Why the Jeremy Forrest case is NOT a love story

[Trigger warnings: sexual abuse, grooming, victim-blaming]

Clearly the Sun must have either a short memory or a lot of gumption. Today they’re trumpeting the headline that Jeremy Forrest wants to wed the teenage girl he abducted, and the girl’s father would be happy to walk her down the aisle. Yesterday they reported that other teenage girls, some as young as 13, had received advances from him. The story focuses particularly on one girl who describes what sounds like some fairly classic grooming behaviour, while another was touched inappropriately and a third was receiving texts and online messages from him.

Really, Sun? From sexual predator to star-crossed love story in the space of 24 hours? Don’t you read your own newspaper?

I’ve read a lot of comments on social media trying to depict the Forrest case as some sort of modern-day Romeo and Juliet, in which the authorities have simply over-reacted. The trouble is, such suggestions are immediately scotched simply by reading the judge’s remarks prior to sentencing. There are almost no mitigating factors and a whole slew of aggravating ones.

Just to prove what absolute rot is being spoken out there, I’ve juxtaposed some excerpts from the sentencing remarks with a selection of quotes that I found through a quick trawl on Twitter. The sentencing remarks are in bold. The tweets are in italics.

“I really don’t understand how Jeremy Forrest is guilty of abduction when she willingly went with him”

“the evidence showed clearly how concerned your fellow members of staff were for your reputation as a teacher. They responded to the reports from students of your behavior and their own observations. Time and time again between Feb and July 2012, they warned and advised you and offered you support. You lied to them as to the nature of your developing relationship and denied sending the messages and photos that pupils had seen.”

“This is so wrong, she consented”

“You even complained that the rumours that were circulating were lies by X. You lied to her mother and complained that X’s silence in relation to those ‘false’ rumours was ruining your career and that she was harassing you. She felt mortified that her daughter was behaving in that way.”

“Wife and him were distant well before this happened. She didn’t and still doesn’t get on with her Mum. Jeremy was her saviour.”

“I am satisfied that you deceived X, too, about the true nature of your relationship with your wife.”

“Prosecution used terms like ‘paedophile’ and ‘grooming’ and the jury bought it.”

“I have seen nothing in the evidence which shows that at any stage you tried to provide proper boundaries between yourself and her, to discourage her, or let other staff deal with the matter appropriately. Indeed all the evidence shows that you encouraged her infatuation and provided opportunities for her to communicate with you and be alone with you.”

“Maybe she exploited his sensitive and caring vulnerability :-)”

“Your research into what might happen to you, if caught, is proof of the deliberate nature of your behavior.”

“I don’t really get how Jeremy Forrest got 5 and a half years, he didn’t exactly abduct her or do anything she didn’t want :S”

“On 20th September you took her to France. I suspect you went for your own purposes. In taking her with you, you subjected her family to appalling distress and concerns for her safety. You made no attempt to think of their welfare or let someone know she was safe.”

“he may have done it the *wrong* way, but he potentially saved her from suicide or some other fate on her own in France”

“You have contested the abduction charge raising a spurious defense, so that she had to give evidence, evidence very different in content from her original account and designed to support it. She had clearly received assistance in relation to what she should say.”

“He said sorry for failing her, and putting her through all the proceedings – that’s what a genuinely caring guy would do :-)”

“Where is that genuine care for her welfare that is the hallmark of a truly loving relationship?”

The Socialist Workers Party: Sex, Power and the Abuse of Trust

[Trigger warnings for rape and sexual exploitation]

I’ve blogged a couple of times about the scandal engulfing the Socialist Workers Party, an organisation I regard as closer to a cult than a political party. Just to recap, a senior figure in the SWP was accused of rape by a female party member. Rather than call the police, the SWP held an internal inquiry by a “Disputes Committee” made up of the accused’s friends, who completely exonerated him. Details have been published on the internet, prompting an internal revolt.

There’s been intense discussion of this on various left-wing blogs. This has resulted in details emerging that paint the whole affair in an even more disturbing light, bringing to bear issues over possible abuse of power dynamics.

To summarise these details, here’s a post by former SWP member Anna Chen. She replied to an exhortation by one of the SWP leadership not to listen to “filth” on the internet.

WHAT IS FILTH?

“Filth” is an alleged rape taking place when a woman is nineteen, 2 years after she and her party leader meet, at which time he is forty-six and she seventeen.

“Filth” is an appeal to the party’s internal disciplinary body being met with a kangaroo court run by several of the party leader’s friends, who then exonerate him.

“Filth” is the woman denied access to his evidence while he sees hers: the game is surely “I’ll show you mine IF you show me yours.”

