Wednesday, June 1, 2011

How do we stop abuse in care?

If you didn't watch last night's Panorama, then watch it on Iplayer. It concerns the treatment of people with learning disabilities by one of the UK's biggest private social care providers. Panorama shows people being physically and verbally abused by staff who are clearly out of all control.

I would like to say that this is shocking by its novelty. But the truth is that I have seen similar things with my own eyes, albeit less often. And I have, throughout my time in advocacy, frequently come across stories of such goings on. The truth of the matter is that mostly goes on without senior managers knowing about it.

I don't have to think hard to recall one home I worked in. Presided over by a powerful personality, M, who clearly had 'issues', staff and residents alike were afraid of her. M was a bully and, on her bad days, a bit of a sadist. People would sit in their own shit if she felt they had done it to 'piss her off'. People's genitals would be laughed about as though they weren't there. On one occasion, she struck someone, not hard, but enough to know where they stood. Families even were intimidated by her. She had everyone in her thrall.

I was just a relief worker - this was one of many places I worked as a 23 year old. Having nothing to lose, I complained about M to senior managers verbally. Nothing happened. I put it in writing and threatened to go public. M was suspended. Then others came forward to substantiate and add their stories. People who themselves had joined in with M in her constant goading. By the end of it, M was lucky not to go to jail. Thankfully none of the other staff lost their jobs. They were all, in essence, decent people led by a monster.

This episode taught me something very important about people and leadership. Without great leaders in those places I worked, they quickly become hellish as staff take their cues from whoever is in charge. Which brings me back to the role of private companies in public services. I am categorically not one of those people who thinks that profit cannot be honestly made out of providing good care and support. That is nonsense as experience every day tells us. Nor is the answer for care to be socialised. The NHS, let's remember was only last week lambasted, again, for letting elderly patients effectively starve to death on its wards. And one of the last big learning-disability scandals was at Orchard Hill, an NHS facility.

No, it isn't just about public-private. It is about mission and leadership. It is about focus on what matters. If these places are run according to imperatives beyond providing best-service, things slide. The best places I worked were, bizarrely, run by the same group that employed M. Two miles down the road, their other place was and still is exemplary. I would place my own child there. What made it work was strong, empowered, proud local leadership backed, yes, by management with good values.

This is one reason I prefer spin-outs to either retained public sector or outright privatisation. Ownership and control we know have a positive effect on behavour. So too does focus and specialism and a strong sense of social purpose. We will, of course, one day see a scandal in a spin out. But I think in organisations which lose their sense of purpose through an excessive focus either on profit or too much public-sector politicking, when eyes leave the ball, the chances of scandal are all the more extreme.

My thoughts today are with the people on the wrong end of the kicks, shoves and hair-pulling in that programme. Several people today are in custody and hopefully those people are now safe. But, rather than just put this down to 'evil people', I hope this whole affair helps us think more carefully about the kinds of services - and the requirements of leadership - needed to keep people safe. Most people in social care are good, decent people. So too are most managers, right up to the top. I have no doubt that the company involved will respond in a concerned and reasonable way. I just hope that this also addresses some of the deeper reasons why these things happen.


NTemple said...

Great post, Craig. Nothing much else to add.

Mark Brown said...

Good point about leadership but the fundamental weakness of our care system is the practical and effective voicelessness of service users especially people with learning difficulties. Winterbourne View was a powerful illustration of this.

Edward Harkins said...

I had to make myself continue to watch this programme - by way of some sort of, at least, 'bearing witness' to what the survivors suffered.

But for me, here we are again in a core public services failure scenario despite the presence of a well-heeled and well-resourced regulator. Yet in the UK we never, ever, seem to get down to the enduring issues of: what do we have a regulator for; why did the regulator fail and what are the sanctions; who comprised the regulator (i.e. any service users with real power?).

When I say sanction, I'm looking for something better that the predictable Minister thumping a populist drum and declaring "I'm going to take drastic action and sort this out" (step forward Mr Balls). And isn't always striking how Ministers speak in the first tense "I" when its a populist, scape-goating action they are declaring... but when it's a failure on their portfolio, they speak in second, third or inanimate senses - such as "Doctor" John Reid's infamous pontification that the Home Office was not 'fit for purpose'?

Craig Dearden-Phillips said...

Thanks for these thoughtful responses. Edward, your words well-heeled struck a chord. I know an ex CQC guy - not very senior - but he couldn't stand the culture of mediocrity, lavish rewards and detachment from core purpose. He said they would get their cumuppence and here we are

Anonymous said...

I doubt very much that the regulator is exempt from the government cutbacks to the public sector. Like much of the public sector, including Social Services and the Police, I would imagine they are desperately trying to find a way of fulfilling their increasing responsibilities within an ever-decreasing budget.

Abuse such as this takes place behind closed doors. Any visitor to the service whether a family member or a regulator, however effective, is hardly going to witness this level of abuse when they step over the threshold of a care service are they?

Sadly, we live in an age where it can be very difficult to prove that abuse is going on especially where you have people who do not have a voice. Hence the fact cases often don't make it to court because vulnerable adults may be deemed 'unreliable witnesses'. I agree with Mark Brown in that it is the voicelessness of vulnerable people that is the real tragedy here.