The #Rotherham #UKIP fostering row: Further details emerge

Another day, another set of details emerge about the UKIP fostering row. This time courtesy of the Daily Mail. I’ve said before that I’m not comfortable with the way a sensitive case about vulnerable children is being played out and discussed in the media, but since other people are clearly going to comment on the case, I suspect throwing a tuppence forth from this little blog isn’t going to make much difference in the grand scheme of things.

Last week the Guardian alluded to tensions between Rotherham Council and elements of the local East European community, and yesterday’s Daily Mail fills in some of the blanks regarding this. Apparently the council has been the subject of protests from Slovakian families following a number of removals of children into foster care. These families are accusing the council of “child-stealing” for racist reasons and of trying to impose British values on them. This has led to protests from the Slovakian government who appear to be taking the side of the families.

Though the “British values” in question appear to be things like children going to school, not wandering the streets at 2am, and not living in a mice infestation.

The Mail being the Mail, they don’t appear to see any irony at all in, a couple of weeks after accusing the council of ideologically-driven fixations with multiculturalism, then granting a fairly uncritical interview with an alleged abuser, strongly suggesting that the council are racist towards East Europeans.

The words “shot at from both sides” spring to mind.

And naturally, there’s a rentaquote from John Hemming, an MP who seems to live in a strange parallel world where child protection proceedings are nearly always due to scheming, malicious social workers and hardly ever about averting another Victoria Climbie or Baby Peter.

These arguments appear to have been made in the courts as well as in the media and council meetings, apparently with some success. As the Guardian said,

But a family court judge ruled three of the children should be returned to the parents after the birth parents successfully argued that the council had failed in their duty to ensure the children enjoyed the linguistic right to learn and speak the language of their birth.

In the light of the Guardian and Daily Mail reports, I’m going to make a rough educated guess at the backstory here, which may or may not have to amended as further details emerge into the public domain.

It seems likely that the council would have been anxious to avoid a repeat of this judicial ruling. It also seems likely that they may have been vigilant for anything that would be immediately be pounced upon by the birth family’s lawyers, by the Slovak protesters, possibly even by the Slovakian government and media.

Something like the foster carers being members of UKIP. They may well have been doing a perfectly good job as carers, but that wouldn’t be what the family’s lawyers would say in court.

One could argue that the local authority should have challenged the judicial rulings, ignored the Slovak government and media, and served up the local Slovak community a hefty slice of if-you-don’t-like-our-rules-you-don’t-have-to-come-here. I’ll leave others to argue that one out.

But either way, the application of Occam’s Razor doesn’t require the council to be acting out of an ideological crusade about multiculturalism, or a Labour-inspired grudge against UKIP, in order to have acted in this way.

It certainly doesn’t require any David Icke-style conspiracy theories about Common Purpose.

Such a scenario is entirely consistent with the local authority trying to tiptoe around one set of legal, social and political grenades, and in doing so accidentally setting off a completely different grenade. And that’s my guess as to what’s happened. Eventually time will tell whether I’m right or wrong.

One thing this case does show is how complex and difficult fostering cases can be. When such cases are seized upon for political reasons, whether by UKIP or the Slovakian government, such complexities and difficulties are rarely grasped.

The #Rotherham #UKIP Case – Will Nigel Farage and Michael Gove now apologise?

When the story broke that three children had been moved from a foster family in Rotherham, reportedly for being members of UKIP, I went out and talked to social workers, solicitors and care leavers. Consistently I got a response that the reported account was implausible, and there was almost certainly a more complex story to it. I put up a blog post saying so, and got a barrage of responses, much of them abusive.

Now a more complete picture is coming out about the affair. And – surprise, surprise – it was more complex than that. The details emerging are not of politically-crusading social workers with a grudge against UKIP, but of a difficult court case, dealing with distressing circumstances, with social services trying to comply with court rulings and fend off legal counter-arguments from the birth family.

This was not a case that should have been played out in the public domain like this. These are incredibly vulnerable children and their privacy has been invaded in an atrocious manner. I’m not going to repeat the details here (though people can just go to the Guardian for that)  but the distressing nature of their abuse gives a clear reason why such matters should be kept confidential. Not because social services have anything to hide, but to safeguard the wellbeing of the children.