“Filth” is a woman ostracised, cast out as unclean with a scarlet letter “A” carved into her forehead.

“Filth” is her friends put under heavy manners by the party’s attack dogs, fresh from their two-minute hate.

What particularly concerns me here – quite aside from what sounds like allegations of disgraceful treatment of the woman by her party – is the age difference between the two people involved. When they met he was 46, and a party leader, and she was only 17?

Given the widespread discussion of the case on various blogs, I don’t think it’s breaching any secrets to say that the accused is Martin Smith, former SWP secretary, and currently the national organiser of Unite Against Fascism. My understanding is that he denies rape – not that the truth can now be established either way. The SWP’s kangaroo court will have massively prejudiced any attempt at a criminal prosecution. However, he admits to having had a consensual sexual relationship with the girl in question.

There’s references to this in the transcript of the Disputes Committee report, which was leaked onto the Internet.

We also however thought it was important to be clear that the disputes committee doesn’t exist to police moral, er, bourgeois morality, so we agreed that issues that weren’t relevant to us were whether the comrade was monogamous, whether they were having an affair, whether the age differences in their relationahip, because as revolutionaries we didn’t consider that should be our remit to consider issues such as those.

Trouble is, this isn’t just about “bourgeois morality” but power relations. Let me draw an analogy. Normally, the age of consent for sex is 16. However, if the older person is classed as being in a “position of trust” over a younger person, then the age of consent runs up to the 18th birthday, for the simple reason that trust can be abused. Teachers are an example of this, and I previously made this point while discussing the Jeremy Forrest Case. As a nurse in Child and Adolescent Mental Health Services, I too would be classed as being in a position of trust. Hence if I slept with a 17 year old patient I wouldn’t only be committing gross professional misconduct. I’d also be committing a crime under the Sexual Offences Act.

Obviously, leaders of Trotskyist sects are not subject to the same legal obligations as teachers and nurses. Even so, the power relation still exists. When considering the power relation, remember that the SWP is absolutely notorious for authoritarianism, control-freakery and groupthink.

At its most extreme, the sycophancy appears cult-like.  A number of [Central Committee] members are big fans of jazz music. Under their leadership over the past few years, the party has organised a number of (mostly loss-making) jazz gigs as fundraising events.  Regardless of their own musical tastes, comrades were told they were disloyal if they didn’t purchase tickets.  This elevates the cultural tastes of the official leadership to a point of political principle; and clearly is not in any way a healthy state of affairs.

This is an organisation that claims to speak truth to power. Yet they seem incapable of understanding the potential for abuse of power when a middle-aged party leader is having sex with a teenage volunteer barely old enough to be out of school.

Then again, maybe their relationship had nothing to do with power relations, and Mr Smith cuts a dashing Robert Redford-style figure?

 

The #Rotherham #UKIP fostering row: Further details emerge

Another day, another set of details emerge about the UKIP fostering row. This time courtesy of the Daily Mail. I’ve said before that I’m not comfortable with the way a sensitive case about vulnerable children is being played out and discussed in the media, but since other people are clearly going to comment on the case, I suspect throwing a tuppence forth from this little blog isn’t going to make much difference in the grand scheme of things.

Last week the Guardian alluded to tensions between Rotherham Council and elements of the local East European community, and yesterday’s Daily Mail fills in some of the blanks regarding this. Apparently the council has been the subject of protests from Slovakian families following a number of removals of children into foster care. These families are accusing the council of “child-stealing” for racist reasons and of trying to impose British values on them. This has led to protests from the Slovakian government who appear to be taking the side of the families.

Though the “British values” in question appear to be things like children going to school, not wandering the streets at 2am, and not living in a mice infestation.

The Mail being the Mail, they don’t appear to see any irony at all in, a couple of weeks after accusing the council of ideologically-driven fixations with multiculturalism, then granting a fairly uncritical interview with an alleged abuser, strongly suggesting that the council are racist towards East Europeans.

The words “shot at from both sides” spring to mind.

And naturally, there’s a rentaquote from John Hemming, an MP who seems to live in a strange parallel world where child protection proceedings are nearly always due to scheming, malicious social workers and hardly ever about averting another Victoria Climbie or Baby Peter.

These arguments appear to have been made in the courts as well as in the media and council meetings, apparently with some success. As the Guardian said,

But a family court judge ruled three of the children should be returned to the parents after the birth parents successfully argued that the council had failed in their duty to ensure the children enjoyed the linguistic right to learn and speak the language of their birth.

In the light of the Guardian and Daily Mail reports, I’m going to make a rough educated guess at the backstory here, which may or may not have to amended as further details emerge into the public domain.

