NB: THIS TRANSCRIPT WAS TYPED FROM A TRANSCRIPTION UNIT RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT: BECAUSE OF THE POSSIBILITY OF MIS-HEARING AND THE DIFFICULTY, IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH FOR ITS ACCURACY.
PLEASE LOOK AFTER MUM
Reporter: VIVIAN WHITE
RECORDED FROM TRANSMISSION: BBC ONE
JEREMY VINE: Good evening. I am Jeremy Vine and this is Panorama. Tonight we ask: how can you tell if your relatives are safe and cared for in private nursing homes?
SARAH BARRETT: Apparatus were only used to pick 'em up when people were there, when relatives were there. If the relatives weren't there, they were pulled up!
VINE: And we expose the loopholes that leave families in the dark when things go wrong.
JOHN HOYLE: You see behind the closed doors we really just don't know. Trust takes over.
VINE: When your parents dropped you off for your first day at nursery school the chances are there were tears all round. The fear was not that you'd be harmed, just homesick. After all, there is a whole industry out there to protect the young. But now fast forward 40 years and imagine it's you dropping your parents off at a care home. Can you be so confident? Not if what we found is anything to go by.
VIVIAN WHITE: Putting a close relative into a nursing home is often traumatic, a step families dread having to take.
MANDY HIRST: I was working, I was trying to look after my mum, I was trying to look after my dad, and so was my family, and it came near impossible to do that.
MARILYN HARTLEY: We were told by the GP that my mum would be safer in a home.
HOYLE: It was the ultimate.. it represented the ultimate in trust.
WHITE: Halifax in West Yorkshire - the local council wants this to be the safest place in the UK for older people in care homes. But in Halifax, as elsewhere, neglect and abuse have gone on for years. Just ask Agnes Moore, a double amputee but, as we'll find, a real survivor. Her family says what happened in a local nursing home nearly killed her.
Did you ever expect in a month of Sundays that the things that happened to you in the nursing home would happen to you?
AGNES: Never... no, never.
WHITE: What had you expected?
AGNES MOORE: I was so ill I didn't expect a right lot (laugh) I never got a right lot but I didn't expect a right lot.
WHITE: But she expected to be safe. Agnes Moore was in a nursing home chosen for her by the local council, yet they say: "We need to remain vigilant."
Calderdale Social Services
There are too many examples of people in care homes suffering either abuse or very poor care, there's no question about it. Many members of the public, even though there's been a lot of publicity, are still unaware of the kinds of risks that can happen to people when they're in institutions.
WHITE: But the risks can be well concealed. John Hoyle, a magistrate, was a good son to his widowed mother Irene. He'd been helping to look after her at her own home, but he had to find a nursing home for her after she had a stroke. He visited her there every day, yet he couldn't keep her safe.
HOYLE: You see behind the closed doors you really just don't know. Trust takes over. That trust was betrayed, and it was betrayed in a most cynical fashion.
WHITE: He'd chosen Heath Bank Nursing Home. It was owned and run then by two registered nurses. The brochure promised: "a high standard of care in safe and relaxed surroundings." Because of her stroke, his mother couldn't communicate, and unknown to him she was being severely neglected. All she could convey was her distress.
JOHN HOYLE: She did dissolve into tears of frustration, almost exploding with tears, and the picture is engrained in my memory of two of us really sobbing together.
WHITE: The home told him she had pneumonia and should be allowed to die there with dignity. But Irene Hoyle had untreated bedsores and they'd caused blood poisoning and she was badly dehydrated and heading towards the final terrible crisis of her life.
HOYLE: It was a septicaemic fit which I've never seen before, nor would wish to view again, very few people do witness that and it is an awesome sight. The worst thing of the lot was the froth billowing from her mouth. It perturbed me so much that I asked one of the nurses and she said she was simply getting it off her chest. It turned out to be rather more than that.
WHITE: At his insistence his mother was taken to hospital but she died there soon afterwards. A post-mortem established the true cause of her death and then John Hoyle set about getting justice for her.
He had photographs taken of his mother's body in the morgue.
HOYLE: I happened to know a forensic photographer with whom I worked in the courts, and he volunteered to take these photographs.
WHITE: The sores had split his mother's flesh wide open and the fever had consumed her. The photographs of the appalling evidence of neglect kept hidden from a careful son.