A badly-handled interview with Joyce Thacker, Rotherham’s director of children’s services, didn’t help. Though with hindsight this is likely to be partly due to being caught on the hop on a Saturday morning, and also partly due to trying to be careful about what she said about a complex case. It may have been better for the council to have simply put out a “no comment” rather than trying to rush out an interview at the weekend.

Quite possibly the foster carers may well now have some difficult questions to answer about the way they went to the media and ignited a political firestorm. But politicians also have some questions to answer about the way they conducted themselves in this case. Nigel Farage practically turned  the whole thing into a party political broadcast for UKIP. Then there’s Michael Gove, the minister responsible for children’s services. He called it “indefensible” though in fact it turned out to be totally defensible. He also called it “the wrong decision in the wrong way for the wrong reasons”. Did he even know the way or the reasons when he said that? Was he even interested, or was he simply putting the Rotherham by-election before his ministerial responsibilities?

Ed Miliband emerges only marginally better in that, unlike Gove and Farage, he admitted he didn’t know the facts of the case and limited himself to calling for an investigation.

If politicians were cynical and opportunistic, some in the media were even worse. For example, the inexplicably-respected blogger Guido Fawkes ran an absolutely barking mad article. “Rotherham’s UKIP Child-Catcher Joyce Thacker Follows Common Purpose Progressive Agenda.” He leapt on a set of conspiracy theories, straight from David Icke territory, that accuse a rather dull training company called Common Purpose of trying to rewire our society along a “Marxist and Fabian” agenda. He concluded.

Thacker is yet another graduate of the Common Purpose organisation which pursues a“we know best” Fabian-style progressive agenda in the public sector. She was a project advisor for a pilot programme, run by Common Purpose, that was concerned with diversity issues in the West Yorkshire area. Something tells Guido she has an axe to grind in this and is not a neutral public servant…

Something tells me that Guido had better hope Ms Thacker doesn’t find herself a decent no-win-no-fee libel lawyer.

Nothing good has come out of this affair. Vulnerable children have had their privacy invaded. Hardworking and honest public servants have been grossly slandered. And why? For short-term political gain in a by-election. The likes of Nigel Farage, Michael Gove and Guido Fawkes need to apologise for their shameful behaviour in this ridiculous and unpleasant case.

Familiarity Breeds Contempt

Over the course of the past months, who could help but feel a plethora of emotion as the horrors of Winterbourne View have unfolded before our very eyes: Absolute disgust that an organisation could get to the point where such blatant institutional abuse becomes a part of daily life, anger at the systems in which we work as they are revealed as insufficient to protect the most vulnerable in our society or perhaps a heart-wrenching empathy towards the vulnerable and a passion that things have to change and something done… but what?

It will hopefully have challenged us all as a professionals.  Is it just possible that as we go about our business there is a very real danger of becoming complecent unless we keep on out toes and remain true to our professional standards and ethical practices?  I’ve been reminded how very important the role of those who commission services and the need for greater accountability when choosing services for individuals who can’t choose for themselves.   Are we pressured into choosing the cheaper option even when we know in our heart that it isn’t the most suitable?  Do we sigh a sigh of relief and accept without question when we find a service that will accommodate the individual with particularly challenging behaviour knowing that the option will be limited? Do unrealistic case-load sizes prevent us from spending time to think outside of the box and identify the very best service and then think how it might be achieved? Do we have a professional relationship with providers when a less formal relationship can be so much easier? If we become too familiar those so important boundaries can become distorted and increase the risk of poor practice or even abuse going unnoticed or being excused.

I started my social care career working in a residential home for children with autism and it must be said that in my experience the majority of carers are decent caring people who go the extra mile.  Most don’t get paid heaps, have to work shifts but still turn up at work asking how they can make the next 8 hours the best they possibly can for those they have come to work for.  However, there are some for whom that isn’t the case and over the past couple of weeks we have seen 11 photos that will probably remain imprinted on our minds long after the media frenzy has died down.

I’d really like to hear how recent events have perhaps challenged you as a health or social care worker as you strive to help deliver the very best services to those who need them. I also look forwards to hearing how the Department of Health is going to drive service commissioning, delivery and safeguarding forwards.  What is agreed upon is that there needs to be a radical overhaul of social care; what doesn’t see so clear is what that will look like.

 

Winterbourne View owners sponsor learning disability nursing award. Satire dies.

