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.

 

UKCP takes 3 years to find therapist guilty of misconduct, another year to publish its findings

Over the last few months I’ve been chronicling the series of mishaps and cock-ups over the John Smalley case. This was a fitness to practice investigation by the United Kingdom Council for Psychotherapy. The hearings found him guilty of seven allegations. I can now reveal that this won’t be published until a year after the ruling.

The story so far…The UKCP took over three years to investigate complaints about Mr Smalley, a Jungian analyst with the Independent Group of Analytical Psychologists. At the end of a long sequence of delays, they decided that seven allegations had been proven. This included smoking during therapy, inappropriately setting two clients up in a business relationship with each other, and making a sexual suggestion about one client to another. Despite this they decided not to sanction him. The fact that he admitted in the hearing that he destroyed his notes doesn’t seem to have prompted a sanction. The UKCP’s laughable response to this is that they didn’t sanction him for destroying his notes because there wasn’t a complaint about destroying his notes.

The final ruling was in March 2012. The outcomes of fitness to practice rulings are supposed to be published in the UKCP’s magazine, The Psychotherapist, which comes out three times a year. The Smalley ruling hasn’t been published yet. I have since been informed that it’s currently scheduled to appear in the Spring 2013 edition.

Seriously, Spring 2013? That’s a year after the final ruling! I e-mailed the UKCP to ask them why there’s such a long delay, and also to ask if there are any other fitness-to-practice outcomes that haven’t been published yet. They declined to comment.

John Smalley is no longer a UKCP member, as he resigned his registration during the hearings. However, he’s still registered with the Independent Group of Analytical Psychologists, and continues to advertise his therapy services on their website. To date, the only place where you can find out that he’s had allegations proven against him is on this blog. There’s nothing on either the UKCP or IGAP websites to suggest there’s anything wrong with his practice.

For comparison purposes, the British Association for Counselling and Psychotherapy has hearing outcomes up on its website, the most recent of which are from last month. Or, if you look at the Nursing and Midwifery Council website, they get hearing outcomes up within days.

The UKCP also has an online complaints archive. It looks pretty lonely. In fact, there’s only two decisions on it, neither of which are for John Smalley. One of them is Derek Gale. He was a notorious abuser who emotionally, sexually and financially exploited his patients, and was struck off by the Health Professions Council as well as by UKCP.

The details on the UKCP archive are also pretty scanty by the standards of regulators. For comparison, have a look at the HPC ruling for Derek Gale, which gives a long and detailed account of why you wouldn’t trust him to look after your cat, never mind a vulnerable adult. Meanwhile, the other decision on the UKCP website is for an Arbours Association therapist called Geoffrey Pick. It simply says:

Geoffrey Pick of The Association of Arbours Psychotherapists (AAP) has been found to be in breach of Article 6 of the AAP Code of Practice. Article 6 of AAP’s Code of Practice provides that ‘a member should maintain appropriate boundaries with their patients and take care not exploit their patients in any way, financially or sexually’.

In view of the above decision Mr Pick is:

1) suspended from the membership of AAP (and UKCP) for a period of one year from 16 May 2011;

2) required to enter therapy at least once a week with a therapist approved by AAP’s Ethics Committee and reports from the therapist are to be submitted to the AAP’s Ethics Committee once a quarter;

3) required to engage in further professional development as agreed between him and the AAP’s Ethics Committee liaison; and

4) required to meet a member of AAP’s Ethics Committee once a quarter.

 

Really not a very clear account of what he the misconduct was. Incidentally,  if anyone out there is reading this and knows what he did, my e-mail address is thus_spake_z at hushmail dot com.

 

RCN withdraws Castlebeck sponsorship of learning disability award

Yesterday I and others blogged and tweeted about how a Royal College of Nursing award for learning disability nurses was being sponsored by Castlebeck, the company responsible for the Winterbourne View abuse scandal.

Today, the RCN announced that Castlebeck’s involvement has been withdrawn.

Castlebeck, the company that owns Winterbourne View hospital, will no longer be a sponsor of RCN Publishing’s 2013 Learning Disability Nursing Award.

RCN Publishing took the decision to accept sponsorship from Castlebeck last month based on the substantial developments within the company since the first Panorama television programme was shown 16 months ago.

However, the very strong reaction from many learning disability nurses across the country has led to RCN Publishing withdrawing from the sponsorship arrangement. 

In a statement, the Royal College of Nursing said: “The RCN supports the decision of RCN Publishing to withdraw from its sponsorship arrangement with Castlebeck, due to the strong feelings of some members, including the whistleblower Terry Bryan, given the serious crimes committed against vulnerable residents at Winterbourne View.”

While RCN Publishing is a wholly owned subsidiary of the RCN, it is editorially independent.

In all fairness to Castlebeck, it appears that it’s been working hard to transform itself, sacking incompetent managers and bringing in proper clinicians. Even so, I don’t think the RCN should giving the company any leg-ups in trying to restore their reputation. They need to do that themselves.