HOYLE: I'd no idea that I could have looked under her dress to find the bones protruding as you can see on the photographs. Who would normally assume that in that atmosphere of total trust that that is something that one ought to have done.
WHITE: But now, armed with his photographs, he fought for her. He expected the authorities to be outraged. As a magistrate he knew they would have been if this had been a child. He took legal advice but he was told there wasn't even any point in going to the police without evidence of a deliberate assault.
HOYLE: Had a child been involved I'm quite certain there would have been a trail lit to the very doors of Whitehall. It would have been in all the papers on the front page. But I think, with old people, it's something that's part of the package.
WHITE: He didn't give up. He took the two nurses, who then owned and ran Heath Bank, to their own professional body. The investigation took nearly two years and before it was over the home had been sold to its new owners who have no connection to the Hoyle case. Bridget Massey and her sister, the former owners, were finally struck off the Nursing Register in 2003. When we're vulnerable because we're young a strong body of law now protects us. If children are believed to be at risk of harm the authorities can intervene and remove them from danger. If anyone so much as lays a hand on a child the consequences can be dire. Just like old people, children often make poor witnesses, but the system defends them.
[chatting with children]
WHITE: What colour is your hair?
WHITE: Your hair's black. What colour is my hair?
WHITE: Why is my hair grey?
CHILD: Because you're old.
WHITE: Do you think it's a bit sad?
WHITE: To be old?
WHITE: Why do you say it's a bit sad to be old.
CHILD: Because you're gonna die soon.
WHITE: For many of us, old age will mean becoming as weak and vulnerable as children again, but their legal protection against abuse is way ahead.
Commission for Social Care Inspection
We think that the levels of awareness are increasing, we're certainly seeing more referrals of allegations, but I think we would conclude that there is definitely a gap in the legislative framework for adults and for children.
WHITE: Which is bad news for relatives. They can check the published annual inspection reports on care homes for the elderly and visit and ask awkward questions. But a succession of Halifax families have discovered that being vigilant doesn't always do the trick. Marilyn Hartley's mother had to go into a home because she had dementia.
MARILYN: I'm driving to Leeds today to visit mum, knowing that when I get there she'll be safe and cared for, but the memory of the home that she was in, in Halifax, never ever leaves you. It was dreadful.
WHITE: Marilyn checked everything when she chose the home her mother, Lily Leatham, is in now, and she's very happy with the care she gets there. But Marilyn Hartley thought she'd been as careful as could before as well. She originally chose a home called Laurel Bank.
MARILYN HARTLEY: Laurel Bank had quite a good reputation, so we rang and spoke to assistant matron and asked if we could come and have a look round, and she said: "Yes, pop round whenever you want." So my sister and I went to look round and she was very, very nice. We then decided that mum would be fine to go and live there.
WHITE: The family paid £425 a week, but there were lots of things about Laurel Bank relatives could never have known - not unless they worked there.
Former care worker
They only saw what they were supposed to see. Cups of tea were offered round when relatives were there, but not when they weren't. It's ridiculous. People were fed when relatives were there and not when they weren't, they were left to do it on their own, and if they didn't eat, it were a case of: "Come on, get it down yer and let's go, chop chop" cos there just wasn't enough staff or time to do anything.
WHITE: What, you're saying...
SARAH: Apparatus were only used to pick 'em up when people were there, when relatives were there. If relatives weren't there they were pulled up.
WHITE: There were two versions of the same home, there was even a part of Laurel Bank relatives didn't normally see, a lounge they weren't shown.
SARAH: Well there were a few names for it, the 'baby lounge' the 'loopy lounge' because all the violent, noisy ones.. you know, they weren't put in the conservatory or in the dining room where the flowers were and things. It was a very dark, dingy room that smelt awful.
WHITE: Would you call it the 'loopy lounge' in front of them?
SARAH: I don't think it occurred not to.
WHITE: Before Lily Leatham had been at Laurel Bank very long her daughter, Marilyn, became concerned at the change in her.
MARILYN: I began to notice that mum didn't always look like she used to look, and I'd say to matron: "You know, my mum looks really tired." And she'd say: "Well, you know, that's what you have to expect when people have dementia and.. you know, she's not going to get any better." And because she was a qualified nurse you just take on board what they say because you put your trust into them.
WHITE: It was only when Lily Leatham was taken to hospital with a suspected deep vein thrombosis that doctors found that she too had been terribly neglected.
