Thread by @GeorgeJulian

This has had the best legal minds on it, I'm not doubting their skill or ability, but I can't wrap my head around so much in this case and the Supreme Court's judgement. Jackie Maguire was deprived of her liberty, in a

@unitedresponse care home.

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https://twitter.com/TorButlerCole/status/1671457628797452293

If #socialcare truly had parity with healthcare I wonder if the same conclusions would be reached.

I note in the judgement learning difficulties and learning disabilities are used interchangeably, which is deeply problematic given they mean different things.

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Jackie, had complained of sporadic stomach pain for two months before her death [Para 68] but an ultrasound wasn't able to be performed in Dec 2016 as she was upset.

There appears to have been no further interrogation of what could have been done to change that situation.

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From 16 February 2017 it was noted that she was not eating well and was complaining of a sore throat. She suffered from diarrhoea [69]

>>> 6 days before she died of sepsis. The post mortem found a 3 cm stomach ulcer had perforated Jackie’s stomach, resulting in peritonitis

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On 20 February 2017 Jackie vomited and had a raised temperature. She asked to see a GP, but this request was not acted on [70]

>>> Why wasn't it acted on? She's got sporadic stomach ache, a sore throat, diarrhoea, she's vomiting and has a temperature, but no action taken?

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>>>> No action taken despite Jackie herself requesting to see a GP. Jackie who is presented at other points as resistant to medical assistance, but here an opportunity for her to receive medical assistance, at her request, not acted upon, and from what I can see not explored?

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On 21 Feb 2017 one of the support workers at the care home, Susan Egan, noted that Jackie was experiencing breathing difficulties. Later that morning, Jackie asked to see a doctor. Ms Egan did not act immediately on that request [71]

>>> Why? Jackie asks for help. Ignored

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but at 2.55 pm she telephoned Jackie’s GP practice and requested that a GP visit her, as she had suffered a “possible collapsing episode at 2.15 pm” and had refused food and drink. [71 cont]

>>> Jackie's pleas ignored until she ultimately collapses, then staff ring the GP

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The GP’s receptionist told Ms Egan that the request for a visit would be considered later that day. At 3.20 pm Ms Egan telephoned again to report further symptoms. [71 cont]

>>> Left wondering if this was you, or I, would we wait for a GP, or would we go to A&E?

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At 3.36 pm Ms Egan telephoned the NHS 111 service for the North West of England (“NHS 111”), an out-of-hours medical advice service run by the North West Ambulance Service (“NWAS”). [72]

>>> If Jackie was at your house wld you have done this, or taken more direct action?

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>>> Of course we all know that care homes are usually working on skeleton staff, and we hear time and again of people not calling ambulances, and not taking people to hospital themselves because there's no cover for remaining residents

Unclear to me whether that's a factor

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She informed the call handler that Jackie had been vomiting, and described her vomit as being like coffee; she was complaining of terrific pains in her stomach; she had had a fit; and she had been saying earlier that she did not feel well and wanted a doctor

>>> Poor Jackie

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>>> Coffee grain vomit usually indicates internal bleeding, a quick google would inform anyone of that. I think of the number of times I've had to seek medical assistance for family members and just can not imagine opting for GP/111 in this situation, but I'm not an expert

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When asked if Jackie had any physical or sensory disabilities, Ms Egan responded “No”. NHS 111 advised Ms Egan to telephone Jackie’s GP, and Ms Egan explained she had done that already. NHS 111 said that she should try again with a request for a home visit within two hours

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>>> Why just ask about physical or sensory disabilities? Where does learning disability fit within that?

Never mind that elsewhere it states that Jackie tended to use single words to communicate, had Down Syndrome and *was* physically disabled due to curvature of the spine

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The judgement isn't about any of this, the judgement is about the coroner's decision that Article 2 did not apply.

It's detailed, and technical, and you'll have to read it to learn more

16/supremecourt.uk/cases/uksc-202…

The judges said the coroner had examined the systems in place at the care home and concluded there was no arguable breach of the systems duty in relation to them. They decided that he was entitled to find that on the evidence before him.

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It is clear that the systems in place at the care home were capable of being operated in a way which would ensure that a proper standard of care was provided to residents at the home, even though there may have been individual lapses in putting them into effect [146]

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>>> So systems there, individual lapses are what does it.

Except are the systems really there? Are they well enough developed?

Are learning disability providers breaking their backs to ensure people live happy, healthy lives? Given what we know about premature mortality?

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Can't help wondering how many more premature and preventable deaths of learning disabled people will be swept under the cloak of societal indifference as a result of this judgement.

Look forward to the legal analysis that will hopefully follow.

Hope I'm proven wrong

/END