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.

Timpson and Social Work Training

Yesterday at the Annual National Children and Adult Services Conference in Eastbourne, the Children Minister, Edward Timpson – appointed one month ago –  decided to share his expertise (!) in the sector by proposing a change in Social Work Education.

As the Guardian reports

Social work training should be overhauled so that newly qualified staff are “match fit” when they join the workforce, says the new children’s minister.

Edward Timpson, who was appointed in last month’s cabinet reshuffle, said he wanted the profession to attract the “brightest and the best”.

Well, there’s a way to indicate how little you know about social work, Mr Timpson.

I feel very strongly that we need to be clear what social work degrees should be delivering and what we expect them to deliver. Personally, I feel strongly that a social work degree course, whether at undergraduate or postgraduate level does not have the role of pumping out ‘match fit’ social workers ready to slot straight into a team.

Employers have to take some responsibility for delivering and training post-qualification for the workforce that they want to meet their own needs. A social work degree is a generic academic course which provides the tools, knowledge and understanding of social work theory, social policy, law and ethics to be able to interpret and use in many varied practice situations both in the statutory sector and in third sector and private sector.

What I don’t want the social work degree to become is a ‘training course for LA social workers’ and to absolve employers of the responsibility for training.

The expertise of universities is to deliver the academic training and study and the role of the placement is to give some practice experience but two placements is not enough to deliver ‘match fit’ and I’d rather universities concentrated their time on delivering to their strengths which is the academic/research/knowledge base of social work.

Then we get on to Timpson’s comment about attracting the ‘brightest and best’ to the profession. I will refrain from swearing here although I’m tempted to say something rude to Timpson at this point.

To say that is to insult those of us who feel we actually ARE the brightest and best – practitioners and students from many different backgrounds – who are committed to deliver the best we can of our profession.

What exactly does he mean by ‘brightest and best’? Oxbridge degrees? Is that the mark? We need to ensure we have a broad range of entrants to the profession but I genuinely don’t see we aren’t getting that now.

I wish ministers would actually look at the profession and try to understand it, what the role of training is and what the intake actually is before trying to make grandstanding statements about unnecessary ‘overhauls’.

Maybe we need a bit more focus as a  nation on creating ‘match fit’ politicians – and if we did, it would be none of those career politicians who come from private schools and Oxbridge into Think Tanks and public life. Maybe they should just look into the mirror or try and understand the sectors they are responsible for before claiming they have all the answers.

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.

A Culture of Care?

I can’t help it but I’m somewhat unimpressed and uninspired by claims that Castlebeck’s transformation is nearly complete (As reported by The Guardian).  I’m sure Mr Sullivan has done a sterling job in dragging the remains of homes such as Winterbourne View towards acceptable standards but the very fact that such poor standards of care are evident in contemporary care is a shameful indictment on our society.

It riles me not only that such abuse took place in the first instance, but that it wasn’t picked up by the care provider.  Would the abuse still be happening if it were down to Castlebeck to identify it and take action?  I shudder to think that the answer might be a resounding “Yes”.  Also to think what else may be happening within care homes across the UK where vulnerable adults don’t have the benefit of family involvement or carers with the insight to blow the whistle on abuse … or Panorama!

 Having worked with numerous residential and nursing homes, it is not hard to see how totally dependant some vulnerable members of our society are on those paid to provide good quality care:  Care that is monitored and regulated and where safeguarding policies are in place to ensure that those who can’t speak up for themselves are protected from abuse… Really?

I can’t help but recalling one particular home, the manager was sitting in a very well equipped, spacious office when I arrived congratulating herself at the marvel that were her new, glossy brochures. Showing prospective families just exactly how decent the home was with its ample garden blooming with flowers and general good cheer.  Carers smiled on the front cover in a manner that exuded quality, person-centred care from more carers than one could possibly need whilst care-free residents tucked into their gormet meals.

Sadly, the reality was very different:  Insufficiently trained carers that didn’t have the time to answer a call-bell that had been rung for the umpteenth time as the room’s occupant continued to lie in urine soaked sheets.  Then there was the missed opportunity after missed opportunity to spot pressure wounds that were silently getting progressively worse – out of sight, out of mind.  All the time, the owner continued to congratulate herself and confidently sell the homes’ services to prospective new residents and their families.  Oblivious to the reality that was unravelling the other side of her plush office door.

Of course, such business’ need to be well run but when business comes before quality of care something needs to change.  Whole cultures need to change because if the underlying ethos of a home’s manager is developing a thriving business, how can the ethos of carers within that home be anything different … such as caring perhaps.  Whilst I’m all for serious case reviews and learning from past mistakes, I’m not convinced my ministers’ exclamations that, “We must learn from this so that these things must never happen again!”   I fear that they will happen again … and again until the whole culture of care changes to one of … well, care.