MARILYN: They discovered that mum had grade four necrotic pressure sores which apparently in layman terms is gangrenous flesh which smells appalling and that smell never ever leaves you, never.
WHITE: These are the hospital's own photographs of Lily Leatham's untreated sores.
MARILYN: They're horrible, and I can close my eyes and I can still see those photographs.
WHITE: During Lily Leatham's six months stay in Laurel Bank, she'd also been severely malnourished. Had the patient been a child, alarm bells would have rung, the victim would have been removed from harm, but the hospital wanted to send Lily Leatham back to Laurel Bank.
What do you think the hospital should have done at the time?
MARILYN HARTLEY: I think they should have been in touch with the regulators and informed them the state of my mum's condition. They didn't do, although the hospital social worker suggested that I did. I also think they should have involved the police. It was abuse and neglect and if that had of been an animal with those injuries, the RSPCA would have involved the police and the CPSS would have been involved, and they would have gone to court. But there is no protection for elderly people.
WHITE: Prompted by Lily Leatham's family the regulators began an investigation into Laurel Bank and found its problems ran far wider than a single case of neglect. One of the staff they talked to was Sarah Barrett. She told them how upset she was about the abuse of residents there.
Former care worker
Name-calling towards residents considering genitals and things: "Look at the state of your XXX, I bet your husband wouldn't XXX you anymore, would he.... rah, rah, rah.... They have not seen a hair... if there was screaming and shouting it was just a case of: "Shut your mouth! Get it over and done with, get 'em out of here, they're doing my head in" sort of thing.
WHITE: "Shut your mouth" as their hair was being brushed?
SARAH: "Will you shut up with your carrying on" etc.
WHITE: And she witnessed one female resident being especially humiliated.
SARAH: Towels, flannels, you know, just slapped on her bare arse, water splattered in her face like that when she's screaming, to shut her up. Not to... well the only way I can explain it, is to give her something to scream about really. You know when a child's being naughty... "I'll give you something to scream.. to cry about" or whatever. You know what I mean? That's the only way I can explain it, and that's mental torture, that's abuse if you ask me. That is abuse.
WHITE: Sarah Barrett left her job after reporting her concerns.
This was a place where people weren't safe, wasn't it.
Commission for Social Care Inspection
That's absolutely correct and we have no doubt that the standard of care at that time was unacceptable, and looking at what the NCOC did at that time, they certainly brought those issues to attention and they took action against it. We're absolutely clear that standards then were unacceptable.
WHITE: The regulator relied on the home to put things right. After an internal investigation three members of staff were fired. Laurel Bank's manager, Linda Parker, and the owner, Christopher Bolland, promised things would improve.
You were trusting to the owner and manager of this nursing home, the people who'd let things get into this state in the first place, to remedy the situation for you, weren't you.
ROURKE: Well our approach is that it is the provider that is responsible for providing services. Our role as a regulator is to make sure that the services are being delivered according to the regulations and the national minimum standards. In most cases our experience has been if you bring an issue to the attention of a provider, they will act responsibly.
WHITE: Meanwhile, Calderdale Social Services stopped sending people in to Laurel Bank, but they never told the public this home is not safe.
Did you tell the relatives of the other residents inside that nursing home that you'd suspended admissions?
Calderdale Social Services
I think that that's one area in which there's definitely room for improvements and the council has learnt from that experience.
WHITE: Did you tell the relatives of other residents?
PHILLIPS: I think in that case not all residents were aware.
WHITE: In October 2003 the regulator decided that Laurel Bank was putting itself in order and social services started sending people there again, and one of them was Agnes Moore who had no idea the home had a history of problems. A diabetic who'd had an amputation, she was obviously vulnerable. Agnes herself had once looked after the elderly as an auxiliary nurse.
How did you expect to be looked after at Laurel Bank?
AGNES MOORE: I expected them to look after me like I looked after other people in my day, I gave them my best. I never had a cross word with the elderly. I felt sorry for them and it were the end of their day, that's how I looked at it.
WHITE: But though the general public hadn't been told, there had been worse than cross words in Laurel Bank, and very soon after Agnes arrived there, Marilyn Hartley won a legal case against the home for the clinical negligence of her mother, Lily Leatham. And now, what had been going on inside Laurel Bank became front page news. But there was more bad news to come. Agnes Moore had been placed in the home by Social Services. She heard an argument going on between two members of staff and tried to help.
