Don't get old in Britain
Elderly left at risk by NHS bidding wars to find cheapest care with reverse auctions
An online auction system developed for councils to buy cheap wheelie bins and stationery is being used to buy end-of-life and dementia care for vulnerable elderly people. The NHS in London has held a series of 30 “reverse e-auctions”, where bids are driven down instead of up, for £195 million worth of contracts for palliative and dementia care for patients leaving hospital.
Reverse auctions to buy care for the elderly are relatively new and The Times has found that standards and quality have deteriorated rapidly where they have been used. In one case a company that won a local authority’s reverse auction in the North East of England was struck off the national register of approved providers weeks later because the palliative care it offered was of such poor quality. The results of another auction in South Lanarkshire to buy domiciliary care were so disastrous for elderly people that the Scottish Parliament is to hold an inquiry into whether they should be banned.
Companies who took part in the London NHS auction told The Times that they were asked hardly any questions about the quality of palliative or dementia care that they provided, beyond whether they complied with minimum standards.
During the e-auction, companies were invited to reduce their prices for one bed with round-the-clock specialist care for one week by £8 a time.
The NHS and local authorities are under increasing pressure to drive the hardest bargain they can for services, such as care for the elderly, which they buy in from the private sector. Reverse e-auctions, though, were intended to be used to drive down prices for basic goods such as office furniture, IT or stationery, which have limited and exact specifications and where quality is not a serious concern. Critics of care e-auctions say that those who hold them are aware that driving prices down affects the quality of care.
Richard Jones, director of adult social services for Lancashire County Council, said that he would never use an auction to buy care. “If you put your providers into an auction, pushing them to a lower and lower price, somebody is going to lose out, and the losers in this case are vulnerable elderly people and their carers,” he said.
Information given to The Times by the BBC programme Panorama showed that four local authorities — Walsall, Bedfordshire, South Lanarkshire and Edinburgh — had used the system to buy care for elderly people.
In Walsall, the Working Together Specialist Care Agency won a contract to provide palliative care to elderly people in the last few months of their life. Within weeks, the local authority stopped the company taking on any new cases, and then terminated the contract after it emerged that dying people were not receiving the pain relief and help with feeding and washing that they required. The Care Quality Commission (CQC), the health regulator, confirmed that the agency had been deregistered after an investigation. The agency could not be reached for comment.
Walsall said that price was not the sole consideration in awarding the contract to Working Together. Sue Ryder Care, the specialist charity that held the palliative care contract before the auction, said that it could not even afford to start bidding at the opening price because it was so low.
In South Lanarkshire, Panorama found that services deteriorated sharply when Domiciliary Care, the company that won the reverse e-auction, started work. The half-hour appointments for elderly people were reduced routinely so that workers could make all their calls, and one man was fed on crisps and sandwiches. Domiciliary Care has since been taken over by Choices Care Group, which said that it was appalled by what Panorama found and had apologised for the shortcomings. The Scottish Parliament has started a cross-party investigation into the use of reverse e-actions with a view to having them banned for purchasing care.
In England, the CQC warned NHS purchasers and local authorities that it would examine closely what happened to standards of care in areas where e-auctions were used. “We’ll be keeping a very close eye on standards across the health and adult social care sector. Where we see standards slipping, we won’t hesitate to act,” a spokesman said. Martin Green, chief executive of the English Community Care Association, has written to Alan Johnson, the Health Secretary, to alert him to the practice.
The London Procurement Programme, which ran the NHS reverse e-auction, defended its use of the system. Stuart Saw, chairman of the steering board, said: “We are confident the framework will deliver consistent high-quality standards in nursing home care across the capital. Quality has been embedded throughout the procurement process while making the most of taxpayers’ money.”
Four months in a British jail -- on charges that were based on an uncorroborated accusation from one person and later dropped
Otis Ferry on the politically correct British police: 'They put me in jail for my beliefs' Because he supports hunting to hounds
Ferry, 26, who has inherited the good looks and quiet charm that led to his father being labelled the "coolest living Englishman", remains "sickened" that he was locked up for four months in a Category B prison with murderers, rapists and robbers, while awaiting trial on a charge of perverting the course of justice, which was later dropped.
The dismay of Prisoner RB7994 is not, however, directed at his fellow inmates, most of whom he says he liked, but at the police and Crown Prosecution Service (CPS) which he claims targeted him unfairly. "This has been politically motivated. I am a Tory-supporting master of foxhounds, and the current Government is anti everything that someone like me stands for. This is a socialist Government and I am the epitome of everything they detest.