It seems likely that the council would have been anxious to avoid a repeat of this judicial ruling. It also seems likely that they may have been vigilant for anything that would be immediately be pounced upon by the birth family’s lawyers, by the Slovak protesters, possibly even by the Slovakian government and media.

Something like the foster carers being members of UKIP. They may well have been doing a perfectly good job as carers, but that wouldn’t be what the family’s lawyers would say in court.

One could argue that the local authority should have challenged the judicial rulings, ignored the Slovak government and media, and served up the local Slovak community a hefty slice of if-you-don’t-like-our-rules-you-don’t-have-to-come-here. I’ll leave others to argue that one out.

But either way, the application of Occam’s Razor doesn’t require the council to be acting out of an ideological crusade about multiculturalism, or a Labour-inspired grudge against UKIP, in order to have acted in this way.

It certainly doesn’t require any David Icke-style conspiracy theories about Common Purpose.

Such a scenario is entirely consistent with the local authority trying to tiptoe around one set of legal, social and political grenades, and in doing so accidentally setting off a completely different grenade. And that’s my guess as to what’s happened. Eventually time will tell whether I’m right or wrong.

One thing this case does show is how complex and difficult fostering cases can be. When such cases are seized upon for political reasons, whether by UKIP or the Slovakian government, such complexities and difficulties are rarely grasped.

The #Rotherham #UKIP Case – Will Nigel Farage and Michael Gove now apologise?

When the story broke that three children had been moved from a foster family in Rotherham, reportedly for being members of UKIP, I went out and talked to social workers, solicitors and care leavers. Consistently I got a response that the reported account was implausible, and there was almost certainly a more complex story to it. I put up a blog post saying so, and got a barrage of responses, much of them abusive.

Now a more complete picture is coming out about the affair. And – surprise, surprise – it was more complex than that. The details emerging are not of politically-crusading social workers with a grudge against UKIP, but of a difficult court case, dealing with distressing circumstances, with social services trying to comply with court rulings and fend off legal counter-arguments from the birth family.

This was not a case that should have been played out in the public domain like this. These are incredibly vulnerable children and their privacy has been invaded in an atrocious manner. I’m not going to repeat the details here (though people can just go to the Guardian for that)  but the distressing nature of their abuse gives a clear reason why such matters should be kept confidential. Not because social services have anything to hide, but to safeguard the wellbeing of the children.

A badly-handled interview with Joyce Thacker, Rotherham’s director of children’s services, didn’t help. Though with hindsight this is likely to be partly due to being caught on the hop on a Saturday morning, and also partly due to trying to be careful about what she said about a complex case. It may have been better for the council to have simply put out a “no comment” rather than trying to rush out an interview at the weekend.

Quite possibly the foster carers may well now have some difficult questions to answer about the way they went to the media and ignited a political firestorm. But politicians also have some questions to answer about the way they conducted themselves in this case. Nigel Farage practically turned  the whole thing into a party political broadcast for UKIP. Then there’s Michael Gove, the minister responsible for children’s services. He called it “indefensible” though in fact it turned out to be totally defensible. He also called it “the wrong decision in the wrong way for the wrong reasons”. Did he even know the way or the reasons when he said that? Was he even interested, or was he simply putting the Rotherham by-election before his ministerial responsibilities?

Ed Miliband emerges only marginally better in that, unlike Gove and Farage, he admitted he didn’t know the facts of the case and limited himself to calling for an investigation.

If politicians were cynical and opportunistic, some in the media were even worse. For example, the inexplicably-respected blogger Guido Fawkes ran an absolutely barking mad article. “Rotherham’s UKIP Child-Catcher Joyce Thacker Follows Common Purpose Progressive Agenda.” He leapt on a set of conspiracy theories, straight from David Icke territory, that accuse a rather dull training company called Common Purpose of trying to rewire our society along a “Marxist and Fabian” agenda. He concluded.

Thacker is yet another graduate of the Common Purpose organisation which pursues a“we know best” Fabian-style progressive agenda in the public sector. She was a project advisor for a pilot programme, run by Common Purpose, that was concerned with diversity issues in the West Yorkshire area. Something tells Guido she has an axe to grind in this and is not a neutral public servant…

Something tells me that Guido had better hope Ms Thacker doesn’t find herself a decent no-win-no-fee libel lawyer.

Nothing good has come out of this affair. Vulnerable children have had their privacy invaded. Hardworking and honest public servants have been grossly slandered. And why? For short-term political gain in a by-election. The likes of Nigel Farage, Michael Gove and Guido Fawkes need to apologise for their shameful behaviour in this ridiculous and unpleasant case.

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.

