Category Archives: News and Interest


What makes a care home outstanding?

Less than 1% of homes are rated as outstanding – all share three common attributes.

Click here for a guaranteed way to improve a Care Homes CQC and Care Inspectorate rating

Around 80% of care homes for older people, in England, have been rated by the Care Quality Commission (CQC). So far, approximately 62% have been rated good, 37% as requires improvement or inadequate and just less than 1% are outstanding. Following up on my Care Home Inquiry, I have spent time reading the reports on those outstanding care homes and visiting them to try to understand their secret. What has enabled them to achieve this rare accolade?

Outstanding care homes share three common attributes:

  • They have an outstanding manager who is well supported and valued.
  • They have sufficient resources to do the job well and these resources are invested in the service. An outstanding care home wholly reliant on state funding is an incredibly rare thing.
  • The provider organisation’s values and ethos are clear and effectively translated from the board room to the floor of the care home. Profit is never the raison d’être of these care homes.

The ratings concentrate on individual homes but what of the effectiveness of providers in ensuring consistently high ratings across their portfolios? Are there outstanding care organisations as well as outstanding care homes?

Small private providers run the majority of outstanding care homes; typically they have only one or two homes in their portfolio. A clear majority of larger providers, whether for profit or not, struggle to achieve consistency. When you find an outstanding care home in a large provider organisation you commonly find one rated as inadequate or at least some that require improvement, in the same stable. Providers with solidly good or outstanding ratings across their stock are very rare.

To learn from these rare providers, I’ve visited and spoken to some of them to find out how they do it. What I found is that they work incredibly hard at ensuring adequate resources and an unflinching dedication to championing quality. But they are still highly reliant on recruiting good managers. They are aware that all their efforts in auditing, quality assurance and governance will have little effect if the manager is not well supported, confident and competent in their role. You can’t standardise care homes like burger joints. They need to be resilient in themselves.

The recent Skills for Care briefing on registered managers (pdf) highlighted that one in four care homes lose their manager each year and the figure is one in three for nursing homes.

More than half of all care home managers are over 50. Recent evidence suggests that managers are finding the role almost untenable as the complexity of their job grows and they face an external regulatory system increasingly adversarial and critical. In all but the very best organisations, they feel vulnerable and alone. The role of registered manager is a challenging one. Even a small care home will have a turnover in the millions, a significant workforce and more rules and regulators than you’d care to count. Even so typically salary levels are only in the mid £30k range. No other sector bestows so much responsibility on its management cohort with so little recognition or reward.

Inspection on its own will not improve the quality of care homes consistently across the sector. Yes it can provide the impetus for an individual service to improve but it doesn’t stop the previously good care home slipping into trouble. Inspection only weighs the pig, it doesn’t nurture it and help it grow.

One of the first outstanding care homes I visited, in mid-2015, was recently inspected again and rated as inadequate. It went from wow to awful in a matter of months. The primary reason was that the manager left. Neither the external regulators nor the parent organisation were able to prevent this decline.

We can’t continue to put all the responsibility of quality on to individual services. We have to recognise that care homes need to be supported, not just held to account.

If we want our care homes to be good, commonly and consistently, we should be recognising the fundamentals that underpin quality care. If registered managers are the fundamental primary keystone of quality why are we making their jobs so hard? Why are we driving them out? If we want the best people to run our care homes, we have to give them more status, better rewards and make their job easier.

This is why registered managers need a national professional body. It would set professional standards, provide support and development and crucially give this essential profession status at a national policy level. They are currently an unheard and unacknowledged voice. They need some power to balance their responsibilities.

Social care is crying out for leadership. There are many things we need to do to support care homes to be good. Investing in registered managers would be a positive start.

Source The Guardian



Gene Wilder might have spoken openly about his Alzheimer’s if dementia wasn’t one of the most stigmatised illnesses of our time

I remember my father being brought back home by the police because he’d been found wandering down the central reservation of a dual carriageway. Understandably, his diagnosis came with a lot of fear. But we need to face up to dementia’s realities and tackle the stigma surrounding it.

