Contact Us 0330 1330 235

Request a Callback

Contact Us

CQC experts threaten mass walkout over pay cuts

Hundreds of staff are on the brink of quitting the care home Inspectorate after their roles were outsourced to a private firm – which is making them reapply for the jobs on less than half their pay.





The mass exodus of staff from the CQC threatens to undermine the health and social care regulator’s ability to ensure elderly people are being properly looked after.

The Independent has been told that care home inspections are already being delayed because experts are refusing to work for £8.25 an hour

The experts – who are often people who have personal experience of care services – play a vital role in the inspection process. While CQC inspectors assess staff training files, check regulations and interview managers, the experts sit and chat with the residents and observe how they actually live. Their findings are often included in the inspection report.

Claire Bolderson is quitting her role with the Care Quality Commission after being told by new bosses to expect a large pay cut

The new experts will help carry out around 10,000 annual inspections across London, the South and North of England – three of the four contract regions which were previously managed by two charities, Choice Support and Age UK. Only central England will still be run by Choice Support.

Case study: ‘This isn’t austerity – just insulting’

“I’m about to lose the zero-hours job I love. Maybe “lose” isn’t the right word. But the contract under which I work has been taken away from the charitable sector and awarded to a private company. The new bosses refuse to honour, or even discuss, existing terms and conditions. Instead, they’re offering the same work with a 44 per cent cut in pay (51 per cent for those living outside London).

“For the past two years I have worked as an “Expert by Experience” for the Care Quality Commission, accompanying inspectors on unannounced visits to care homes. Remploy/Maximus have promised to deliver hundreds more “experts” for the CQC. But the budget is tight and presumably they also have to deliver profits for their shareholders. Hence the big cut in our pay.

“In other words, people with expertise and years of experience, selected through a rigorous interview process and then given specialist training, are being offered the Living Wage.

“This is less than my student nephew gets for a match-day shift at the pub. So thanks, but no thanks. There’s austerity, and then there’s just plain insulting.”

Edited extract from Claire Bolderson’s blog, ‘Calling time on my zero-hours job’

Remploy wrote to experts this month telling them their pay would be halved from £17 an hour to the Living Wage of £8.25, or £9.40 in London. As casual staff on zero-hours contracts the experts cannot insist that their previous terms and conditions are maintained.

Remploy’s “derisory” pay offer is outlined in a list of FAQs sent to experts this month and seen by The Independent. The Independent spoke to 10 Experts by Experience. They were frustrated and saddened that the role was being “devalued” by Remploy, a company they had no intention of working for. Many said most of their colleagues also planned to quit – indicating that hundreds of trained experts could be lost.

Enid Irving, in her late 70s, from Islington, north London, has a master’s in gerontology from King’s College, London, and had been going on inspections for several years.

“A lot of us [experts] are older so understand the problems older people have,” she said. “You ask people about their food and see the menu, the entertainment, how they’re cared for and what activities they’re encouraged to do – and this varies enormously from home to home. How could a person on £8 an hour do that job? Age UK are good people. I’ve no idea who Remploy are.”

Claire Bolderson, an expert who published a blog this week announcing she is quitting after two years in the role, said: “Big business has taken over our charity jobs. The elderly and vulnerable will suffer.” She set up a Facebook group for aggrieved Age UK experts and conducted a survey of around 65 people to see if anyone was prepared to join Remploy. Almost 75 per cent said no

“Who are Remploy going to get [to replace them] who will accept that kind of money? And of the people completely new that apply, with no experience, how will they get trained fast enough to begin inspections from Monday?” she said.

She added: “We’ve heard from CQC inspectors, who are also exasperated at the change, that they can’t book any inspections for February because there aren’t enough Experts by Experience yet.”

John Godley, 65, from Leeds said: “I was disappointed when Remploy took over. My role was mainly inspecting elderly and dementia care homes. My father has been in and out of care homes and my mother had dementia so I wanted to give something back.”

University of Southampton experts develop revolutionary new treatment

A cancer cell

BY THE time you go to bed tonight, 910 people in the UK will today have been given the devastating news they have cancer.

It is the harsh reality of a frightening disease which comes in more than 200 different forms and is causing a “massive health burden” which currently sees one in every two people given the life-changing news that nobody wants to hear.