 

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.

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.

Winterbourne View – The Serious Case Review

Yesterday the Serious Case Review written by Margaret Flynn about Winterbourne View Hospital was published. It catalogues the series of circumstances which led to those scenes seen on BBC’s Panorama programme and it makes important and salutary lessons for everyone involved in health and social care.

It is a well-written, detailed report which catalogues a series of holes in the process of provisioning, commissioning, managing and monitoring a long stay hospital for people with learning disabilities but the most important lessons can easily be extrapolated out to many other areas of residential, nursing and long stay hospital care.

In summarising my own reading of the report, I have added some of my own thoughts as I go but I do recommend going to read the full version. No doubt I’ll be reflecting on it more over the next few days/weeks.

Introduction

This sets out the background to the airing of the programme on 31 May 2011 and the scope of the serious care review (SCR) which covers the period between January 2008 – when South Gloucestershire Council received their first safeguarding referral to 31st May 2011 when the Panorama programme was aired.  It explains the terms of reference of the report and some of the specific incidents seen on Panorama which caused concern.  This included illegal restraints procedures and

‘notions of a hospital, nursing, assessment, treatment, rehabilitation and support were emptied of meaning and credibility’

The Place and the Personnel

Winterbourne View opened in December 2006 after a ‘feasibility’ study by Castlebeck Ltd which had assessed that there was a need in that particular geographic location for this kind of service. As seen in the programme the placement of a hospital on a business park seems unbelievable but according to the ‘Statement of Purpose’ quoted in the report, there was local access to ‘amenities and a main bus route’ – one does wonder how much this was important to those in the hospital as opposed to those working at the hospital.

Families were not allowed into the bedrooms of those living there which rings many alarm bells to those of us in the sector but may not have been seen as something unusual if you don’t know how these things should operate.

Learning disability nursing and psychiatry were the only disciplines employed in the so-called ‘multi-disciplinary’ teams. The report explains the structure of the service and staffing which was heavy on support workers, which in itself isn’t surprising however a ‘hospital’ employing no occupational therapy, for example, is particularly surprising.  There was a very high turnover and sickness rate among staff which in itself is a sign of there being something particularly wrong in the structures.  12 hour shifts were the norm which may have suited the service and staff more than those who use the service and there was certainly a lack of detail regarding day time activities and timetables for those who lived in Winterbourne View.

I do wonder where the input from care managers/care co-ordinators were in terms of monitoring care plans and ensuring their were adhered to. My gut feeling is that with out of area placements, there was less impetus to be able to monitor these. Commissioners didn’t seem to make many demands that the operating guidelines for Winterbourne were met in terms of providing a therapeutic and rehabilitative environment.

Chronology

This section details the concerns raised and is an analysis of what was actually happening at Winterbourne along a timeline.  Unsurprisingly there are a string of concerns raised that when seen along a timeline can build a picture of a hospital and an organisation that is not fit for purpose.

Part of the concern as a whole is that the dots were not connected in terms of the series of incidents and concerns to build a coherent picture of what was happening. Whilst it’s ‘easy to be wise with hindsight’ it’s important to remember that we have systems which are supposed to protect vulnerable adults which should include collating and using information, concerns and reports to build cohesive pictures of what is going on – that’s even without the whistleblowing which took place.

It makes very difficult reading – all the more so in the context that it was not sufficiently investigated, not internally, not locally and not by the regulator nor police. The key worry that ran through my head is that this may have continued had it not been for both the intervention of determined ‘whistleblowers’ and the involvement of a BBC journalist. That’s a very very worrying lesson that needs to be acted on.

The Experiences and Perspectives of Patients and their Families

The author of the report spoke to six families in particular and explains their perceptions, experiences and understanding of what was happening at Winterbourne View.  The report gives life to some of those who lived at Winterbourne View and humanises them in a way, it seems that the service itself never did – with hopes, aspirations, character and personality.

One patient said

he had been in ‘loads of worse places than them, all over the country’ and that he had been abused in lots of care homes

And if there’s a key lesson to learn it is that Winterbourne View is not an anomaly and shouldn’t be seen as such.

The patient recollections of abuse and treatment at Winterbourne is very powerful. It evidences the importance both of listening and humanising approaches within residential care and hospital care. The importance of being near families and the disruptions of constantly changing placements seems to be the nature of life for some groups of people who have particular care needs and I wonder where the power in commissioning is coming from to look at different models.

When families raised concerns that their children had brought to them these reports were often disbelieved or families were not given the full details of what was going on.  It also raises the importance of visiting and monitoring – particularly for those who may not have families.