"The police and Crown Prosecution Service were baying to screw me over as hard as they could. The Gloucestershire constabulary are notorious celebrity-hunters – not that I consider myself a 'celebrity'. I hate the word. The pressure from the Crown Prosecution was not normal. They put an enormous amount of effort and money into a bog-standard case."
It is not just Ferry and his supporters who think he was hard done by. Even the judge who had presided over his case after Ferry was accused of perverting the course of justice could not hide his anger at the defendant's treatment when the charge was dropped.
Ferry is no stranger to controversy, and has been arrested at least five times for his pro-countryside and hunting protests. In 2002, he was seized at 4am as he approached Tony Blair's constituency home "armed" with pro-hunting posters. Two years later, he led a famous assault on the House of Commons chamber when he and seven other pro-hunting protesters disrupted the parliamentary debate.
His latest woes began on November 21 2007 when he had been due to ride out with the South Shropshire Hunt, of which he is joint hunt master. Because his hounds were ill, Ferry called off his own hunt and, along with his girlfriend, Francesca Nimmo, and another huntsman drove to nearby Gloucestershire to ride out with the Heythrop Hunt.
However, he arrived late and was struggling to find the main group when he came across an incident in which a pro-hunt supporter clashed with two hunt monitors – widely known as "antis" or saboteurs to the hunting community. What exactly happened next is disputed, but Ferry admits that he instinctively went to the aid of the pro-hunt supporter in his scuffle with two women who were seeking to gather evidence of a breach of the Hunting Act 2004.....
Ferry was taken by police car to Gloucester police station, where he was interviewed and, later, released. In April last year, Ferry was charged with robbery and common assault and a trial date was set for September. Matters then escalated from bad to worse for Ferry, the eldest of four brothers, who was educated at Marlborough College before leaving school after passing 11 GCSEs.
Ferry says he received a mobile message from an anonymous texter just days before the trial, saying that he or she was going to be interviewed by the police. Ferry says he rang the number out of curiosity and found himself speaking to his former groom, David Hodgkiss. He says he was puzzled that Hodgkiss had contacted him, but was unperturbed, especially as the groom had not witnessed the dispute. However, when the police turned up to take the statement, Hodgkiss told them he had been warned by Ferry not to give evidence against him.
Days later, on the first morning of Ferry's robbery and assault trial, Hodgkiss's statement was revealed to the court. The hearing was adjourned until the next day when Ferry was again arrested, this time on suspicion of perverting the course of justice through "witness nobbling". He was interviewed at Stroud police station and, at the insistence of the CPS, refused bail and detained overnight in a police cell. The next day in court, the prosecution lawyer again opposed bail on the grounds that Ferry might re-offend. Judge Martin Picton remanded Ferry in custody, which meant he had to go to Gloucester prison, a Category B institution that houses murders, rapists and violent criminals.
"This really sent a shiver down my spine," says Ferry. "I was handcuffed and booked into this prison with 400 other people. I was absolutely petrified because I had no idea what I might be up against." Initially, he thought he would be in his single cell for just a night. But the jail was to become his home for the next four months. In his 12ft-by-7ft cell, he had a bed, sink, lavatory and colour television. "The first week was a blur. I just could not believe that this was happening to me."
His worst moments were changing from his prison uniform – a grey tracksuit – into his suit to go to court expecting to be released on bail, only to be returned to jail: "Going to court to be denied bail is one of the most crushing experiences anyone will ever experience. It happened to me four times and was completely soul-destroying." ....
Ferry found that most prisoners were pro-hunting. "I hope I did a good PR job for the hunting community – and public schoolboys." He says that fellow prisoners offered him drugs – there was an abundance of cannabis and heroin in the jail. It was an offer he found easy to decline.
In January, after four months in jail, Ferry's lawyers persuaded the judge to released him on bail subject to a £25,000 surety, a pledge to live with his mother in west London, and Ferry reporting to the police twice a week. Two months later, the prosecution indicated in court that it was unhappy with witness "inconsistencies" relating to the perverting the course of justice charge against Ferry. This incensed Judge Martin Picton, who described Ferry's custody as "nonsensical and farcical".