But against the frightening backdrop of what people associate with cancer – the gruelling rounds of chemotherapy, radiation, surgery and illness and the overriding fear that it could claim your life – lies a sparkling glimmer of hope thanks to Hampshire scientists who believe they are finally on the cusp of finding a cure.

The “c” word – cure – is one that scientists and senior medics have never before dared to utter, but one that is desperately needed with more than 150,000 deaths in the UK every year caused by cancer.

But now – in the week when we marked World Cancer Day on Thursday and after decades of painstaking work – researchers in Southampton have developed a revolutionary new form of treatment using a deadly weapon – the patient’s own body.

Immunotherapy will see a person’s immune system supercharged so it can spot and then kill off cancer cells as they appear.

Harnessing the bodies “Killer T” cells, they will be taught to recognise and eliminate the diseased cells in the body by forcing them to bubble up and die. What is more, they could provide people with the long lasting protection against any further cancer growth.

The ground-breaking work has been painstakingly mastered in the city over many decades, but only in the last few years have scientists truly got excited, having seen their research getting real results with patients being treated on new trials at Southampton General Hospital.

Now that work is set to be continued in earnest alongside continuing work to create a cancer immunotherapy vaccine which could be available within 15 years, inside a state of the art £25million hub set to be built in the grounds of the Tremona Road hospital.

The Daily Echo can today reveal how work will officially begin on the site within a matter of weeks, with the research centre of excellence due to open for business by the end of next year.

It will provide 60 new jobs including construction work and will put Southampton firmly on the world stage – with no other centre like it.

Ultimately the Southampton Centre for Cancer Immunology will attract the finest cancer research brains under one roof and transform the lives of tens of thousands of patients who will benefit from their discoveries.

Tim Elliott, professor of experimental oncology at the University of Southampton, will be the director of the new centre and told of his excitement over the advances in immunology treatment that were now being taken from the lab to the patient’s bedside and producing “remarkable” results.

He has worked tirelessly looking at cells in the human body called “Killer T” for the past 35 years and now he is seeing the positive results with cancer patients living longer or in some cases even being cancer free having previously been diagnosed as terminally ill and given only months to live.

He said: “This is the first time researchers have felt comfortable talking about a cure. The excitement comes from the fact that there are now trials of Immunotherapy to drugs.”

Prof Elliott described how some patients with advanced of terminal cancers who have taken part in drug trials have been followed over a period of ten years. One fifth of them are now cancer free.

Half of those diagnosed with “difficult to treat” cancers are also showing significant improvement.

He added: “I think we will see vaccines used in Immunotherapy in patients with all types of cancer within 15 years.”

Speaking about the new research hub – £18.5million of the funding required to build it has been found so far – Prof Elliott added: “It’s fantastic and this week we have revealed that it has been recognised by the Solent Local Enterprise Partnership – that is built on the fact it will be very good for Hampshire and the region. It will create new jobs, not only in construction but also highly skilled technical and research positions.”

Jac Samuel, senior Cancer Research UK nurse, heads up the specialist nursing team offering the trials to cancer patients in Southampton.

She described the immunotherapy breakthrough as transforming the lives of those they care for – and she sees the results first hand.

She said: “What we are working on now will be the treatment of the future,” adding that clinical trials were “absolutely vital” in getting the revolutionary research out of the lab and to the patients.

Without volunteers willing to take the chance to try out new drugs and treatments, nothing would ever be achieved.

Currently recruitment is under way for 16 separate cancer treatment trials being offered in Southampton while another 13 are still in the set-up phase. Trials have targeted multiple cancer forms, from lung, to skin, pancreatic to neuroblastoma.

Work has also been undertaken by researchers into mesothelioma, an aggressive form of cancer commonly found in those who worked in industrial environments, which has claimed countless lives in Hampshire.

Professor Martin Glennie, head of cancer science at the University of Southampton, said the results spoke for themselves.

“More than 90 per cent of patients treated with immunotherapy who have survived more than two years remain cancer free.”

Peter Johnson, professor of medical oncology at the University of Southampton, who also leads the city’s Cancer Research UK centre, explained: “Our new treatments in the form of vaccines and antibodies direct special immune cells against cancers. These ‘killer’ cells can control and shrink cancer and give long lasting protection.”

Professor Iain Cameron, dean of medicine, said ultimately the new centre would save more lives and firmly believes that all evidence points to one day being able to make many cancers curable.