Importantly the report says

A family expressed anger that service commissioners making spot purchases to meet the needs of individuals do not know what they want to buy; they do not seek assurance that the service they believe they are buying is delivered; and they do not follow up on what is being provided.

Perhaps more importantly in terms of lessons to be learnt globally

‘As families recalled some of their distressing experiences, it was clear that they had no collective experience of being regarded as partners deserving of trust and respect or even of collaborating with paid carers.

There has to be a shift in the conceit of ‘paid professionals’ or ‘paid support workers’. We have to work with, alongside and for those whom we support and their families as otherwise we should be nowhere even close to a position in social care. Respect, listening and remembering whom we are serving  is the crux of the profession and that seems to have been lost somewhere.

Agencies

Castlebeck Ltd seemed to have a ‘limited executive oversight’ of Winterbourne View with the geographical distance from their head office in Darlington providing significant lapse in responsiveness when concerns were raised.

Interestingly they seem to place some of the blame directly on the CQC and problems with the transition from the Healthcare Commission to the CQC. While no CQC apologist this seems to be a very complacent and worrying dereliction of duty from the organisation that was paid to provide a service which should include self-monitoring.  The SCR looks at Castlebeck’s own analysis of their failings but finds it lacking with attempts to discharge responsibility for the things that went wrong. As it says

Overall Castlebeck Ltd’s appreciation of events leading up to transmission of Panorama is limited, not least because they took financial rewards without any apparent responsibility. The recommendations fail to address corporate responsibility at the highest level

Which is sad, but unsurprising.

NHS South of England also produced a report about commissioning of care and treatment at Winterbourne View.  Out of the 48 referrals made to Winterbourne View, 13 came from commissioners located less than 20 miles away and 9 of those 13 were from commissioners less than 10 miles away.

Worrying is that there were some placements made with few checks and some not even reading the most recent inspection reports.  Interesting that of the 48 English patients (the experiences of Welsh patients – not being the responsibility of the NHS in England were not counted in these figures) 35 were admitted under a section of the Mental Health Act, 13 were admitted informally and 6 were detained after being admitted informally. Unfortunately there are no details regarding the Deprivation of Liberty Safeguards but it would be interesting to know more about those ‘informal’ admissions legally.

NHS South Gloucestershire PCT was the ‘coordinating’ commissioner being where Winterbourne View is located. They produced another report.  Hospital records were also accessed but there seemed to be no linking of information together and agencies not speaking to each other seems to be a major problem and continuing concern.

South Gloucestershire Council also provided a Safeguarding Review.  South Gloucestershire received 40 safeguarding alerts between October 2007 and April 2011. The system locally to follow up some safeguarding alerts seemed to be flawed in terms of not receiving relevant and necessary information requested back from Winterbourne View.  Many of the alerts ‘tail off inconclusively with no clear decisions and no rationale for decisions’.  Each alert was dealt with discretely and the pattern was not allowed to emerge.

Avon and Somerset Constabulary were also involved as there were a number of assaults reported and they also provided a report. There were some flaws in the sharing of information between the police and the local council.

CQC also compiled a report.  The SCR picks up on some confusion in language in terms of the CQC and notes the importance  to note that Winterbourne View is not a care home but is a hospital. The CQC admits that it’s creation has had a significant impact on inspection of services – something we all knew – but it’s good to see them acknowledge this finally rather than paint the biased hue of everything ‘being better’ under the new regime.

The lack of specialist inspectors is a particular factor that the new systems of regulation have lost. Apparently ‘professional regulators’ is a better way of doing things rather than those with specific knowledge of particular service areas. Perhaps this isn’t quite the right way to develop regulatory services.

Findings and Recommendations

The report finishes with a summary that is robust. Winterbourne View is a particular snapshot which has been able to take place due to a series of circumstances that put the spotlight on the services. These spotlights aren’t often shined into the world of long stay hospitals and residential care. But for a BBC programme, it might never have been picked up. That’s a lesson in itself.

Castlebeck Ltd didn’t provide a poor service because it had no money. It provided a poor service because it didn’t see any reason not to.  There were no reasons to question itself or what it was doing. Those questions weren’t being asked by any of the agencies responsible for protecting those who lived in Winterbourne View.

The recommendations are that the Clinical Commissioning Groups, Local authorities and NHS Commissioning Board should be looking more closely at the services they commission, where they are commissioning them and aim to cut down in-patient services.

The report emphasises

‘Commissioning is a professional activity that should be led by trained specialists who know and develop the market according to public policy’

This made me sigh as it seems in my own experience that we are moving backwards on this. I see fewer specialist commissioners who know their areas and more general commissioners who come from non-health or care related backgrounds and with little understanding of the sector or the needs locally of those who use the services they commission.