I can recall perhaps just a handful of small care homes where the managers rota themselves on shift so they know what’s going on and can identify any training needs.  Where more money is spent on care than on prtraying a good image to prospective new residents.  They may not be glistening with a new coat of paint every 6 months or benefit from TV advertising but they are run with an underlying ethos of care and respect and reflect far more the brochures that are displayed elsewhere, but they don’t have their own glossy brochures.  All they have is a good reputation which gets them by more than adequately.

Home really is where the heart is

Home really is where the heart is.

My other  (less political) blog on health and social care. The above  post summarises a recent report  published on home care in England.

Sickness benefits, suspicion, and anxiety

Inequalities

In a guest post, Kayleigh Garthwaite talks about her recent research with sickness benefit claimants.  Prompted by a hostile email from a GP after speaking about her research recently on national radio, Kayleigh reflects on the real barriers that sickness benefit claimants face, and the challenges of living in a climate of institutionalised suspicion.

What does it mean for sickness benefit claimants to live in a climate of suspicion?

For the past three years, I have been studying the lives of long-term sickness benefits recipients in North East England as part of my PhD research. Recently, I was asked to appear on BBC Radio 4’s ‘Thinking Allowed’ to discuss welfare reform, following a symposium organised by Ben Baumberg and Ruth Patrick in Leeds.

On the programme, I spoke about how a deep-seated fear of welfare reform pervaded the daily lives of people in the study. Some people were afraid of…

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What I would say to Norman Lamb

Working in dementia services at the ‘frontline’ I often consider what messages I’d feed back to the local and national policy makers if I ever had the opportunity. Of course, I don’t have these opportunities as I’m not a manager so I thought I’d imagine I were at an important meeting with Norman Lamb, the minister for Care Services.

This is what I’d say.

Make policy practical. Making the right noises about setting up a wonderful plan to ‘challenge’ dementia is all well and good but I see nothing of that at the ‘frontline’.

What I see are cuts. I see respite narrowing in terms of ability to access. I see provisions which had been helpful, closing. I see a lack of beds in the local hospitals when they are needed and I see people who need support being denied it because there are no provisions left.

So take your pleasantries and policy ideas and come and spend a day with me in the community and you’ll see why I am impatient and unbelieving about the platitudes that emerge from those who don’t seem to understand what is happening ‘out there’.

I’m tired. I’m tired of saying ‘no’ to people whom I see need services because the provisions are so tight. I’m tired of saying ‘no’ to people at the early stages of need when I know it will prevent higher costs in terms of pain and suffering but also in terms of money in the longer run. I’m tired of logging targets that have no meaning in the lives of those whom I work with. I’m tired of jumping through artificial targets so I can ‘prove’ I’m doing my job when neglecting visits to actually talk to people because I have to catch up on the paperwork.

I have waited for years for a fair system of implementing personalised responses to care which include people with dementia but am still waiting because the entire focus on the programmes developed through personalisation have been on those who are more able to be involved in the processes or those who have involved family members to help them. I’m tired of wading through appallingly designed forms, self assessments and RAS (resource allocation systems) that focus entirely on physical health needs and marginalise mental health needs thereby ignoring equality legislation.

I want action and yes, sometimes, action includes money. I know what the people I work with ask for and I know I can’t deliver it – not through a lack of will – I want to be able to go home thinking I’m doing a good job and doing my best – and for the most part, I think I do – but the best I can offer is very sparse. The best i can do isn’t good enough.

We have few residential homes locally and are placing people further from their families. We have nothing ‘creative’ left to offer as those agencies which are helping with ‘support planning’ aren’t trained to offer support in non-directed advocacy and therefore if someone doesn’t ask, they don’t get.

So what would I do? I don’t have a budget and it’s probably for the best as I’d steam through it in five minutes – one of the many reasons I’m not and will never be a manager – but I would focus on trying to create a system of social care which offers equality of access to good and creative support planning.

I’d commission more non-directed advocacy into support planning. I’d roll out Individual Service Funds for people with dementia and I’d allow more time for carers – and for social workers to work with people who have dementia because honestly, that’s what’s needed.

However all we get is platitudes about how wonderful services will be without extra money being provided. Yes, I’m sure early diagnosis is important. It is. But please, please can the Department of Health and local government concentrate their minds on what is happening now and the poor services we are providing now and do something, anything to make them better.

I want to do my job well and I want to support people but all the tools I had available for doing so are being ripped away from me. It’s sometimes hard to keep the motivation up when you don’t believe you are helping anymore.

I’m the person saying ‘no’. Me, not the Head of Adult Services, not the Ministers responsible, not the councillors responsible. I sit in people’s homes and tell them what they are not entitled to anymore. I want those who make these decisions to take responsibility for that and to listen to us who go out there and who see.

That’s what I’d like.

picture by Liberal Democrats at Flickr