I was saddened to hear this week about the death of the late, great Gene Wilder as a result of complications of Alzheimer’s disease.It transpired that the man who brought so much laughter to so many people thanks to his comic genius had lived with dementia for a number of years – something which I know, through personal experience with my own father, can be frightening.

It was extremely moving to read from Wilder’s family that they, and he, had decided to keep his dementia a secret so that children who knew him as Willy Wonka would not equate the character with an adult disease. “This illness-pirate, unlike in so many cases, never stole his ability to recognise those that were closest to him, nor took command of his central gentle life-affirming core personality,” their statement read. “It took enough, but not that.”

Understandably, Gene’s family wanted him to be remembered for his legacy, for children to smile when they thought of him and not define him by an illness – not least dementia, a condition that children the world over still know relatively little about. And it was Gene’s decision not to release the details of his illness after he was diagnosed, apparently so that children wouldn’t be upset or frightened by the association of Willy Wonka with a frightening adult disease.

There can be no doubt that having dementia – a term which describes a set of symptoms that may include memory loss and difficulties with thinking, problem-solving or language – can have a profound and devastating impact on the person with dementia and the people who surround them.

Before my own Dad developed dementia – and long before I came to work at Alzheimer’s Society – I must confess I didn’t know much about it myself. Back then, it was often seen as the ultimate death sentence and simply wasn’t spoken about.

With my father, that diagnosis was steeped in fear, often a very physical fear about his personal safety.

He used to go wandering off to go to the off-licence. I remember him being brought back home by the police because he’d been found walking down the central reservation of a dual carriageway.

 Nowadays, the stigma surrouding the disease is slowly being broken down. I’ve dedicated myself to working with children and young people to try and create a “dementia-friendly” generation – perhaps in the future, that means that icons won’t feel as worried about revealing dementia to the adoring younger generations of fans.

We have a long way to go until society displays full acceptance, inclusion and support for people living with dementia and their carers. Research shows that dementia is still the most feared health condition of our time, with people continuing to put off seeking a dementia diagnosis or talking to others about the way in which living with dementia affects their lives – and the lives of those around them.

While the way in which an individual chooses to live with a dementia diagnosis is their choice, and Gene and his family were well within their rights to keep his diagnosis private, I want people to know that it’s OK to be open. Counter-intuitive as this may sound, not everything about a dementia diagnosis has to be doom and gloom.

The staff on our National Dementia Helpline can provide information, support, guidance and signposting to other appropriate organisations and can be contacted on 0300 222 1122. Read more about how Alzheimer’s Society’s Dementia Friends initiative is changing the way people think, act and talk about dementia

Source The Independent


Blood-sucking ticks which can paralyse and kill humans with ONE bite invade UK

Experts say a new breed of the quick-spreading brown dog tick is fast becoming a UK epidemic.

Their rapid growth as summer looms has been helped by our unusually warm winter.Pest control firms say the parasitic bugs now here are variants from Europe – and bring with them a deadly threat to Brits.Worringly, they now believe the critters – which carry potentially-fatal Lyme Disease – are currently breeding in thousands of UK homes.

The tiny bugs can induce paralysis with one bite, leaving victims in wheelchairs and facing years of painful treatment. The infection can lead to death.
Typically found in warmer climates, these are like regular ticks only a nastier, ramped-up version of the blood-suckers familiar to the British Isles.Unlike the typical tick these nasties can survive inside for up to 18 months without feeding – sparking fears that they are already lying dormant in Brits’ homes before coming out to feast this summer.Female ticks can lay up to 4,000 eggs at time – usually in cracks or crevices in a house.

Pest control experts Rentokil told Daily Star Online they had been warned about an invasion of the new strain of critters in the UK.David Cross, head of the company’s Technical Training Academy explained it would be very difficult to control the bugs – as experts are still learning about how it survives.He said: “The brown dog tick behaves very similarly to bedbugs but it can survive indoors.

“They are very new to the UK – we were alerted about them 12 to 18 months ago but they could already be here.