The report strongly criticises the commissioning of long stay hospitals for people with learning disabilities as perpetuating the ‘out of sight, out of mind’ type modelling for care services.

Recommendations include a more robust use of the Mental Capacity Act 2005 and particularly that

‘The Department of Health should assure itself that CQC’s current legal responsibility to monitor and report on the use of Deprivation of Liberty Safeguards provide sufficient scrutiny of the use of DoLS’

There was a lesson in poor multi-agency working which needs to be worked on actively and there is a recommendation that those who are subject to provisions of the Mental Health Act or Deprivation of Liberty Safeguards as well as all who make a complaint have access to independent professionals, whether social workers, Best Interests Assessors, IMCAs or IMHAs or more than one. Advocacy is crucial to prevent abuses.

As far as the CQC is concerned, the report explains that the ‘light touch’ regulation, enamoured by the CQC doesn’t work with settings like Winterbourne View. The CQC has been too reliant on self-reporting and trusting providers are complying.

There’s a recommendation that the ‘

Mental Health arm of the CQC should have characteristics akin to HM Inspectorate of Prisons in terms of standards’

That would be an interesting and useful development but I doubt the current CQC is set up to provide a robust monitoring procedure.

Conclusions

I haven’t been able to cover all the points of the SCR. It is worth reading in its entirety. It concludes by emphasising that services like Winterbourne View should not exist as they create no aspirations and hope.

They are not therapeutic environments and were created to provide a funding stream to the private company rather than to improve the quality of treatment and care to those who need them.

Commissioning should look at what exactly is being commissioned and what is needed to achieve the end result of an improvement of quality of life.

I look at this report and it is an excellent report, and I despair. I recognise parts of it but it is a particularly appalling litany of pain, distress and human suffering that could have been identified earlier. We relied on a television programme to identify these issues when there were so many people who should have identified this sooner.

No one comes out of this well apart from the whistle blowers who tried to make a difference.

Good services can and do exist but we need to be very clear about expectations of services and what we expect a hospital built on an industrial estate and factoring in amounts of income possible can achieve as opposed to services which truly exist in local communities.

It’s an awful situation but the SCR offers an opportunity to learn and do things differently. Let’s listen more and better across the whole sector and remember that this job is always a matter of partnership and never should be one of dictation. We have to do things better.

Winterbourne View – Profit from Cruelty

Today I’ve been reading the Serious Case Review for Winterbourne View, and it makes for grim reading. A monumental tale of casual abuse and violence by staff against patients with autism and learning disabilities. Whistleblowers ignored. Police and regulators failing to take action.

But here’s something that makes it doubly sickening, from the opening paragraph to Section 6 of the review.

We have been here before. There is nothing new about the institutional abuse of adults with learning disabilities and autism.

Events witnessed at Winterbourne View Hospital recall the custodial treatment associated with decommissioned, long stay, NHS hospitals. However, unlike the hospitals and institutions described in previous inquiries and reports of institutional abuse, Castlebeck Ltd was not starved of funds. The financial costs of out of area services for people with learning disabilities, autism and or mental health problems are considerable, as reflected in the weekly average fee charged.

The fee they refer to was £3500 per patient per week, paid for by the taxpayer. Putting them up in the Savoy would be cheap by comparison. And what did the patients get in exchange for these generous payments, apart from the opportunity to be taunted and thumped?

The skill mix at Winterbourne View seems to have been surprisingly dismal, given what was being paid. The only professional groups employed were psychiatrists and learning disability nurses, and there weren’t that many of those. The overwhelming majority of staff were unqualified support workers. No psychologists. No occupational therapists. Some activities coordinators to organise recreation, but as is often the case in units with staffing issues, they regularly wound up being used as relief care workers instead.

During 2010, “on the job” training and inadequate staffing levels persisted with poor recruitment practices and further instances of unprofessional behaviour in an increasingly non-therapeutic hospital. Patients lived in circumstances which raised the continuous possibility of harm and degradation. Castlebeck Ltd’s managers did not deal with unprofessional practices at Winterbourne View Hospital. Absconding patients, the concerns of their relatives, requests to be removed and escalating self-injurious behaviour were not perceived as evidence of a failing service. The documented concerns of a whistleblower made no difference in an unnoticing environment.

In all fairness, unqualified support staff can and do provide good quality care, with the right leadership and a good culture. Not that they got it from the owners, Castlebeck Ltd. They seemed happy to rake in the dosh from their remote headquarters in Darlington while an ethos of abuse, over-medication and excessive use of restraint ran rampart at Winterbourne View.

