form their decision based on the patient's best interests.

The occupational and physiotherapists in hospital did not see it as their role to consider context, and admitted to knowing little about external resources.

Yet the panel gave the greatest weight to their opinions.

The question of my mother's future rests on fine judgements concerning the difference between nursing and social care. I find it perplexing that the professionals whose opinions seem to carry least weight were the carers who looked after her daily, and a social worker who actually met and assessed her needs.

Linda Goldsmith is a committee member of the Registration and Conduct Committees for the General Social Care Council, but is writing in a personal capacity.