The abuse of people with learning disabilities that took place at Winterbourne View “care” home was utterly horrific. Castlebeck, the company that owned the home, took £3500 per person per week from the taxpayer for mostly unqualified staff to abuse and assault its residents.

I have to thank Mark Neary for spotting this. He noticed exactly what Castlebeck are doing with their dirty money, and who’s taken it. The Nursing Standard, the weekly magazine of the Royal College of Nursing, has announced its Nurse of the Year Award. Scroll through the categories, until you get to the Learning Disability Nursing Award. This is “for nurses working within the field of learning disability who can clearly demonstrate that their initiative has improved the health, well-being and social inclusion of people with a learning disability.”

And who’s sponsoring the award? Unbelievably, it’s Castlebeck. While I’m hardly surprised that this sordid company wants to try to mend its shredded reputation by associating itself with such an award, I’m utterly shocked that the RCN would accept their tainted gold.

Remember that when Castlebeck trousered public money to take in these deeply vulnerable people, they didn’t provide the Winterbourne View residents with psychology input, or an occupational therapist. They didn’t even have that many learning disabilty nurses. The overwhelming majority of the staff were unqualified support workers. Tragically, some of them turned out to be the sort of thugs that I wouldn’t trust to look after my cat.

I’m not entirely surprised by the RCN. They’ve always had a bit of a reputation for shameless establishment schmoozing. It’s for that reason that several years ago I switched my union membership from the RCN to Unite. Even so, this is an appalling decision on their part. I don’t know how they keep a straight face and a clear conscience from doing so.

Exposure and the CQC

Last night, ITV examined the state of residential care and regulation of the sector in Exposure. While I watched the programme through the lens of someone who has had significant experience of the sector, I’ve also followed the birthing pains of the Care Quality Commission avidly so some of the information given wasn’t ‘new’ to me. I probably didn’t approach the programme as an ‘average viewer’ might.

There were a few issues raised that I think useful to explore. The programme seemed to rightly raise the void of inspection that took place through the initial years in which the CQC was established. The organisation was established with less money than it’s predecessor bodies, the Healthcare Commission, the Mental Health Act Commission and the Commission for Social Care Inspection.  While focusing on registering services, the CQC dropped the ball on maintaining inspections and relying on previous ‘good and excellent’ reports to step back on regular on-site checks.

An ‘excellent’ service can fail very quickly if there are changing in funding and personnel in a home, for example and the lack of attention to frequent unannounced inspections was something that was highlighted in this programme.

However while not resolving the organisation of responsibility, this focus has changed and the CQC has stated that regular, unannounced inspections are taking place now.

The website has long been a gripe as far as I’m concerned. There seems to be less information with each iteration and the scope and searchability isn’t as helpful as it used to be. The CQC website remains the only one I have come across at work which has become progressively less user friendly  with each iteration  (and yes, I have always given feedback on the changes when it’s been an option!). The lack of reports from both predecessor organisations (for example, not being able to access CSCI reports or reports when an organisation has changed hands – as was highlighted in the programme) is a big issue. As members of the general public, we can determine how useful or not historic information is but we have to have access to it. More information is better.

Reports need to be very easily understandable and clear about what is expected and what good and bad care look like. They are better than they were. People liked star ratings because they were easy to understand. They were abolished but the star ratings remained on the website for a long time afterward which was poor information in the extreme. While the government excellence scheme was shelved, I think there’s a real desire for people to have an understanding beyond a care home being compliant or non-compliant – people want to know if St Matthew’s Home in Hull is better than St Francis’ Home in Bridlington and a TripAdvisor type comment site won’t always provide an independent and authoritative understanding of that. I’m not sure if it’s the place for the regulator but it was in the past and understanding what good care looks like as well as bad is something that Behan, the new CEO of the CQC has stated he wants to work on.

The footage of Cynthia Bower at the select committee was positively painful and her links with Mid Staffordshire made her a particularly poor choice of CEO initially. They could never establish any credibility in the sector with that background and proved that she was not up to the task. The only concern was how much damage she did in the meantime.

I do have more hope with the new CEO, David Behan and some of the changes that have taken place but the programme showed the need for a strong and authoritative regulator within health and social care.

The problem is that all these cuts happened in the regulator as commissioners like local authorities were hammered by substantial cuts which – certainly in my experience –  have seen monitoring units slashed. You see the monitoring teams – they were the so-called ‘back office’ which were cut but the input that had on day to day care is significant.

