Wednesday, July 06, 2011

McDonald, R (on the application of) v Royal Borough of Kensington & Chelsea

David Cameron, October 2010

The Supreme Court have made a decision in the case of Elaine McDonald a former principal ballerina in the Scottish Ballet. The legal arguments are varied but centre around whether there was a fair review of care conducted, whether the decision infringed Ms McDonald's rights under Article 8 of the European Convention on Human Rights and whether there was a breach of section 21 and 49A of the Disability Discrimination Act (1995) (now superseded by Equality Act 2010)

On a 4-1 majority the Supreme Court have dismissed Ms McDonald's appeal. Whilst the legal principles are important, for most of us they aren't relevant. The crux of this issue is very simple.

"What do we, as a society, think is an acceptable way to treat our elderly people, our disabled people, our sick people?"

The answer from the courts is damning to us all. It says that as a country we find it acceptable to leave our elderly people, our disabled people, our sick people lying in their own piss. All night. Even when that person is not incontinent and only requires a few moments assistance from another person to ensure their dignity and comfort.

Is this what we want for our mothers and fathers? Is it what we want for our grandparents? For a generation who fought for all our freedoms? Is this what we want for ourselves? Even if you don't really care about sick or disabled people one day we will all be old. We will all be vulnerable. We will all learn the lessons of powerlessness, of how it feels to have our lives held in an uncaring hand. When that time comes for you, do you really want to be left in your own urine. All night. Every night. Until you die?


Anonymous said...

Or, to put it another way - a woman who isnt incontinent wants a paid staff member onhand all night just in case she fancies a pee.

Is is so weird to expect that maybe she should do what all parents do with their 3 year olds and not have a drink two hours before bed? Decent social services means providing reasonable support - not lumping taxpayers with another £700pw bill catering to every whim.

Anonymous said...

Even Neanderthals cared for their old, sick and disabled. They fed, clothed and kept them warm and safe evidence shows that they nursed them too healing broken bones and other injuries and gave them valuable shells to trade. Even today Chimps do similar they even hug each other for comfort. Are we a lessor primate tribe to these?

OneOffDave said...

Brave Anonymous should read the full ruling and note that Miss McDonald has a neurogenic bladder, increasing frequency of need to urinate. Reducing her fluid intake to a level that enables her to go all night may lead to irreversable kidney damage.

Using pads all night greatly increases the risk of pressure sores. The last figures I saw about these (c1995) showed they cost the NHS an average of £27,000. In the long run, this course of action is likely tocost more overall than providing the care. This is if you assume that following this course won't shorten her life span.

Elle said...

Dear Anonymous,

This lady was a taxpayer for most of her life and imagined she was paying for care when she was in need. It's not her fault that successive governments squandered her money.

Lying in your own urine and faeces versus £700 may seem like an easy choice when it's not you in the sh*t but if it were, your feelings might change. And, it may be you some day. No one plans to get a long term illness.

Compassion costs nothing.

Anonymous said...

Big Bad Dave. Its simple - use an intermittent catheter before bed. No need for spenco pads. No lost sleep, no overnight staff.

Elle. If you are going to comment on government expenditure, you should at least know that all governments operate a pay as you go system. This years tax take pays for this years services. In 2011 welfare services will cost £355 billion - around £12,600 for every taxpayer. Spending on other essential services is dwarfed by comparison eg the police at £15bn.

The will never be 'enough' money for health and welfare services simply because in every case there is more you could do if you had the cash. A decent society does indeed look after the vulnerable. It also strikes a balance about what is fair levels of taxation for working people on modest incomes trying to raise children and care for their own elderly relatives who are not lucky enough to be across the assessed needs threshold.

Do I feel sorry for the woman affected, yes of course. Do I feel more sorry for her than 10s of millions of refugees displaced by war and famine - no. Does this ex successful high paid ballerina deserve more public support than un skilled low paid factory workers living in substandard housing, sending their kids to sink estate schools and still paying tax to support welfare services for others - no.

Elle said...

Dear Anonymous,

I am not unaware of the math and I do know that the government operates a pay as you go system now but would respectfully suggest that most current OAP's, and indeed most of the population, were/are either unaware of this or would not expect to find themselves in nappies, despite being fully continent, as a consequence of it whatever their age, wealth or health status.

Whilst, I accept your point that expenditure is high and services will be rationed, most of us do not imagine 'balance' (between those paying into and those receiving from the welfare state that we are all committed to) as being achieved from depriving those who need assistance of the dignity, respect and personal care that the rest of us have.

Surely this whole issue is about setting the bar for a de minimus standard of care for everyone and then choosing how to allocate financing. According some people less respect and dignity than others, by limiting access to toilet facilities for example, just because we can is too low a bar, to my mind and to claim that it is justified for cost reason is nefarious.

Many people are alone with their health condition and unable to help themselves. If it were you, your wife, child, parent, in this situation, would you think this decision is acceptable?

I find your last point bewildering. Is compassion in some way limited? Is it OK for someone to suffer because someone else suffers more? That this woman was a highly paid ballerina is irrelevant to the principle being established here which will apply to everyone, rich or poor. And she has paid in a huge amount in her time plus is using all the assets and wealth she gained from her post-tax income to pay for herself at the moment. Her concern is for the time when every penny she has earnt has gone!

I do not think she should get more than someone who is struggling financially but she is entitled to equal support at least.

Best regards, Elle

irishmist said...

Well said Elle. I wonder though why people like Anonymous take the trouble to visit this site, what are they trying to find out? I am totally bewildered by the mindset of this person. The natural need to urinate at night is described as 'fancying a pee', like it's some kind of leisure activity. What if she had an upset stomach. Can you imagine, and I'm sure you can, how that would feel, lying in bed wracked with spasms, soiling your 'nappy', lying there in absolute discomfort until some time in the morning when some overworked and underpaid person came to sort you out.
But of course, Anonymous, this will never happen to you, will it?

Anonymous said...

Shes a prima donna ballerina who wont even consider pads - shes not incontinent and they would reduce the possibility of injuries. Whats the right balance between the cost of night time carer and this lady not being prepared to try the proposed solution ?