THE construction may be about to start, but there’s still help needed in order to fund the creation of Southampton’s Centre for Cancer Immunology – and your help is needed.

The University of Southampton is spearheading the “The cure for cancer? Youreit” campaign as it continues its work into immunology and the revolutionary drugs that could change the life of a cancer sufferer for ever.

Already the fund has received philanthropic gifts and community support as well as grants from leading organisations – but there is still £6.5million outstanding that needs to be raised.

You can show your support for the campaign by visiting or text YOUREIT to 70660 to donate £3.



Elite Live In Care Are Currently Recruiting for Live In Carers

Contact Donna for more information

Due to high demand for live in care, we’re always looking for the best carers to work with Elite Live In Care Limited.

If you are kind, genuine, committed and looking for a career in care please read on.

Elite live in care has been created to provide the highest quality care and this means we only employ the very best carers.

  • All of our carers are specifically recruited as live-in care carers.
  • No previous care experience is needed as we train to the highest standards at Elite.
  • We value all of our employees and reward them accordingly.
  • We need dedicated, caring, reliable people.
  • You must be eligible to work in the UK.
  • You must be over 18 years of age.
  • You must NOT have a criminal record.
  • You must be willing to participate in training and want to achieve excellence in care delivery.

To express an interest in working with us please email us at

In return for your commitment to Elite Live In Care Limited we offer you;

  • Very competitive pay rates.
  • Training provided free of charge.
  • Free uniforms.
  • Continuous development program.
  • Food allowance.
  • 24/7 Support.
  • Free DBS.
  • Promotion prospects to reward your dedication to excel in care delivery.
  • Be part of a care company run by caring people.
  • Our 100% backing to become a Dementia Friend.

Don’t Just Ignore This Post Act Now Stand Up and Be Counted

Click here have your say click here

Alzheimers' campaigners logo

Dear Steve

This is Geoff. He is 86 and has vascular dementia. Last year, he fell down the stairs and had to be rushed to hospital. Geoff was in hospital for a long time and the care he received throughout his stay was appalling.

Eventually Geoff was told that he could go home, but at discharge he was left alone with his medication. When his daughters came to pick him up, he’d opened it and had started to take it. This should never have happened.

Last month Alzheimer’s Society launched our #FixDementiaCare campaign to make sure that stories like Geoff’s become a thing of the past, but we need your help.

TAKE ACTION >> Send a message to the CEO of NHS England. Demand better care for people with dementia in hospitals

A few minutes of your time will help improve the way people with dementia are treated in hospitals. Send a message to Simon Stevens the CEO of NHS England. Ask him to make sure all hospitals publish an annual dementia statement.

If every hospital in England published an annual dementia statement, everyone would be able to see the quality of dementia care in their area. Not only that, but dementia statements will help motivate hospitals to make the improvements necessary to ensure that people with dementia get the care that they deserve.

We believe everyone has the right to the same, high standard of care and support, wherever they live – and to know in advance what they can expect.

Find out more about our #FixDementiaCare campaign and read our report on dementia care in hospitals here.

Francesca & the Alzheimer’s Society campaigns team




Alzheimer’s Society is a Registered charity no. 296645. A company limited by guarante and registered in England no. 2115499.

Carers suspended over dementia doll ‘torture’

Doll in a tumble dryer
Doll in a tumble dryer Photo: MEN syndication

A care home in Rochdale has suspended two workers following claims they were taunting dementia patients by ‘torturing’ dolls used to comfort them.

A video taken at Ashbourne House nursing home in Middleton appears to show a member of staff throwing a doll to the floor while shouting ‘die baby, die!’ In the video a colleague of the female staff member asks her: “How do you feel that you’ve just done that? How do you feel?”

Doll in a cooking pot
Doll in a cooking pot Credit: MEN Syndication

The woman can be heard loudly laughing, then responding: “Great, because [resident’s name] is upset.”

Pictures also appear to show dolls being strung up by the neck and put into a tumble dryer. The Manchester Evening News report that it’s believed the pictures and video were shared by some staff on WhatsApp.

Doll being pulled along the floor
Doll being pulled along the floor Credit: MEN Syndication

Doll therapy is increasingly used with dementia patients to easy anxiety and engage with loved ones.