The only way forward is for commissioners (local authorities/NHS and yes, private funders), regulators and providers to work very closely regarding responsibilities and tie information in with each other but most important to make that sure those who use the services and local communities, families and advocates can understand and know cohesive lines of communication with organisations responsible for developing and regulating good care.

It doesn’t help for organisations to be siloed when life is more complex and while I would never want to absolve those government bodies like the CQC of their responsibilities, I think the structures and information streams need to be better regarding lines of responsibility.

If the organisation isn’t able to do its job properly due to cuts, it needs to return to the government and tell it.

I have become more hopeful that there will be a change in culture in the regulator with a change in leadership. Use of more and more ‘experts by experience’ and experienced specialist professionals in inspections is also a positive move but it’s not good enough to stand still.

As Barbara Young said in the programme, the CQC needs to the a regulator for people and particularly for people who have their voices quietened by organisations which can display power in terms of delivering care. It isn’t good enough to rely on families complaining as many people in residential services don’t have families who visit. Proactive regulation needs to happen alongside proactive safeguarding investigations by local authorities and proactive monitoring. Organisations which provide care can’t resolve their own responsibilities to provide quality care. If money is cut by local authorities, it has to be challenged and challenged hard before quality slips rather than afterwards as an excuse.

There is room for hope though. I do think the CQC consultation is positive and the move towards regular unannounced visits is a good one. It should never have been otherwise but we can’t change the past.

If we want a regulator that works, it has to be given the tools and the resources to regulate in a way that we want and expect it to. That costs. So be it, it is a necessary cost.

I want a responsive, responsible, proactive and mostly a listening regulator. I’m willing to give them time seeing that some progress has been made, but there really does need to be a change noticed in the reports that feed back to Parliamentary committees and published reports next year.

Jeremy Forrest and the Abuse of Trust

A couple of years ago, I was working as a nurse in child and adolescent mental health services (CAMHS) with a 16 year old girl. One day, out of the blue, she confessed an attraction to me.

My immediate response – other than to put in a referral to an optician’s, obviously – was to politely but firmly remind her that I was her nurse, that there was no prospect of anything but a professional relationship, and to suggest to her that she look for a boyfriend her own age. I also made sure that I didn’t work with her again unless there was a female colleague present.

Despite what you may think from Mills and Boon novels (those aren’t grounded in social realism? Who knew?) sexual relations between nurses and patients are strictly verboten under the Nursing and Midwifery Council Code.

20. You must establish and actively maintain clear sexual boundaries at all times with people in your care, their families and carers

If I hadn’t kept my boundaries, I wouldn’t have only been committing serious professional misconduct. I would also have been committing a criminal offence. The girl was 16, and therefore over the age of consent. However, she was in my care, and that would make it a crime under the Sexual Offences Act of “abuse of a position of trust”, which runs up to the 18th birthday. There are good reasons for this. The power of a teacher, nurse, social worker or children’s home worker over a young person can be enormous. With that comes the capacity to do enormous damage to vulnerable kids if boundaries aren’t respected and trust is abused.

I mention this because of a depressing slew of responses – often left in the comments threads to online newspaper articles – accusing the police and media of “hounding” a “young couple in love”. Some of those people seem to think if Jeremy Forrest had waited a few months then it all would have been fine – and for the reasons listed above, it wouldn’t. Others seem to regard the girl as some sort of teen seducer.

Have a look at this comment piece in the Independent. The author, quite rightly, takes the Daily Mail to task over a tacky, voyeuristic article that dissect’s Forrest’s relationship with his wife and with his pupil, by trawling their social networking accounts. If the Independent piece is good and well-argued, the comments left underneath are…..Oh dear.

As his lawyer said, his only crime was that he fell in love with a 15yr old…he was stupid the way he went about it, but I don’t think there will be any more than 5-10% of anyone who knows about this story that thinks he did it with any malice or force/manipulation of the girl, and that she didn’t know what she was doing. Again we’re casting judgement…but all I’m said is that I agree with Martin – love has no boundaries.

Was this a manhunt for murderers and war crimials or just a besotted couple? ………….Sad sad journalism indeed.

There’s been a few surprising voices added to this chorus. Peter Tatchell, for example, is someone I often agree with.