“It’s hard to advise the public as we are still finding out more about the tick.

“However, traditional ticks found in Britain are usually picked up when people are walking their dogs or when sitting on the grass.

Mr Cross explained that the brown dog tick carries Lyme Disease – a bacterial infection that nestles in the nervous system and can cause brain and spinal cord inflammation – as well as frequent pain and paralysis.And fears of an epidemic come as campaigners and sufferers gather outside Parliament Square today to protest the UK Government over a condition that is seeing 3,000 new cases a year in the UK.

Source The Daily Star


Cardiff University dementia genes study breakthrough hope

Scientists in Cardiff say they are on the verge of an “enormously exciting” breakthrough in understanding the causes of Alzheimer’s disease.

Their study will suggest the body’s own immune system could be attacking brain cells of those genetically susceptible.

It builds on global studies identifying 30 genes linked to the disease.

About 45,000 people in Wales are thought to be living with dementia, with Alzheimer’s the most common form of the illness.

For years, scientists have been looking at a small number of genes which apply to very rare forms of Alzheimer’s but they have been trying to find the ones which apply to more common forms of the disease.

To do that, they need to study of the genes of far greater numbers of people.

Forty research groups led by scientists in Cardiff, France and the United States have been working more closely together and have now pooled a worldwide database of 90,000 samples.

“We’re about to submit a paper that is enormously exciting and which I think will really change, without a doubt, what we think of Alzheimer’s disease going forward,” Professor Julie Williams, head of the research team at Cardiff University, said.

“Over the last five or six years we’ve been successful in identifying 30 genes that increase – or decrease – your risk for Alzheimer’s disease.

“Now this is telling us what some of the major components in disease development are. It’s new, it’s exciting; it’s a different perspective on what Alzheimer’s disease is.”

A lot of dementia research over the last two decades has been looking at a few elements in brain behaviour such as amyloid plaques – the tangles that occur within the neurons.

Prof Williams said now they were looking at something different – backed by genetics – which is the immune response in those people who go on to develop Alzheimer’s disease.

“Our immune response is about how the brain keeps us safe, it’s about getting rid of things which might invade the brain, getting rid of nerve cells and bits that go wrong,” she said.

“It has a very complicated set of activities and some of those are actually, I think, dismantling the brain at its roots.”

One of these involves a pruning function which is quite normal and helps our brains develop as we grow.

But now scientists believe it is triggered again in some people as they get older and actually eats away at synapsis [connections between nerve cells] and brain cells.

Researchers will also look at how factors such as lifestyle and exercise could play a part.

Cardiff University’s range of scanners at its new £44m brain imaging research centre Cubric will be used in the research.

It includes Europe’s most powerful brain scanner – which has been described as the “Hubble telescope of neuroscience”.

One research project is targeting 180 people in the Cardiff area, aged between 40 to 60, to help study the genetic risks of Alzheimer’s and how issues like lifestyle and obesity interact.

Volunteers will be given MRI scans as well as having blood and saliva samples taken.

Cardiff University is also looking for volunteers for research into early onset dementia.

Meanwhile scientists in Bangor have developed new ways of helping individuals develop new skills or re-learn skills they have lost, and lead projects allowing patients to create visual art.

They are looking into ways to communicate with patients who have lost the ability to speak.

Prof Williams said: “It’s great people are living longer, it’s something to celebrate but it means there will be more disease out there and Alzheimer’s and dementia will be up at the top of that list unfortunately.”

Source BBC News

Mobile game Sea Hero Quest ‘helps dementia research’

Dementia researchers have developed a video game that could lead to the development of early diagnostic tests for the disease.

The way players navigate the 3D levels in Sea Hero Quest will be anonymously tracked and sent to the researchers.

Understanding how people navigate 3D environments is important because the skill is often one of the first lost by people who have dementia.

Researchers say the game could generate an unprecedented amount of data.

“We have never seen anything undertaken in dementia research at this scale before,” said Hilary Evans, chief executive at Alzheimer’s Research UK, one of the organisations involved.

