Wednesday 16 January 2019
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The heroes of Winterbourne View

While we should be grateful to Panorama for revealing the disgusting treatment of residents at Winterbourne View, the real heroes are Terry Bryan, the whistleblower, and Simon, Simone and the other residents who resisted and fought back.

Let’s face it, without the Panorama expose, what we saw happening at Winterbourne View would still be happening and the CQC would still say that the place was “compliant” with the “essential standards of quality and safety”. People would still be being placed in this hell-hole; the “hospital’s” manager would still be sitting in his office completing his returns to assure his bosses and CQC that all was well, and Castlebeck (the company that runs the “hospital”) would be happily raking in £3,500 a week for each resident’s “care”.

And Simon, Simone and the other residents would still be struggling to survive, to maintain their sense of “personhood”, and fighting back against the physical and emotional battering of the “carers”. They were treated like dirt and yet they survived, resisted, and had the extraordinary courage and character to fight back. It appears that the only ally they had was Terry Bryan.

Appointed as a senior nurse, Terry quickly saw what was going on. He sent a four page e-mail to Castlebeck managers outlining the abuse. This was ignored. He e-mailed CQC; again he was ignored. He e-mailed again and was still ignored. He telephoned them and was told that the person dealing with the matter was on holiday. He contacted Panorama and they sent in an undercover journalist who filmed what was going on. Had Panorama not got such solid evidence, Castlebeck and CQC would have continued to ignore and cover up. Terry did the job that dozens of other people should have done if they had had the courage and commitment to do their jobs properly.

Where were all the people on whom the residents should have been able to rely?

Where was the manager of Winterbourne View? We can only assume that management in its true sense was non-existent. Did the manager know what was going on or did he avoid knowing? It is a manager’s job to know what’s going on in a care home. (This so-called “hospital” was essentially a care home in all but name, and there appeared to be no need for the residents to be locked up or in a hospital at all.) And where were the external managers from Castlebeck? Were there regional managers and “quality” managers? What about the Chief Executive and the board? Well, of course, we know that when it was shoved in their faces they were horrified by what Panorama discovered, but until then they chose not to know.

Where were the NHS and social care staff who would have placed people and were meant to provide oversight of the residents’ welfare and progress in the home? And where was the local authority “safeguarding” team? Can any one of them claim to have been doing their job properly?

And where was the fearless regulator, CQC - the quango that claims to “make sure people can expect services to meet essential standards of quality and safety that respect their dignity and protect their rights” and focusses on “outcomes rather than systems and processes, and places the views and experience of people who use services at its centre”? CQC claim to have a sophisticated system for gathering all the available data on care providers from which they compute a “quality and risk profile” to alert inspectors (now called regulators) to the need to review the home or hospital.

Yes, CQC had “inspected” Winterbourne View three times in the last two years so they knew that it was “compliant” with the essential standards of quality and safety. CQC had checked that the people living at the home were safe and well looked after, and that their dignity was respected and their rights protected. After all, they would have placed the views and experience of the residents at the very centre of their assessment.

CQC’s claims are shameful lies, and they have been found out just as the staff of the home were found out.

Not only did CQC fail to see what was going on at Winterbourned View when they visited, they repeatedly failed to respond when they were told of the abuse.

Did CQC examine the Winterbourne whistleblowers’ policy when they registered the place? Did they judge it to be satisfactory? Indeed, do CQC have a whistleblowing policy of their own, because it’s clear that CQC inspectors have been gagged, but the truth about what has been going on at CQC will eventually leak out in the same way as the truth about Winterbourne View could not be suppressed for ever.

The responsibility for Winterbourne View doesn’t stop with CQC or the top management of Castlebeck. It goes right to the top: to the Department of Health and the previous government that set up CQC and allowed it to fail the very people it was meant to protect, and even to this coalition government that continues to tolerate such a dangerously useless quango. And, please let us not for one minute assume that Winterbourne View is the only place where residents are left to fend for themselves against abusive staff and without the support of people and systems of care and protection that they should be able to rely on.

Our care system is deeply flawed. Much of it has been designed and maintained from the top for the twin purposes of substantiating the false claims of government and turning the provision of care into big corporate profits. Pursuing these purposes is an elite bureaucracy that drains the care sector of its resources and lays down the law about work that it despises.

Compliance, complicity and duplicity

Compliance: a disposition to yield or to comply with others
Simon, Simone and some of the other people we saw being bullied on the Panorama programme refused to be compliant. They resisted; they shouted; they kept going . . . somehow. They would not accept the domination that the staff tried to impose. They remained autonomous human beings in spite of everything the staff could do to subjugate and de-humanise them.

We should not forget that Winterbourne View was created and maintained by the wider system of health and social care. It wasn’t some strange cult community that existed in isolation from normal society. It was built, staffed, managed and maintained within a regulated service. Staff were selected, appointed, and had all the necessary checks, and they were paid to do what they did. The home had all the necessary policies and procedures. It was registered and inspected. It was funded and well used by statutory health and social care services. There was medical and psychiatric supervision and input. In order to be registered by CQC, Winterbourne View had to “comply” with the section 20 regulations of the Health and Social Care Act 2008.