I subsequently had a Twitter exchange with Mr Tatchell. In all fairness, he was very clear that his view was that he’s not defending Forrest, and if he had a sexual relationship with his pupil, then he should be prosecuted for it. Mr Tatchell insisted his only objection was use of the word “abduction” for taking her to France.

Fair enough, but does Mr Tatchell really think any parent would agree that a teacher should be allowed to take their 15 year old daughter out of the country without their knowledge or permission?

Ironically, it’s the tacky Daily Mail article that gives a few hints that describing them simply as a couple in love is dubious to say the least.

[The girl], who describes herself on Twitter as a ‘self-loathing, music-loving, art and fashion-obsessed nostalgic loner’ was reported missing last Friday after failing to turn up at her school in Eastbourne.

A “self-loathing loner”? Admittedly it’s entirely possible to read too much into somebody’s Twitter profile. Even so, it does beg the question of whether that sounds like the self-description of a confident, beckoning Lolita.

One could argue – and admittedly this is speculation on my part – that it  sounds more like a girl who may be quite vulnerable. Perhaps even someone who might be susceptible to grooming.

Ultimately these are questions that will be decided in a court rather than in blogs, tweets and online comment threads. Even so, it ought to give those who depict the girl as an equal partner – or even a teenage seducer – some pause for thought.

Winterbourne View – The Serious Case Review

Yesterday the Serious Case Review written by Margaret Flynn about Winterbourne View Hospital was published. It catalogues the series of circumstances which led to those scenes seen on BBC’s Panorama programme and it makes important and salutary lessons for everyone involved in health and social care.

It is a well-written, detailed report which catalogues a series of holes in the process of provisioning, commissioning, managing and monitoring a long stay hospital for people with learning disabilities but the most important lessons can easily be extrapolated out to many other areas of residential, nursing and long stay hospital care.

In summarising my own reading of the report, I have added some of my own thoughts as I go but I do recommend going to read the full version. No doubt I’ll be reflecting on it more over the next few days/weeks.

Introduction

This sets out the background to the airing of the programme on 31 May 2011 and the scope of the serious care review (SCR) which covers the period between January 2008 – when South Gloucestershire Council received their first safeguarding referral to 31st May 2011 when the Panorama programme was aired.  It explains the terms of reference of the report and some of the specific incidents seen on Panorama which caused concern.  This included illegal restraints procedures and

‘notions of a hospital, nursing, assessment, treatment, rehabilitation and support were emptied of meaning and credibility’

The Place and the Personnel

Winterbourne View opened in December 2006 after a ‘feasibility’ study by Castlebeck Ltd which had assessed that there was a need in that particular geographic location for this kind of service. As seen in the programme the placement of a hospital on a business park seems unbelievable but according to the ‘Statement of Purpose’ quoted in the report, there was local access to ‘amenities and a main bus route’ – one does wonder how much this was important to those in the hospital as opposed to those working at the hospital.

Families were not allowed into the bedrooms of those living there which rings many alarm bells to those of us in the sector but may not have been seen as something unusual if you don’t know how these things should operate.

Learning disability nursing and psychiatry were the only disciplines employed in the so-called ‘multi-disciplinary’ teams. The report explains the structure of the service and staffing which was heavy on support workers, which in itself isn’t surprising however a ‘hospital’ employing no occupational therapy, for example, is particularly surprising.  There was a very high turnover and sickness rate among staff which in itself is a sign of there being something particularly wrong in the structures.  12 hour shifts were the norm which may have suited the service and staff more than those who use the service and there was certainly a lack of detail regarding day time activities and timetables for those who lived in Winterbourne View.

I do wonder where the input from care managers/care co-ordinators were in terms of monitoring care plans and ensuring their were adhered to. My gut feeling is that with out of area placements, there was less impetus to be able to monitor these. Commissioners didn’t seem to make many demands that the operating guidelines for Winterbourne were met in terms of providing a therapeutic and rehabilitative environment.

Chronology

This section details the concerns raised and is an analysis of what was actually happening at Winterbourne along a timeline.  Unsurprisingly there are a string of concerns raised that when seen along a timeline can build a picture of a hospital and an organisation that is not fit for purpose.