“The largest spatial navigation study to date comprised fewer than 600 volunteers.

“Providing the research community with access to an open-source data set of this nature, at this scale, in such a short period of time is exactly the kind of innovation required to unlock the next breakthrough in dementia research.

The free game was developed by the charity, researchers from University College London and the University of East Anglia, with the backing of communications giant Deutsche Telekom.

Players follow a sailor’s quest to revisit some of his father’s memories, and battle fantastical sea creatures.

The routes they take will generate global “heat maps” that will show researchers how people generally explore 3D environments.

The ultimate goal is to develop new diagnostic tests that can detect when somebody’s spatial navigation skills are failing.

Researchers from UCL said the game generated useful data about 150 times faster than lab-based experiments.

“In my research team, I could only test about 200 people a year, and that’s working hard,” Dr Hugo Spiers, from UCL, told the BBC.

“But last night I tested 200 people in one minute with this game.”

Players can opt to reveal their gender, age and location to the researchers, although they can choose to take part completely anonymously.

“This project provides an unprecedented chance to study how many thousands of people from different countries and cultures navigate space,” said Dr Spiers.

“It’s a massive online citizen science experiment that will give us an idea of what is ‘normal’ through this game.

“If we tile that information together, we can get a sense of how dementia changes over a lifetime, and other demographic factors.”

Dr Spiers stressed the game was not itself a test for dementia.

“If you’re worried about your memory or any changes to your health, speak to your GP,” he said.

The researchers plan to share the first results of their data collection in November.

Source BBC News

Is a sexually transmitted yeast infection making people mentally ill?

Yeast infections and a malfunctioning immune system could ‘disturb those brain processes that are important for memory’, researcher says

A sexually transmitted yeast infection has been linked to schizophrenia in men and also appears to damage the memory of mentally ill women, according to new research.

The Candida albicans fungus is usually present in the human digestive tract, but if it grows to much it can cause burning, itching, thrush in infants, and a genital infection in adults.

The study found 26 per cent of 261 men with schizophrenia were producing immune-system antibodies designed to fight a Candida infection, compared to 14 per cent of those without the conditnd, while there was no similar pattern in women, those with schizophrenia and the highest Candida antibody levels performed significantly worse in tests of their memory.

Professor Emily Severance, of the Johns Hopkins University School of Medicine, stressed while they had found a link between the yeast infection and mental illness, it was “far too early to single out Candida infection as a cause of mental illness or vice versa”.

“However, most Candida infections can be treated in their early stages, and clinicians should make it a point to look out for these infections in their patients with mental illness,” she added.

“Although we cannot demonstrate a direct link between Candida infection and physiological brain processes, our data show that some factor associated with Candida infection, and possibly the organism itself, plays a role in affecting the memory of women with schizophrenia and bipolar disorder, and this is an avenue that needs to be further explored.

“Because Candida is a natural component of the human body microbiome, yeast overgrowth or infection in the digestive tract, for example, may disrupt the gut-brain axis.

“This disruption in conjunction with an abnormally functioning immune system could collectively disturb those brain processes that are important for memory.”

Professor Severance added Candida infections can be avoided by reducing sugar consumption, avoiding unnecessary antibiotics and maintaining good hygiene. Normally Candida is controlled by friendly bacteria in the body and the immune system.

The researchers, who published a paper on their work in the journal NPJ-Schizophrenia, now plan to look into whether there is a cause-and-effect relationship between Candida infections and memory problems.

Last year, a separate study published in Nature Communications suggested anxiety and depression could be linked to bacteria in the intestines.

Source The Independent


Germany to legalise cannabis for medicinal purposes

Germany is to legalise cannabis for medicinal purposes early next year, the health minister said on Tuesday.

“Our goal is that seriously ill patients are treated in the best possible way,” said Hermann Groehe, who will present draft legislation to the German cabinet on Wednesday.