AGNES: They were arguing. I says to her: "Are you alright love? What's the matter?" And she just... it wasn't a wallop, it were just a smack, she walked away from me. It wasn't a very vicious wallop, it were just... I imagine she would have been crying because she was upset. And I never said anything to anybody.
WHITE: But hang on, you're telling me you were slapped in the nursing home?
WHITE: Across the face?
WHITE: So Agnes Moore got casually slapped in a home which had been given the all clear, and she was neglected. She'd arrived at Laurel Bank with a sore on her back which needed treatment.
So what sort of condition was your back getting into, the sore?
AGNES: Bigger, deeper. I once put my hand on my back to see if I'd got any dressing on it. My God! I wish I never did that. It was so deep, I come away and it had all sorts on it and it smelt terrible. I used to be shouting: "Please do my back" and there were some nurses that come on duty I thought thank God, they'll do my back - and they did. But there were many times them girls weren't around and I had to go on crying with my back.
MANDY HIRST: I walked in and my mum was laying there and she looked quite sick. She was sweated up and disorientated. I was absolutely disgusted at the fact my mother had a towel placed between her legs at 66 years old.
WHITE: Mandy immediately got her mother out of Laurel Bank into a rehab centre but her condition continued to worsen and she was rushed into hospital.
MANDY: A doctor took us into a side room and told us that my mum had silent pneumonia and septicaemia, and if she did not respond to the drips and the treatment within 24 hours my mum will die, and that's three days after leaving Laurel Bank.
WHITE: Agnes Moore pulled through and survived, but it had been a close run thing. The system had failed. Protecting vulnerable adults wasn't the priority.
Weren't you wrong to trust Laurel Bank at that time? Isn't the proof of it that afterwards Agnes Moore was admitted to the home as a social services client and she had happen to her exactly what had happened to Lily Leatham a year before.
Commission for Social Care Inspection
I think our view would be today that we would not have been so patient. I think we would have required a much faster turn around. We would have been less inclined to allow the provider to be tawdry, frankly, in addressing the issues.
The owner of Laurel Bank nursing home refused all our requests to discuss what had happened there.
Mr Bolland... Mr Bolland, could I possibly have a word with you.
(Mr Bollond, leaves car and hastily retreats into building closing door)
WHITE: (knocking on door and following Mr B. inside) I'm sorry to bother you, Mr Bolland. Are you Christopher Bolland, the owner of Laurel Bank.
BOLLAND: (appearing gingerly from behind a wall) You're not allowed to photograph me.
WHITE: Well I wondered if I could have a word with you because, as you know, Laurel Bank has had issues of frail and vulnerable people....
BOLLAND: You are not invited....
WHITE: ... being unsafe and unprotected for a long time.
BOLLAND: Would you mind leaving these premises. You've been...
WHITE: So you don't want to talk to us at all?
BOLLAND: Certainly not.
WHITE: Or answer any questions?
Laurel Bank's manager, Linda Parker, a nurse, will face a professional conduct hearing later this year. But the home is said by the regulator to be significantly improved now. After Laurel Bank the local council, Calderdale, held an inquiry into protecting the elderly. It reported in 2004, recommended improvements and declared: "Calderdale aspires to be the safest place in the UK for older people in care homes." The Department of Health has issued guidance on the abuse of the elderly called: "No Secrets". The regulator is now publishing more information about homes on the internet.
What can you do to protect your relative? Visit the Panorama website at bbc.co.uk/panorama
But do families now get told the facts they need to know? In 2005 Arthur was put into the Haven in Brighouse near Halifax because of his worsening dementia.
Secret filming with family's consent.
But within days, Arthur's stepson, John, and his wife, had their first doubts about whether this home could be trusted.
DOROTHY and JOHN BURTON: John went to the home to see Arthur and he came home to see me and he said I'd like you to go and see him because there's some bruising on his arms. I'd like you to go and look at them. So I went up to see him and I said: "I don't like these, John." And I took some photographs. I went to the office to see the manager.
JOHN: The manager, yeah, Angela.
DOROTHY: And I said: "Can you tell me what all these bruises are on Arthur's arms?" "Oh he's got thin skin and he came in with them." And I said: "You're a liar because he didn't."