This may be worth remembering as the government applies the rhetoric of “any qualified provider” to the NHS. Castlebeck were regarded as a “qualified provider”. Whether they gave value for money is another matter entirely.

 

 

 

Hobson’s choice – voluntary or compulsory removal of a child?

CA (A Baby), Re [2012] EWHC 2190 (Fam) (30 July 2012)

By an extraordinary coincidence, it was only this week that I mentioned in a blog the case which came to national tabloid prominence four years ago as “the Nottingham baby case”. Extraordinary that I have cause to review it again, so soon, in considering a judgement given on Monday; and coincidence that @suesspiciousmin covered both cases and indeed his blog drew my attention to the case which prompts me to drag it up for the second time. His blog on yesterday’s judgement is here: http://suesspiciousminds.com/2012/07/31/i-need-two-volunteers-you-and-you-how-voluntary-is-voluntary-accommodation/

But, having dug out the Nottingham baby case so recently, I had to find myself reflecting that the issues in this week’s case have been aired before, and indeed to remarkably similar effect.

Hold on a minute, I hear you saying, I have no idea what you are talking about. What is the Nottingham baby case, and what happened this week? OK, one at a time.

The Nottingham baby case By an extraordinary coincidence, in late January 2008 a judicial review by a care leaver of her pathway plan was listed to be heard a few hours after she had given birth early, and her baby had been removed. Thus very publicly, in judicial review rather than family proceedings, the court was asked to, and did, order the baby’s return in the absence of any court order authorising his removal.

A full hearing of the issues took place two months later, and there, the local authority argued that, as the mother knew of the plan to remove her child at birth and had not objected, she should be treated as having consented to the baby being accommodated under section 20. The judgement G, R (on the application of) v Nottingham City Council [2008] EWHC 400 (Admin) (05 March 2008) robustly rejected this argument.

I analysed the case at the time, in an article in Professional Social Work magazine, which you can read here: http://www.celticknot.org.uk/publications/canishouldimusti.pdf

What happened this week? An expectant mother who had had previous children removed for adoption was subject to a plan for the same for her fourth. When the birth came there were life threatening complications, and among other things she received morphine during and after birth. The authority sought to accommodate the child voluntarily but she did not consent. She was asked again over the course of the day until later in the day, while dosed with morphine, she agreed and the child was removed. She challenged the lawfulness of the removal and judgement was given yesterday in CA (A Baby), Re [2012] EWHC 2190 (Fam) (30 July 2012).

This week’s judgement records an agreement to pay human rights act damages for the interference with her family life, and sets out forcefully observations on the use of section 20 in these circumstances. The court was not referred to the Nottingham baby case, possibly because it was a judicial review rather than a family case.

The issues in common

Both cases:

• concerned the removal of a child at birth in accordance with a birth plan;
• used voluntary accommodation under section 20 as the vehicle for achieving that removal;
• involved challenges to whether consent was properly obtained;
• asserted breaches of the Article 8 right to respect for private and family life;

Lessons on consent – a reminder

The Nottingham baby case resulted in a robust judgement which distinguished acquiescence from consent:

To equate helpless acquiescence with consent when a parent is confronted in circumstances such as this with the misuse (or perhaps on another occasion the misrepresentation) of non-existent authority by an agent of the State is, in my judgment, both unprincipled and, indeed, fraught with potential danger… Submission in the face of asserted State authority is not the same as consent. [paragraphs 55, 61]

This week’s judgement also distinguishes acquiescence from consent [paragraph 36].

Both cases also serve up reminders that the immediate aftermath of birth is not a good time for proper informed consent [Nottingham case at paragraphs 52, 57; this week’s case at paragraph 38].

Both cases also remind us that consent which is obtained in circumstances where the mother believes they have no choice is not proper informed consent either [Nottingham case at paragraph 55; this week’s case at paragraph 35].

Thus far, I am happy. Disappointed, perhaps, that the assertion of non-existent authority by an agent of the State is still being used to procure the removal of children with neither proper consent nor the sanction of a court. But if that is the case, then this is a timely reminder to get it right.

Lessons on capacity – a difference

Yesterday’s case raises the issue of capacity and consent. Effectively, it reminds us that you cannot consent without the capacity to consent. Since the European Court in H.L. v. THE UNITED KINGDOM – 45508/99 [2004] ECHR 471 (5 October 2004) holds that the absence of objection cannot be equated with consent, and those who for reasons of capacity cannot object still need an effective remedy, that judgement seems to draw together the Nottingham baby case and yesterday’s case. One may have concerned a capacitous individual not objecting and the other a non-capacitous one, but the principles which hold that there is actually no consent actually apply to both.