The draft bill comes as many parts of the world are relaxing laws on cannabis use and medicinal marijuana is gaining popularity to ease suffering from cancer, glaucoma, HIV or AIDS, Hepatitis C, Parkinson’s disease and other serious conditions.

However, the issue of recreational and medical cannabis use is controversial in many countries, as opponents fear crime connected to drug abuse and addiction. Some argue pot use could lead to dependence on harder drugs.

Groehe acknowledged that cannabis was “not an inoffensive substance” and stressed that cannabis would be available from pharmacies only on prescription.

Until specially supervised plantations have been established to grow cannabis, Germany will import “medical marijuana”, the minister added.

“Without wishing to pre-judge the work of the Bundestag (lower house of parliament), it is likely that the law will come into force in the spring of 2017,” Groehe told German daily Die Welt.

Source The Telegraph

Campaigners ‘disappointed’ as muscular dystrophy treatment denied

A new drug used to treat the underlying causes of Duchenne muscular dystrophy has been rejected for routine use in Scottish hospitals.

Michael Young, nine, who has the condition, recently lobbied Nicola Sturgeon campaigning for the treatment.

The Scottish Medicines Consortium (SMC) said it was not satisfied that routine use of ataluren would “represent a good use of NHS resources.”

It said there was “uncertainty” over health benefits in relation to cost.

SMC chairman Prof Jonathan Fox said it was “disappointing” that the committee was unable to recommend the drug, whose trade name is Translarna, for routine use.

He said: “We know that DMD significantly reduces life expectancy and the committee heard about its profound impact on people with the condition, their families and carers.

“There is a clear unmet need for an effective treatment for this devastating condition.

“Despite the very powerful and moving testimonies given by patient groups and clinicians for this medicine, there was uncertainty around the overall health benefits in relation to the medicine’s cost and the committee was not satisfied that it would represent a good use of NHS resources.”

‘We are bitterly disappointed’

Michael, from Larbert in Stirlingshire, took part in a clinical trial during the development of Translarna.

He wrote to Ms Sturgeon explaining about his condition and asking for her to “help boys to keep walking”.

The first minister explained that the assessment procedure had to be “entirely independent of government”.

PTC Therapeutics, the company which develops the treatment, is expected to resubmit the drug to the committee.

Muscular Dystrophy UK’s chief executive Robert Meadowcroft said: “We are bitterly disappointed by today’s announcement.

“Our thoughts are with the Scottish families whose every hope has been pinned on this decision.

“They have endured an 18-month wait for news about a drug that could transform their sons’ childhoods, only to receive this blow today.

“We are now calling on Translarna’s producers to negotiate a sustainable price and to work with the SMC towards a solution, to ensure Scottish families don’t miss out on a drug that could transform lives.”

The SMC said in a statement: “The committee was unable to recommend ataluren for routine use in NHS Scotland for patients with Duchenne Muscular Dystrophy (MD).

“The treatment is licensed for use in those patients with a rare genetic mutation that affects 13% of those with the condition.

“Duchenne MD is life limiting disease which causes muscle wasting.

“The committee was unable to recommend ataluren as there was too much uncertainty about the overall clinical benefits it might bring in relation to its cost.

“Following a meeting between the company and SMC, the company has indicated their intention to resubmit.”

The committee accepted three new medicines for routine use in Scottish hospitals.

These were everolimus for advanced breast cancer, isavuconazole for serious fungal infections and camellia sinensis for genital and perianal warts.

Eculizumab, which is used to treat rare genetic blood disease Paroxysmal Nocturnal Haemoglobinuria (PNH) was also rejected for routine use along with ataluren.

Source BBC News

Spike in deaths ‘due to dementia and flu’

 A spike in the number of deaths in England and Wales last year was due to an increase in dementia and respiratory diseases such as flu among older people, according to official figures.

The peak happened in the early months of 2015 when flu was common, according to the Office for National Statistics.

People with dementia were particularly vulnerable to flu, figures show.

2015 saw the largest rise in deaths in England and Wales in over a decade.