Compliance is not a good foundation for the design of social care. Our full development as human beings, with personality, spirit and free will, takes place through creativity not compliance. We are each unique and uniquely social; our relationships with other people are essential to a full life. We learn and grow as people through non-compliance. We experiment. We find our own way. We try things out and see what works and what doesn’t work . . . for us. We are not given a set of rules for life. There are no procedures for becoming a person, for relating to and caring for others, for love, friendship and growing up. The task of a care home is to create with residents and staff a way of living that is homely, nourishing (in every way), supportive, creative, developmental (for some), comforting, therapeutic, and safe. That is not done by procedure or by compliance. There are some events and situations for which a procedure (a set and agreed way of doing things) is needed as a clear and reliable response. Handling medication is one example but every procedure should be created to meet the residents’ needs and to fit their circumstances. (Winterbourne View would have had a procedure for administering medicines and it would have complied with the essential standards. And we saw how that compliant procedure was practised when a resident was held down and forced to take a paracetamol tablet. Procedures like that are worse than having no procedure.)

While it is important to have nationally agreed standards of care, those standards should be owned and “internalised” by the home, and the ways of achieving them should be created within the home through the collaboration of residents and staff. This is how good care homes work. Mere “compliance” with externally imposed standards both misses the point of living in community with other people or of running a “home” together, and undermines the self-determination and individuality of the residents.

But this idea of compliance is now built into the structures of all organisations that surround and dominate care homes. Once the regulator determines that no care home can operate without being “compliant”, everyone, from the cleaner to the chief executive has to strive for compliance - survival depends on it. Not only is it mandatory to demonstrate compliance but the very notion enters the ethos of management, of training and staff development, even of residents’ leisure and social relationships. Senior staff are appointed to “ensure compliance”, to write “provider compliance assessments”, and to check that all paperwork, policies and procedures are compliant. Instead of a home being run for the people who live in it to meet their needs, the home is run to comply with the demands of external organisations and regulators. This is clearly the wrong way round.

Complicity: the fact or condition of being an accomplice - esp. in a criminal act
The staff at Winterbourne View who looked on while the abuse took place and the managers who ignored it or chose not to know about it were complicit. They were accomplices. The charge nurses who witnessed the abuse but took no action to stop it, allowed it to happen and in doing so, encouraged it to happen. Terry Bryan (the whistleblower) refused to be complicit.

But equally, the health and social care establishment who have watched the growth of the compliance culture knowing or suspecting that it was detrimental to good care, who have accepted the destructive impositions of the Care Quality Commission, who have known that CQC’s failure to attend to their core task would lead to such outrages as was exposed on Panorama, this establishment is guilty of complicity. They have let it happen and in doing so they have encouraged it to happen.

Duplicity: deception or double-dealing
The culture of compliance and the practice of complicity has led to duplicity - saying one thing and doing another. We heard how at Winterbourne View a report was to be worded so that it was “compliant” following the provocation and repeated assault on a resident. Requiring providers to make statements of compliance when it is obvious that these cannot be honestly made is requiring them to lie. This is no different from insisting that medication records show no mistakes or that care plans are completed when everyone knows that they do not honestly reflect what actually happens. This is simply getting paperwork “in order” and encourages providers to operate at two levels: the officially compliant level and the reality. Winterbourne View was an extreme but far from unique version of this double-dealing. Castlebeck’s website portrays a completely (and knowingly) inaccurate picture of the care provided at Winterbourne View. It is the only acceptable version of a large care provider and it is a lie. All providers are required to have a statement of purpose (and dozens of other equally empty aspirations) yet most have been copied from other providers. A manager moves from one provider to another and brings with them all the paperwork. Occasionally you can even see the logo of another provider or a name that hasn’t been changed. It is a sham and deception actively encouraged by the unthinking demands of the regulator.

Indeed the regulator practises a similar deception. CQC claims to “continuously monitor compliance with essential standards as part of a new, more dynamic, responsive and robust system of regulation. Our assessors and inspectors will frequently review all available information and intelligence we hold about a provider.” That is simply not true.

Extract (as written) from the last CQC Inspection Report 2009/2010 on Winterbourne View.
Findings: Staff do not receive annual update training in deescalation and physical intervention techniques
Action required: The registered person must ensure that staff receive training, with annual updates, on the prevention management of aggression, techniques to defuse situations and physical intervention techniques. This will ensure that patients receive treatment and care from appropriately trained staff. By 30 June 2010

CQC did not follow this up and Panorama showed staff repeatedly provoking, teasing, torturing and seriously assaulting residents. When Terry Bryan alerted them to this, CQC ignored him. Their failure in this one exposed instance is, in Jo Williams’ (Chair of CQC) words, “unforgivable”. So let’s, for once, agree with CQC and not forgive them.

The Association of Care Managers calls for a new approach to regulation and inspection of adult social care:
Prioritise the quality of care and the rights and safety of the people who use the services – this is the primary purpose of inspection
Inspect services as often as necessary but at least once a year
Inspectors should aim to prevent bad practice rather than to condemn it after it has occurred and after residents have suffered
Inspectors should be locally based and known – and accessible - to the public and users of the services
Inspection reports should be written for the public
Inspectors should work directly with residents and relatives, staff and managers of individual homes, NOT with the provider groups and organisations
Inspectors should respond to and investigate complaints, and be willing and available to visit the service without notice and at any time
Inspectors should understand how the services work and be willing and able (when appropriate) to help services to improve
People who use services should have a formal and influential voice in the assessment of care.

We believe all of this can be achieved without increasing inspection fees. However, it will mean a total reorganisation of the CQC, dismantling the centralised bureaucracy and grandiose management structure, and setting up local Healthwatch inspection teams employing independent inspectors who will be judged by - and paid by - results.

ACM supports the effective inspection of care services, concentrating on the rights, safety and wellbeing of those who use the services.

John Burton, Head of the Association of Care Managers
June 2011