Ashbourne House, run by Silverdale Care Homes, accommodates up to 29 people over 65 who need nursing or personal care – including residents with dementia and learning disabilities. Bosses say they are stunned by footage and took ‘on-the-spot’ action within hours of being made aware of the footag

Two members of staff have been suspended pending an investigation. The home has reported the incident to the police and says it is now consulting employment lawyers.

Greater Manchester Police confirmed a complaint had been made. Care Quality Commission chiefs have been informed – and the matter has been passed on to the Health and Care Professions Council and the Disclosure and Barring Service.


“We take this very, very seriously. People like this should not be working in the care industry.

“We have taken immediate action and the appropriate authorities have been informed. We will ensure the people involved in this unfortunate incident are reported – and there will be a full investigation.

“Both members of staff have been suspended and will face disciplinary procedures.

“The welfare of our residents is our highest priority.”

– Carehome spokesperson

The families of residents involved have been informed of the suspensions and told about action bosses intend to take.

The home was told to make improvements following a Care Quality Commission inspection in July last year, with inspectors identifying breaches of the Health and Social Care Act. Officials said some people felt there were areas of improvement for staff regarding their ‘attitude’. They said the service provided was ‘not always caring’.

The first two cases of the Zika virus in the Republic of Ireland have been confirmed.

Aedes aegypti mosquitoes inside a lab

One case is in a man and the other in an older woman. Both have recovered from the infection.

They both have a history of travel to a Zika affected country. The

Republic of Ireland’s Health and Safety Executive (HSE) has said the cases are unrelated.

The World Health Organization has declared Zika a global health emergency as it spreads through the Americas.

‘Not unexpected’

Zika is carried by mosquitoes and has been linked to thousands of suspected cases of babies born with underdeveloped brains.

The US authorities are currently investigating a reported case of the Zika virus being transmitted through sex, but the HSE said neither of the cases in the Republic of Ireland is “at risk of pregnancy”.

It said the majority of people who become infected by Zika virus have no symptoms but the infection can result in a mild illness lasting between two and seven days.

The HSE statement advises people who become ill within two weeks of their return to the Republic of Ireland from an affected area to contact their doctor for assessment.

“The finding of Zika cases in Ireland is not an unexpected event as many other European countries have reported cases as a result of travel to affected areas,” it said.

“The Zika virus is a mosquito-borne infection, which isn’t harmful in most cases.

“However, it may be harmful for pregnancies, as it’s been potentially linked to birth defects, specifically, abnormally small heads [microcephaly].”

The HSE statement added: “While almost all cases of Zika virus are acquired via mosquito bites, one case of sexual transmission of Zika virus has been reported internationally, however the risk of sexual transmission of Zika virus is thought to be extremely low.”

Care homes and the NHS: The silent scandal?

The plight of care home residents has pretty much slipped below the radar in recent years. While there is close scrutiny of everything from A&E waiting times to access to the latest cancer drugs, the support – or rather lack of it – care home residents receive from the NHS has gone almost unnoticed.

But, on Monday morning, the issue bubbled to the surface following a front-page article by the Daily Mail headlined “GPs vote to axe care home visits”.

The fact is that care home residents and their families may well ask what’s new – GPs have long since stopped visiting care homes.

A quick review of the sector in 2012, by the Care Quality Commission, found most of the 81 care homes looked at were not receiving regular visits from GPs.

And it is pretty safe to assume the situation hasn’t improved.

Think about that. These are among the frailest, most vulnerable members of society.

Many are living with a complex range of conditions, including dementia, heart disease and diabetes, with residents on an average of nine medications each.

And yet they are going without the sort of basic health care most take for granted.

Like many problems not given the coverage they perhaps deserve, the issue has been developing gradually over time.

The closure of long-stay NHS beds over the past 20 years or so has meant a cohort of needy, frail people have disappeared from view from the health service.

Before they move into a home, these people will probably be among a GP’s most frequent visitors.

But when they enter a care home, their ability to get down to the local practice diminishes.

They may even move out of the local area.

And GPs, who argue they are struggling to cope with the day-to-day demands placed on them, quickly get consumed by the patients turning up at their door.

What is the care-home sector?

There are 16,500 care homes in England, looking after more than 300,000 residents

  • If nursing homes are included, the number of residents exceeds 400,000 (500,000 across the whole UK)
  • Nursing homes have to have a registered nurse on staff
  • Both care homes and nursing homes work with local GPs, hospital doctors and district nurses


Find out more about care at the BBC’s cost of care website.