Finally, nine days ago, the Crown accepted Ferry's pleas of not guilty to robbery and common assault charges. He admitted a public order offence and was given a one-year conditional discharge for causing "fear, stress and upset" to one of the hunt monitors. He was also fined £350 with £100 costs. Today, he concedes he was responsible for an "error of judgement" and regrets getting involved in the dispute.
Ferry is unclear about his future but remains committed to country pursuits. "I love animals more than people," he says. "I have always been fascinated by the countryside." He admires foxes but says hunting is important for conservation, as it picks off the weakest, oldest animals, unlike shooting, which can kill a fox in its prime. He says the countryside feels "betrayed, victimised and cheated" by the Government, and, as a Conservative supporter, he is now tempted to pursue a career in politics.
"Hunting is like religion in the countryside. I don't think there is anything I could enjoy more than running my hounds and the hunt. The question I now have to answer is whether I feel I have an obligation to other people to try to safeguard rural traditions."
The chaos of British justice
Largely the fruit of 12 years of Labor party government
Two children a week, on average, die in this country as a result of abuse in the home: sadly, the only remarkable thing about the Baby Peter case was the political and public obsession with it – a consequence of the fact that the death was the second in recent years of a child known by Haringey council to be at risk. Against this background it was always likely that the sentences handed down to those involved in Baby Peter’s death would in turn be the subject of a frenzy of attention – and so it has proved.
The Daily Mail and The Sun have mounted instant campaigns of outrage against what they see as the leniency of the sentences handed down by Judge Stephen Kramer nine days ago. Jack Straw, the justice secretary, initially held the line, stating: “The judge has been clear about the minimum terms they must serve, and such decisions must be for the judiciary.”
Characteristically, the government has now retreated in the face of a further media barrage, and the office of Baroness Scotland, the attorney-general, announced last week that she had “called for the papers in this case since [she ]has the power to refer certain sentences to the Court of Appeal, if after looking at all the facts she thinks the sentence was unduly lenient”.
So here are the facts. It is a recent law, passed in 2004, that obtained a custodial conviction for Baby Peter’s mother. Before it was passed, in fatal child abuse cases where each of two partners denied guilt and blamed the other, and neither could be proved to have caused the fatal injury, there was little the courts could do to hold either (or indeed both) directly responsible for the killing.
Baby Peter’s mother and her boyfriend were convicted under the 2004 act, which introduced a new offence of “causing or allowing death”. Kramer sentenced Baby Peter’s mother to a “minimum” term of five years in prison, which meant little more than three when the almost two years she had already spent in custody were taken into account.
This is what has caused so much outrage. However, the public does not seem to have been made aware of the other aspects of Kramer’s sentencing of Peter’s mother. He, in fact, declared a sentence of 10 years, but under the government’s own rules – which automatically release prisoners by executive order after they have served only half their sentence – that arbitrarily comes down to a custodial “minimum” of five.
Kramer further indicated that he would have passed a higher sentence had not Baby Peter’s mother pleaded guilty to the charge of “allowing” the death of her son and had she not on two occasions sought medical help for Baby Peter unprompted.
Most significant of all, the judge also passed on her an “indeterminate [sentence] of imprisonment for public protection”. What this means is that she will never be released unless, as the judge put it, “the parole board determine . . . you are deemed no longer to be a risk to the public and in particular children”.
The indeterminate sentence for public protection is also a recent form of punishment – it was proposed by David Blunkett as home secretary and became law in 2005. At the time it was suggested that it would apply to only a small number of offenders, but since then judges have handed down almost 11,000 “indeterminate” sentences, and so far fewer than 50 such prisoners have been released. Some indeterminate sentences have been imposed on people whose “minimum” term is less than 12 months: such prisoners are now known as “short-term lifers”.
It is not hard to guess why judges have taken up these sentences with such enthusiasm. Not only are they under perpetual pressure from the Home Office to keep fixed sentences as low as possible because of overcrowded prisons, but they also know that any fixed sentence they pass (itself limited by guidelines) is immediately halved by executive order.
In other words, they are statutorily prevented from ensuring that the punishment fits the crime. No wonder many of them seize on indeterminate sentences as a way of passing the buck to the parole board. Then, if the released prisoner reoffends violently after he has been judged by the parole board to be “no longer a risk to the public”, it is not the judge who will be held responsible.