WHITE: Nursing home residents like Arthur are difficult to care for. The Burtons were worried about a series of incidents in which Arthur had been hurt and for which they hadn't been given a clear explanation. But the authorities had been concerned about the Haven for years. In a series of inspections last year alone the regulator found some residents weren't getting baths for weeks on end. Some of them were being improperly restrained. One woman nearly choked. And the home ran out of drugs that residents needed, but relatives were told little of this.
Do you think it may be the case that you're putting the protection of the elderly and frail in nursing homes as a lower priority than keeping private nursing homes going and providing beds?
Commission for Social Care Inspection
Our absolute top priority are the elderly, the recipients of services. But we recognise that it's reasonable to invite a provider to attempt to improve services, and what we find is that in the majority of cases, once the problem is pointed out, providers act responsibly.
WHITE: But there were two years in the Haven in which you were telling them to do things and they weren't doing them and during that time residents were at risk, weren't they?
ROURKE: That's absolutely right. It would be fair, though, to point out that we were inspecting quite frequently, we were issuing notices, and we were keeping a very close eye on the establishment. But your point is well made, and this home did not improve. Elderly, vulnerable people were left at risk and that's why we've taken the decision to go to the care centre's tribunal and seek to close the home.
WHITE: So it took two years before the regulator finally told the owners a company run by the Malik family from a hotel in Manchester, that they'd have to close it down. They've appealed against the decision and it's still open.
Mrs Malik, I wonder if we could just talk to you about the Haven Nursing Home. We're from BBC Panorama. There have been lots of cases, you know, of frail and elderly people there being at risk in the home and it's been going on for some years.
HELEN MALIK: I can't comment on this right now. It's my son you need to speak to and he's not here at the moment.
WHITE: Well he hasn't been dealing with our questions either, because this has been going on for a long time and the home appears to be doing nothing to improve things, and this is a place which calls itself the Haven, hardly seems to be a Haven.
(without further response Mrs Malik makes beeline for car and, without turning, hastily gets into and hastily departs)
And the Haven may still be putting it's residents at risk. Last September, after the closure notice, there was a new allegation, this time of a physical assault, but relatives knew nothing about it.
Do you know that there's been an allegation of physical abuse by a member of staff against a resident and that a staff member in the Haven has been suspended?
DORTHY and JOHN BURTON: No.
DOROTHY: That is a shock.
JOHN: How recent is that?
WHITE: That was in September as far as we know.
JOHN: No. No.
WHITE: What's your reaction, John?
JOHN: Frightened. Absolutely staggered, and again, you know, if I hadn't heard it from you, where would I have heard it from?
WHITE: The Malik family have told us that a member of staff has been fired. The police say they're investigating. The Burtons had already been worrying about whether to leave Arthur at the Haven or move him to another home. The Haven had told relatives that a move could prove fatal. Now their dilemma was even worse.
JOHN: If the trauma of moving causes one in three to die, what the hell do you do? What the hell do you do?
WHITE: So an ordinary family was left to balance the risks. But last month the Burtons finally decided that they had no choice but to move Arthur out of the Haven. So far the news is excellent. They're very happy with the new home and Arthur seems fine. But why was he ever placed at risk at all? What have we found in an ordinary town? We found the elderly and private nursing homes being abused and neglected. We found the authorities not telling relatives, even when the new that residents were unsafe, and we've seen vulnerable old people being left at risk for years when that wouldn't have been tolerated for a minute had a child been involved and it shouldn't be happening. Twelve years ago the Law Commission proposed a full scale reform to give the elderly and the vulnerable the same sort of legal protection that children now enjoy. But the government ignored it, so the elderly in nursing homes remain amongst our least well protected citizens.
Some stories have a happy ending. Last December there was a double family celebration, Agnes Moore was there as the guest of honour on a very special day. At the Halifax Registry Office her daughter Mandy was getting married - but the elderly remain at risk.
AGNES: Even now when I go to bed, I always say a prayer for the people in nursing homes that's being ill-treated.
WHITE: Did you used to do that before?
AGNES: No, I had no reason to do that before. I never seen it before. I never experienced it before.
JEREMY VINE: Vivian White reporting there and I can tell you that an attempt to get those residents of private care homes covered by the Human Rights Act has just failed. There may be an appeal to the House of Lords. We will keep watching this story.