Part of the concern as a whole is that the dots were not connected in terms of the series of incidents and concerns to build a coherent picture of what was happening. Whilst it’s ‘easy to be wise with hindsight’ it’s important to remember that we have systems which are supposed to protect vulnerable adults which should include collating and using information, concerns and reports to build cohesive pictures of what is going on – that’s even without the whistleblowing which took place.

It makes very difficult reading – all the more so in the context that it was not sufficiently investigated, not internally, not locally and not by the regulator nor police. The key worry that ran through my head is that this may have continued had it not been for both the intervention of determined ‘whistleblowers’ and the involvement of a BBC journalist. That’s a very very worrying lesson that needs to be acted on.

The Experiences and Perspectives of Patients and their Families

The author of the report spoke to six families in particular and explains their perceptions, experiences and understanding of what was happening at Winterbourne View.  The report gives life to some of those who lived at Winterbourne View and humanises them in a way, it seems that the service itself never did – with hopes, aspirations, character and personality.

One patient said

he had been in ‘loads of worse places than them, all over the country’ and that he had been abused in lots of care homes

And if there’s a key lesson to learn it is that Winterbourne View is not an anomaly and shouldn’t be seen as such.

The patient recollections of abuse and treatment at Winterbourne is very powerful. It evidences the importance both of listening and humanising approaches within residential care and hospital care. The importance of being near families and the disruptions of constantly changing placements seems to be the nature of life for some groups of people who have particular care needs and I wonder where the power in commissioning is coming from to look at different models.

When families raised concerns that their children had brought to them these reports were often disbelieved or families were not given the full details of what was going on.  It also raises the importance of visiting and monitoring – particularly for those who may not have families.

Importantly the report says

A family expressed anger that service commissioners making spot purchases to meet the needs of individuals do not know what they want to buy; they do not seek assurance that the service they believe they are buying is delivered; and they do not follow up on what is being provided.

Perhaps more importantly in terms of lessons to be learnt globally

‘As families recalled some of their distressing experiences, it was clear that they had no collective experience of being regarded as partners deserving of trust and respect or even of collaborating with paid carers.

There has to be a shift in the conceit of ‘paid professionals’ or ‘paid support workers’. We have to work with, alongside and for those whom we support and their families as otherwise we should be nowhere even close to a position in social care. Respect, listening and remembering whom we are serving  is the crux of the profession and that seems to have been lost somewhere.

Agencies

Castlebeck Ltd seemed to have a ‘limited executive oversight’ of Winterbourne View with the geographical distance from their head office in Darlington providing significant lapse in responsiveness when concerns were raised.

Interestingly they seem to place some of the blame directly on the CQC and problems with the transition from the Healthcare Commission to the CQC. While no CQC apologist this seems to be a very complacent and worrying dereliction of duty from the organisation that was paid to provide a service which should include self-monitoring.  The SCR looks at Castlebeck’s own analysis of their failings but finds it lacking with attempts to discharge responsibility for the things that went wrong. As it says

Overall Castlebeck Ltd’s appreciation of events leading up to transmission of Panorama is limited, not least because they took financial rewards without any apparent responsibility. The recommendations fail to address corporate responsibility at the highest level

Which is sad, but unsurprising.

NHS South of England also produced a report about commissioning of care and treatment at Winterbourne View.  Out of the 48 referrals made to Winterbourne View, 13 came from commissioners located less than 20 miles away and 9 of those 13 were from commissioners less than 10 miles away.

Worrying is that there were some placements made with few checks and some not even reading the most recent inspection reports.  Interesting that of the 48 English patients (the experiences of Welsh patients – not being the responsibility of the NHS in England were not counted in these figures) 35 were admitted under a section of the Mental Health Act, 13 were admitted informally and 6 were detained after being admitted informally. Unfortunately there are no details regarding the Deprivation of Liberty Safeguards but it would be interesting to know more about those ‘informal’ admissions legally.

NHS South Gloucestershire PCT was the ‘coordinating’ commissioner being where Winterbourne View is located. They produced another report.  Hospital records were also accessed but there seemed to be no linking of information together and agencies not speaking to each other seems to be a major problem and continuing concern.

South Gloucestershire Council also provided a Safeguarding Review.  South Gloucestershire received 40 safeguarding alerts between October 2007 and April 2011. The system locally to follow up some safeguarding alerts seemed to be flawed in terms of not receiving relevant and necessary information requested back from Winterbourne View.  Many of the alerts ‘tail off inconclusively with no clear decisions and no rationale for decisions’.  Each alert was dealt with discretely and the pattern was not allowed to emerge.