Last year there were 529,613 deaths registered in England and Wales, an increase of 5.6% compared with 2014, with 86% of the extra deaths occurring in the over 75s and 38% in the over 90s.

Claudia Wells of the ONS said: “The majority of the increase in deaths in 2015 happened during the first few months of the year, coinciding with an increase in hospital admissions for flu and reports of numerous outbreaks of the virus in care homes.

“Respiratory diseases, such as flu, were also mentioned in a third of deaths from dementia and Alzheimer’s last year.”

Prof John Newton of Public Health England added: “A range of factors can push up the number of deaths in older people in a particular year.

“An outbreak of flu can have a big impact, especially on those who are most vulnerable or experiencing other illnesses, such as dementia.

“An increase in deaths will generally lead to a decrease in life expectancy that year, but we have seen these annual fluctuations before and the overall trend has remained positive. ”

‘Devastating impact’

Hilary Evans of Alzheimer’s Research UK, said the report by the Office for National Statistics “further underlines the devastating impact of dementia and the scale of the challenge we face”.

The main flu virus in 2015 was a strain known to target older people.

There were outbreaks in care homes and admissions to hospital and intensive care for flu were higher than usual.

There was also evidence that the flu vaccine was less effective than expected.

The large increase in deaths in the early part of 2015 was not repeated in the early part of 2016.

In Scotland, registered deaths in winter 2014/15 were at their highest level since winter 1999/2000, according to National Records of Scotland.

In 2014/15 there were 870 excess winter deaths in Northern Ireland, the highest since 2009/10, the Northern Ireland Statistic and Research Agency found.

Jeremy Hughes, chief executive of Alzheimer’s Society, said: “These findings serve as a stark reminder of the need for good community care to support the most vulnerable.

“People living with dementia often have a lowered immune system and so are at a greater risk of contracting flu viruses. The condition also makes it harder for people to look after themselves and in the cold winter months this can become a real danger.”

Source BBC News

Scientists discover ‘dementia gene’ boosting hopes of preventing strokes and even Alzheimer’s disease

A gene that triggers stroke and dementia by damaging vessels in the brain has been discovered, offering hope of new drugs for the two most common neurological conditions.

The gene blocks off blood flow denying the organ essential oxygen and nourishment, without which neurons die.

The finding, published in the journal Lancet Neurology, may help researchers better understand, treat and prevent stroke, and perhaps Alzheimer’s disease as well.

Stroke is the leading neurological cause of death and disability worldwide. In the UK it kills about 40,000 people a year, making it the third largest cause of death behind heart disease and cancer.

Previous studies have looked mainly at genes causing hardening of the arteries, known as atherosclerosis, and those behind blood clots that cause a form of the disease called ischaemic stroke. A different set have been associated with haemorrhagic stroke, or bleeding into the brain.

US scientists conducted what is known as a genome-wide association study to identify genetic variations in the DNA of stroke victims, and also a meta-analysis, where data from previous research is pooled into one big set.

This pinpointed a new gene called FOXF2 which increased the risk of having a stroke due to disease affecting the small blood vessels in the brain.

Read more: An apple or banana a day CAN keep the doctor away

No previous study has identified a gene for the common type of small vessel disease stroke although some genes associated with a form of the condition that runs in families, such as CADASIL, are known.

Professor Sudha Seshadri, of Boston University, said: “Our research has identified a gene affecting another type of ischaemic stroke, due to small vessel disease, and also suggests some genes may be associated with both ischaemic and hemorrhagic stroke and may act through a novel pathway affecting pericytes, a type of cell in the wall of small arteries and capillaries.

“Unravelling the mechanisms of small vessel disease is essential for the development of therapeutic and preventive strategies for this major cause of stroke.”

According to the researchers small vessel disease not only causes stroke but is also a major contributor to dementia risk, and is associated with gait problems and depression.

Prof Seshadri added: “Hence, it is exciting we are beginning to better understand the cause of this very important and poorly understood type of stroke.”

There are around 850,000 people with dementia in the UK, with numbers set to rise to more than a million by 2025.

Source The Mirror