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Can small community-based settings reduce the mistreatment of vulnerable patients?

Martin Robb

Martin Robb

International Partner

Phone +44 207 152 5901

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By Bhavna Keane-Rao, Managing Director, Care Consultancy Ltd*

This week CQC published a report relating to the number of people with learning disability and autism being segregated in hospital. This was the day before the Panorama exposé on the mistreatment of vulnerable adults at Whorlton Hall, Durham. 

In December 2012 the government announced, following the abuse at Winterbourne View, that it would introduce measures to dramatically reduce the number of people with learning disabilities being place in hospital. In April 2019 the BMA published figures showing there are 2,245 patients in similar care facilities. This is evidence that there still remains a significant number of people segregated and at risk of abuse, including young children. 

The Panorama exposé showed that both the CQC and NHS had, over the past two years, visited the service on several occasions failing to identify any serious concerns. CQC rated this service Good last year. There are also allegations that a CQC inspector visited the hospital in 2015 and raised these issues, the inspector allegedly resigned following alteration of the report. 

The response to this was an apology from the health minister who promised to initiate an investigation into this failure. The more cynical observer may draw the conclusion that once again we are in a situation where involved agencies are more engaged in deflecting blame than addressing their own failings.

It is obvious that the behaviours displayed by staff, in the Panorama exposé, was a culture that had developed over a number of years, something regulators failed to detect. It is easy to draw the conclusion that the current systems are not working, there is a lack of joined up thinking exacerbated by the lack of provision for patients with learning disability and autism. There are further allegations, other than at Whorlton Hall, of situations of abuse.

The quantitative methodology employed by the regulators is obviously not working, the current tick box exercise such as medication counts and scored audits being an extension of the medical model of care. Although these may have a place in the clinical aspects of care it is obvious that social care requires a more qualitative measure. There are perhaps more important questions such as: how compassionate staff are; how they interact with service users and how effective are the interactions between staff and management. In order to get a true understanding of the care provided more time needs to be spent observing such interactions. It may be time, though controversial, that compulsory CCTV is introduced in communal areas for the sole use of regulators, either to be used as part of their inspection or through regular, random remote checks.

Rather than concentrating on blame maybe it is it time to review the effectiveness of the checks undertaken, including new legislation specific to this client group.

This would need to consider both the role of the provider and regulator as well as the use of assistive technology. There also remains the argument for professional care workers, including a central register of care managers and staff. It is clear that the status quo cannot continue, and that action is now urgently required. Can we afford to continue to allow the most vulnerable in society to be let down again and again?

What the commissioners want is, in brief, community based, small, affordable settings and this expose is likely to put more pressure back onto settings that don’t fit those criteria. This happened in the aftermath of Winterbourne View as well. Unfortunately, the reality is that the development process rarely moves at a suitable pace, whilst new builds usually require higher fee levels not lower, particularly if the smaller settings are unable to achieve the same economies of scale. 

If you wish to discuss this further, get in touch with one of the healthcare team.

*This article has been provided by a third party. All statements and opinions of such third parties are solely the responsibility of the person providing those materials and do not necessarily reflect the opinion of Cushman & Wakefield.