Avon and Somerset Constabulary were also involved as there were a number of assaults reported and they also provided a report. There were some flaws in the sharing of information between the police and the local council.

CQC also compiled a report.  The SCR picks up on some confusion in language in terms of the CQC and notes the importance  to note that Winterbourne View is not a care home but is a hospital. The CQC admits that it’s creation has had a significant impact on inspection of services – something we all knew – but it’s good to see them acknowledge this finally rather than paint the biased hue of everything ‘being better’ under the new regime.

The lack of specialist inspectors is a particular factor that the new systems of regulation have lost. Apparently ‘professional regulators’ is a better way of doing things rather than those with specific knowledge of particular service areas. Perhaps this isn’t quite the right way to develop regulatory services.

Findings and Recommendations

The report finishes with a summary that is robust. Winterbourne View is a particular snapshot which has been able to take place due to a series of circumstances that put the spotlight on the services. These spotlights aren’t often shined into the world of long stay hospitals and residential care. But for a BBC programme, it might never have been picked up. That’s a lesson in itself.

Castlebeck Ltd didn’t provide a poor service because it had no money. It provided a poor service because it didn’t see any reason not to.  There were no reasons to question itself or what it was doing. Those questions weren’t being asked by any of the agencies responsible for protecting those who lived in Winterbourne View.

The recommendations are that the Clinical Commissioning Groups, Local authorities and NHS Commissioning Board should be looking more closely at the services they commission, where they are commissioning them and aim to cut down in-patient services.

The report emphasises

‘Commissioning is a professional activity that should be led by trained specialists who know and develop the market according to public policy’

This made me sigh as it seems in my own experience that we are moving backwards on this. I see fewer specialist commissioners who know their areas and more general commissioners who come from non-health or care related backgrounds and with little understanding of the sector or the needs locally of those who use the services they commission.

The report strongly criticises the commissioning of long stay hospitals for people with learning disabilities as perpetuating the ‘out of sight, out of mind’ type modelling for care services.

Recommendations include a more robust use of the Mental Capacity Act 2005 and particularly that

‘The Department of Health should assure itself that CQC’s current legal responsibility to monitor and report on the use of Deprivation of Liberty Safeguards provide sufficient scrutiny of the use of DoLS’

There was a lesson in poor multi-agency working which needs to be worked on actively and there is a recommendation that those who are subject to provisions of the Mental Health Act or Deprivation of Liberty Safeguards as well as all who make a complaint have access to independent professionals, whether social workers, Best Interests Assessors, IMCAs or IMHAs or more than one. Advocacy is crucial to prevent abuses.

As far as the CQC is concerned, the report explains that the ‘light touch’ regulation, enamoured by the CQC doesn’t work with settings like Winterbourne View. The CQC has been too reliant on self-reporting and trusting providers are complying.

There’s a recommendation that the ‘

Mental Health arm of the CQC should have characteristics akin to HM Inspectorate of Prisons in terms of standards’

That would be an interesting and useful development but I doubt the current CQC is set up to provide a robust monitoring procedure.

Conclusions

I haven’t been able to cover all the points of the SCR. It is worth reading in its entirety. It concludes by emphasising that services like Winterbourne View should not exist as they create no aspirations and hope.

They are not therapeutic environments and were created to provide a funding stream to the private company rather than to improve the quality of treatment and care to those who need them.

Commissioning should look at what exactly is being commissioned and what is needed to achieve the end result of an improvement of quality of life.

I look at this report and it is an excellent report, and I despair. I recognise parts of it but it is a particularly appalling litany of pain, distress and human suffering that could have been identified earlier. We relied on a television programme to identify these issues when there were so many people who should have identified this sooner.

No one comes out of this well apart from the whistle blowers who tried to make a difference.

Good services can and do exist but we need to be very clear about expectations of services and what we expect a hospital built on an industrial estate and factoring in amounts of income possible can achieve as opposed to services which truly exist in local communities.

It’s an awful situation but the SCR offers an opportunity to learn and do things differently. Let’s listen more and better across the whole sector and remember that this job is always a matter of partnership and never should be one of dictation. We have to do things better.