The difference is that in the absence of capacity, in effect there must be a court order, consent being impossible.

Lessons on choice – a problem

But there is, it seems to me, a problem with yesterday’s judgement. The Nottingham judgement explicitly recognises that section 20 consent is at least possible to authorise the removal of a child at birth for adoption – and even cites a precedent – X County Council v C [2007] EWHC 1771 (Fam) (20 July 2007).

Yesterday’s judgement seems to go further. It comes very close to saying that section 20 should not be used in circumstances where a court order could not immediately be obtained.

I am troubled by an issue that brings us up to the furthest reaches of the issues surrounding consent and choice, while at the same time engaging the very nature of social work:

If the only choice you have been given is to hand over your child voluntarily or face an application for a court order, is that a genuine choice? And if you have no real choice, is it effectively unlawful compulsion?

At first blush, a rights-oriented lawyer will deplore the effective compulsion that is involved in the Hobson’s choice between voluntary and involuntary removal. But I also have concerns to see my other profession, social work, engaging in more co-operative practice. Indeed, I think the original ethos of the Children Act – and indeed the statutory guidance accompanying it – assumed that social workers would be trying to work with, rather than against, families even where there were child protection concerns. And I think that such an approach would enhance social work’s standing also.

These concerns lead me to believe that voluntary care and persuasion really ought to be tools in the social worker’s toolbox. And it was with some concern, therefore, that I read @suesspiciousmin‘s analysis of this case which includes the useful summary that the court entered

into a discussion of whether a Local Authority can properly invite a parent to give s20 consent if the circumstances are not such that a Court would authorise separation, before concluding that they cannot.

That, I do not like. I think the more powerful argument is that this week’s case makes persuasion to the use of section 20 more fraught with difficulties and therefore less likely to be attempted, rather than that it outlaws it. After all, the judge does observe,

there will be cases where it is perfectly proper to seek agreement to immediate post-birth accommodation… secondly where a parent has always accepted that the child must be removed and has consistently expressed a willingness to consent (but not of course just to acquiesce)… the right to exercise parental responsibility by requesting accommodation under Section 20 and the local authority’s powers of response under Section 20(4) must be respected  [paragraph 36].

Even so, dissuasion of persuasion (!) is not necessarily helpful. Of course, using section 20 properly means:

• never pretending that you could get a court order if you couldn’t;
• always making clear that there are remedies, and parents have access to remedies to test the lawfulness of the authority’s actions and proposed actions;
• not using a failure to co-operate voluntarily against a parent (this, of course, is particularly pernicious, as explained in this blog)

Surely, if used properly, invitations to section 20 consent should result in:

• some parents giving informed consent, even though they fully understand that they need not and that they could win an argument that the care threshold was not met – because they are persuaded to work co-operatively with the authority in the interests of a child in need;
• others withholding consent, and the child’s being made the subject of an Order, without reliance on the parent’s withholding of consent – because we accept that it is their right to challenge the lawfulness of our actions and we don’t hold that against them;
• still others withholding consent and the child’s not being made subject to an Order – because, let’s face it, if the threshold isn’t met then we cannot and should not be using compulsion, we shouldn’t use compulsion simply in the best interests of a child, only to protect from significant harm.

Precluding the possibility of outcome 1 is not good news in my book. Outcome 3 is consistent with the rights of all involved. My fear is, that if section 20 is confined to cases where the significant harm threshold can be made out,

• this is bad for children, because it removes a potential tool in the toolbox of social workers to help children in need, and reinforces the notion of ‘significant harm or nothing’ which plagues work with children and families;
• it is bad for parents, who cannot accept support without the probable stigma of being labelled as bad parents owing to the threshold test being met;
• and it is bad for social work, reinforcing confrontation because the very fact of social work involvement equates with compulsion and is confined to the more serious cases.

Hobson’s choice? No, the choice between voluntary and compulsory accommodation is a real choice that can benefit us all.

P.S. I have mentioned and recommended two other blog posts on the use of section 20:

‘And for tonight’s rant‘ from @familoo at http://pinktape.co.uk/ (which makes a strong case for the court’s supervision); and

‘How ‘voluntary’ is voluntary accommodation?‘ from @suesspiciousmin at http://suesspiciousminds.com/.

Those two blogsites have been very sweetly courting each other this week – or whatever it is that blogsites do when they contemplate partnership – blush, apparently – but even from my gooseberry’s perspective, I can heartily recommend both, as forming part of my regular and essential reading, and being incisive and quick off the mark in commentary!

Allan Norman (@CelticKnotTweet) is a registered social worker and a solicitor at Celtic Knot – Solicitors and Social Workers.