Why are we dependent on investigative journalism to expose abuse in residential settings?
On October 10 2022 we saw yet another BBC Panorama exposure of the care in Edenfield Centre, part of Greater Manchester Mental Health Foundation Trust. An undercover reporter working at the Edenfield Centre filmed patients being mocked, inappropriately restrained and enduring long periods of seclusion in small, bare rooms. A number of staff have been sacked and 20 suspended pending investigation.
Every time we see evidence exposed in this way we hope and expect it to be the last. Yet with so many inquiries and recommendations resulting from each exposure why do we continue to see this appalling and degrading treatment being enacted in further settings?
Failures to Transform Care
In 2012 we saw evidence of the abuse at Winterborne View. This was followed by 11 people being charged in connection with the ill-treatment and neglect of patients in that establishment. All 11 admitted their guilt to those charges.
From the opening of the hospital in 2006 until 2011, there had been 38 safeguarding alerts raised about 20 patients from the unit. Only one in five of those had been reported to the NHS.
An independent report into Winterbourne View said fundamental changes were needed in how the care of vulnerable adults is commissioned and monitored.
The final report outlined 60 actions to transform services. For example, they advised that people with learning disabilities should no longer live inappropriately in hospitals. Instead, they should be cared for in line with best practice based on their individual needs. Also, their wishes and those of their families should be listened to and placed at the heart of planning and delivering their care.
In 2019, and despite the previous actions identified after Winternborne View was exposed, further undercover BBC filming showed staff intimidating, mocking and restraining patients with learning disabilities and autism at Whorlton Hall, County Durham. All of those arrested, seven men and three women, were members of staff who worked at the unit and were charged with offences relating to abuse and neglect.
Following this, the then-Health Secretary Matt Hancock ordered an investigation into the cases. An interim report published by the Care Quality Commission described the system as “broken” and said people who ended up in hospital were being failed.
But just three years later we see it again.
How Many More Times?
So the question is, how many media exposures and people suffering appalling abuse will it take before we see a real difference in the care and treatment of people requiring specialist care?
It is difficult to understand how one human being can treat another like this. One wonders if this behaviour extends to their home and family life or whether this behaviour is restricted to their time at work. The abuse is deliberate and targeted against people who they seem to view as powerless to complain and less worthy of respect, dignity and choice.
A colleague working in a residential setting contacted me following the disclosures at Whorlton Hall. They were concerned that the people she supported wanted to watch the Panorama programme. They had heard about it and had asked staff to play it.
While the staff recognised their right to watch it they were understandably worried about the distress it may have caused them. But they decided to ensure support would be available as required. I later heard that they had been less distressed watching the programme than the carers watching with them.
What does this tell us? They were not surprised by the programme because they expect to be treated less well than others. They accept receiving inferior treatment, and as a consequence would probably not see the behaviour as shocking and something to complain about.
Toxic Cultures Lead to Toxic Behaviour
We have been talking about this for so long now. Poor behaviour and treatment becomes normalised if it occurs regularly and over long periods of time. And it is not only normalised by the people on the receiving end, but also by those working alongside the abusers, the onlookers. So both they and the victims are less likely to report it.
So where is training, supervision, management structures and governance in all this? And where is person-centred care and Making Safeguarding Personal? All of this needs to be addressed so that exposures such as we saw this month do not reoccur.
Following the report of another inquiry at Mid Staffordshire NHS Foundation Trust in 2013, Robert Francis highlighted the critical importance of fostering and sustaining an open culture. In an open culture, concerns about care can be raised, investigated and acted upon.
Insufficient openness, transparency and candour lead to delays in victims learning the truth, obstruct the learning process, deter disclosure of information about concerns, and cause regulation and commissioning to be undertaken on inaccurate information and understanding. This Inquiry has shown that, desirable though the principle of openness, transparency and candour may be, it is frequently not observed. This has had serious consequences.
- “Urgent action is needed if we want to transform care”. Article by safeguarding researcher Margaret Flynn.
- “Transforming care – how long do we have to wait?” Short video of Norman Lamb MP discussing Winterbourne.
- Working together to build safer cultures. Current Ann Craft Trust campaign which, though focused on the sport and activity sector, discusses principles that all organisations can adopt to create safer cultures.