Use the BBC’s care calculator to find out how much care costs where you live.

A cancer treatment at the centre of an NHS controversy in 2014 causes fewer side effects in children than conventional radiotherapy, according to new research.

The study, published in The Lancet Oncology, suggests proton beam therapy is as effective as other treatments.

Researchers looked at 59 patients aged between three and 21 from 2003 to 2009.

In 2014 the parents of Ashya King took him out of hospital in Hampshire to get the treatment abroad. Their actions led to a police operation to find them. Ashya, who was five at the time of his treatment, is now cancer free, his family said last year.

All the patients who took part in the study had the most common kind of malignant brain tumour in children, known as medulloblastoma. After five years, their survival rate was similar to that of patients treated with conventional X-ray radiotherapy, but there were fewer side effects to the heart and lungs, the study found.

Dr Yock told BBC Radio 5 live: “The major finding is that proton therapy is as effective as photon therapy [conventional X-ray radiotherapy] in curing these patients and what is also very exciting is that it is maintaining these high rates of cure but doing so with less late toxicity, which has dramatic quality of life improvements.”

The paper said: “Proton radiotherapy resulted in acceptable toxicity and had similar survival outcomes to those noted with conventional radiotherapy, suggesting that the use of the treatment may be an alternative to photon-based treatments.”

Proton beam therapy uses charged particles instead of X-rays to deliver radiotherapy for cancer patients. The treatment allows high-energy protons to be targeted directly at a tumour, reducing the dose to surrounding tissues and organs. In general, it gives fewer side effects compared with high-energy X-ray treatments. It can be used to treat spinal cord tumours, sarcomas near the spine or brain, prostate cancer, lung cancer, liver cancer and some children’s cancers.

Independent expert Prof Gillies McKenna, who is the head of the department of oncology at the University of Oxford, said the research suggested that the “side effects are indeed dramatically reduced” with proton beam therapy.

“There were no side effects seen in the heart and lungs and gastrointestinal tract, which are almost always seen with X-rays, and no secondary cancers were seen at a time when we would have expected to see them in X-ray treated patients,” he added.

But Dr Kieran Breen, from Brain Tumour Research, said there was still more research needed into the treatment.

“In the longer term, we need to try and understand what effects it will have on people and there are many other forms of tumour both in the brain and in other parts of the body,” he said.

Proton beam therapy is currently only available in the UK to treat eye cancers, but patients with other forms of cancer can apply for NHS funding for the therapy abroad.

The first proton beam facility in the UK is due to be made available in Newport by the end of 2016, as a “result of direct investment by the Welsh government,” according to a Welsh Assembly spokesman.

The Department of Health has said that from April 2018 the treatment will be offered to up to 1,500 cancer patients at hospitals in London and Manchester, following investment worth £250m.

Two years ago a dispute about the use of the treatment prompted Brett and Naghemeh King, of Southsea, Hampshire, to remove their son Ashya from a hospital in Southampton against his doctors’ advice. The parents wanted their five-year-old to undergo proton beam therapy in Prague, which had not been recommended by his care team in Southampton. Their actions sparked an international police manhunt, and the couple were later arrested and held in a prison in Madrid. They were eventually released and Ashya’s therapy took place, with the NHS later agreeing to pay for it. A spokesman for University Hospital Southampton NHS Foundation Trust, said that medulloblastoma was not currently on the list of tumours approved for this treatment on the NHS. “However, we welcome any update to the existing clinical evidence on cancer treatments and will follow any expansion of the current national criteria,” a spokesman added.

Key events for Ashya’s treatment

  • Ashya had surgery for a medulloblastoma brain tumour at Southampton General Hospital in July 2014
  • His parents, Brett and Naghemeh, removed him from the hospital on 28 August and sparked a manhunt when they travelled to Spain
  • They were arrested but later released and Ashya was flown to Prague, Czech Republic, for proton beam treatment
  • He had six weeks of proton beam therapy, which cost between £60,000 and £65,000, according to the treatment centre, and which was paid for by the NHS
  • Ashya returned to hospital in Spain
  • In March 2015, Brett King announced his son was free of cancer

GPs vote to axe care home visits: Fears elderly patients will be left with inferior care and higher fees after decision at crisis meeting

  • GPs have voted to stop looking after thousands of care home residents
  • Fears remain elderly patients will be left with impersonal or inferior care
  • Residents could also face higher fees as homes pass on the cost of paying to bring in private doctors
  • GPs want the right to opt out of being responsible for frail patients

GPs have voted to stop looking after hundreds of thousands of care home residents, raising fears that elderly patients will be left with impersonal or inferior care.