It is in any case simply a bureaucratic fiction that any parole board knows the likelihood that a released prisoner will reoffend. My wife’s cousin, John Monckton, was murdered by Damien Hanson in 2004, only weeks after Hanson had been released halfway through his sentence for attempted murder, following a parole board recommendation. The board had been impressed by the way that Hanson had attended “anger management classes” in prison: the fact that he would have known such attendance was the sort of visible act that impressed parole boards shows how vulnerable the system is to manipulation.
By contrast, the wrongfully convicted man who refuses to acknowledge his “guilt” can be kept in prison indefinitely. The continued pleas of innocence by Sean Hodgson, released in March after 27 years for a murder he did not commit, had kept him inside long beyond the time served by many dangerous killers – it was only the advent of DNA evidence that showed he had been telling the truth.
One prison psychologist told me, after many years of bitter experience: “We know that a small proportion of prisoners we release on probation will go on to commit rape or even murder; the trouble is, we have no idea which ones they will be.”
He is contemptuous of the fashion for short minimum terms accompanied by an indeterminate sentence, arguing that such custodial packages “don’t take sufficiently seriously what the offender has done, and take too seriously what he might – and therefore might not – do”.
It is very different from the American system, in which indefinite sentences are becoming rare and long fixed sentences without possibility of early release are common. This is at least honest and open: the hallmarks of good justice. Both the public and the criminal know exactly how things stand, which is not the case with the paradoxes and evasions of the English system.
The advocates of our system maintain that it is more humane, since it allows for the prisoner who displays penitence to be released much earlier. Sixty years ago CS Lewis demolished this conceit in his essay The Humanitarian Theory of Punishment. He pointed out that a sentence based solely and inflexibly on the wickedness perpetrated – the concept of just desert, which was increasingly being denounced as “mere retribution” – was the only way of linking punishment and justice.
By contrast, said Lewis, if sentences served were based on a subjective assessment of the rehabilitative process, “grumpy unrepentant prisoners” could be consigned to perpetual incarceration while those cunning enough to “cheat with success” would be freed.
The dystopia foreseen by CS Lewis is now the English system of justice.
British economy losing £4.9m a day - because immigrants send it home to relatives
There is no doubt that if the money were spent in Britain, it would create British jobs
The economy is losing £4.9million every day because of the huge sums immigrants send home to their relatives, official figures show. Analysis by the Office for National Statistics found that £4.1billion was sent out of the UK by migrants working here in 2007. The figure is almost double the £2.3billion sent home in 1998, reflecting the huge increase in the number of migrant workers under Labour. The total amount sent out of the UK over the past decade is £31.5billion.
Britons working abroad are also sending significant sums of cash home to relatives living here. In 2007, they sent £ 2.3billion to the UK, exactly the same level as in 1998. But this still leaves a net outflow from the UK of £1.8billion, or £4.9million a day.
The figures, released in a letter to MPs by National Statistician Karen Dunnell, also show that the amount being sent home in remittances now rivals overseas aid in the support it provides to poorer economies. In 2008, the overseas aid budget was £6.3billion.
Campaign group Migrationwatch UK said the £4billion cost of remittances was the equivalent of the two new aircraft carriers planned for the Royal Navy. Chairman Sir Andrew Green said: 'We are not suggesting that remittances should be stopped - they are an important source of revenue for many families across the world - but claims that there are only positive economic benefits from mass immigration are clearly untrue. 'For years we have been told that immigration can only benefit the economy. But when the evidence is examined, that claim falls apart. 'As employment of foreign-born workers has risen, employment of UK-born workers has fallen. And now we find that remittances have shot up. So much for the benefits of uncontrolled immigration.'
Sir Andrew added that last year the House of Lords Select Committee on Economic Affairs found 'no evidence' that net immigration generates significant economic benefits for the existing UK population. The remittance figures relate to 2007, the latest period analysed by the ONS. But the total for 2008 - when Britain slid into recession - may be even higher, some analysts say.
In a recent speech, Trevor Phillips, chairman of the Equality and Human Rights Commission, predicted that 'as the financial crisis squeezes the developing world' migrants would send home more money 'to see relatives through the bad patch'.
The Government, recognising huge public concern about the scale of immigration when the economy is in such deep trouble, last month reduced the number of work permits available to non-EU migrants. But critics believe the number of non-EU workers is only likely to fall by around 24,300.
Border and Immigration Minister Phil Woolas said: 'People from overseas poured a record £14.2billion into the UK economy in 2007. 'The Government has made it clear that migration only works if it benefits the British people. That's why our tough new Australian- style points system allows in only those workers we need - and no more.'