Residents could also face higher fees as homes pass on the cost of paying to bring in private doctors.

GPs want the right to opt out of being responsible for frail, highly dependent patients in care homes. This could lead to private firms staffed by unfamiliar locums carrying out visits instead.

The prospect has infuriated campaigners for the elderly – but family doctors say they no longer have the time to provide the right level of attention to such increasingly infirm residents.

The cost of bringing in private providers is likely to lead to higher fees for residents. Around one third of care homes already pay GPs for the service

Many require dedicated care and, in the past, would have been looked after in hospital. There are around 300,000 elderly people in care homes in England and managers are obliged to ensure they are all registered with a GP nearby.

Currently, family doctors carry out routine check-ups once or twice a week, in addition to visiting any who suddenly become very unwell. There are 16,589 registered care homes in England. If they were each attended by a GP once a week, that amounts to more than 860,000 visits a year. Controversially, around a third of GPs charge for such services, with fees ranging of between £12,000 and £100,000 a year

The cost of bringing in private providers is likely to lead to higher fees for residents. Around one third of care homes already pay GPs for the service.

Up to 300 GPs’ representatives from powerful regional bodies voted to end being responsible for care homes at a crisis summit this weekend.

The British Medical Association union may now lobby the Government to remove the responsibility of looking after residents from the GP contract.

The Government is due to announce a new contract later this month, which will then be thrashed out with the BMA.

Officials at the Department of Health admit the union could demand that the clause of care home responsibility is removed from their duties.

Up to 300 GPs’ representatives from powerful regional bodies voted to end being responsible for care homes at a crisis summit this weekend

The British Medical Association union may now lobby the Government to remove the responsibility of looking after residents from the GP contract

But Caroline Abrahams of Age UK said: ‘Older people in care homes are just as entitled as anyone else to good NHS treatment and because many are frail and unwell, continuity of care from a GP whom they get to know is especially important.

‘We would be very concerned at any move which hived off healthcare in care homes into a separate category and which led to more fragmented GP care for residents from an ever-changing cast of characters.’

The vote to be allowed to opt out of care home responsibility took place at emergency summit on Saturday, attended by GP representatives of Local Medical Committees – regional bodies. GPs spent seven and a half hours in Central London discussing the urgent measures needed to avert the looming crisis in surgeries.

Rising numbers of family doctors are retiring or moving overseas just as demand from patients is soaring due to immigration and the ageing population.

They specifically voted to have ‘separate contractual arrangements’ for residents in care home or nursing homes. They could choose to subcontract services to private firms – as happens with out-of-hours care – or do it themselves for far more money.

Residents could also face higher fees as homes pass on the cost of paying to bring in private doctors

Dr Stefan Kuetter, a GP in Marlow, Buckinghamshire, who proposed the motion to end care home visits, said: ‘You can’t say no for fear of being labelled uncaring or missing something. Time spent in care homes is disproportionately higher than time with other patients.’

Dr Sam Hilton, who practises near Exeter, said care home residents could only be properly looked after by GPs doing ‘ward-rounds’ – like those done in hospitals. But he said there was ‘not enough time’ as this can take a half-day for a dozen patients.

Dr Chaand Nagpaul, chairman of the BMA’s GP Committee, pointed out that many ‘seriously ill’ patients were being moved out of hospital into care homes.

But Simon Bottery of the charity Independent Age said it would be ‘totally unacceptable’ for GPs to halt care home visits.

‘There is a real risk that this could result in a second-class service for residents,’ he said. Joyce Robins, of Patient Concern, added: ‘The whole point of having a family doctor is that its someone who has known you for years and who you trust.’

GPs also voted to demand the Government increase their funding by 43 per cent, in line with the demand from patients.

A Department of Health spokesman said: ‘GPs are contracted to ensure their patients receive full and proper standards of care – and that includes carrying out home visits where necessary.’