Monthly Archives: October 2012

We can improve care…….

We can improve care if govt provides a clear and coherent strategy, and genuine desire to

Di Galpin

As the abused patients of Winterbourne View hit the headlines again, with Panorama (BBC, 29th Oct 2012) claiming some have been subjected to abuse in their new home, and programme after programme highlighting the poor standards of care older people receive, is’nt it time for all of us to do more than be ‘shocked’ and ‘horrified’?

ITV presented another programme  (Exposure, 24th Oct) outlining the poor standards of care some older people receive, along with  problems in regulation. What a dismal vision of how we care for older people in this country.  However, its not just older people the care system is failing. On Monday (29th Oct 2102) Panorama will expose the further abuse of those adults who were removed from Winterbourne View, who have now been subjected to abuse in their new home!

At the heart of the problem is a culture of indifference, from not just some of those…

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Who cares? BBC and ITV exposes a culture of indifference to the most vulnerable in our society……

As the abused patients of Winterbourne View hit the headlines again, with Panorama (BBC, 29th Oct 2012) claiming some have been subjected to abuse in their new home, and programme after programme highlighting the poor standards of care older people receive, is’nt it time for all of us to do more than be ‘shocked’ and ‘horrified’?

ITV presented another programme  (Exposure, 24th Oct) outlining the poor standards of care some older people receive, along with  problems in regulation. What a dismal vision of how we care for older people in this country.  However, its not just older people the care system is failing. On Monday (29th Oct 2102) Panorama will expose the further abuse of those adults who were removed from Winterbourne View, who have now been subjected to abuse in their new home!

At the heart of the problem is a culture of indifference, from not just some of those who care for vulnerable people, but government and wider society.  I left social work 6 years ago for this very reason, it saddens me to find that 6 years on  little appears to have changed.

What is needed to improve the situation across the care sector?  Given this problem is not new this would indicate we need to change our approach. Whilst successive goverments have highlighted the need for better regulation of providers, whether public or private, better training for care staff and a change in culture within organisations we have never moved beyond the rhetoric.  All of these things would make a difference, but not if we just talk about them.

We need better regulation – so regulate, don’t say we will regulate , do it, and do it now so the message is received by providers, government will not tolerate the abuse of older people. CQC has to be resourced adequately, focused, firm and fearless. Part of regulation also involves good commissioning and contract monitoring at a local level following on from CQCs strong lead.

We need a coherent and regulated training strategy for carers and managers of services – at the moment training is piecemeal and of varying quality, neither is it assessed in any coherent way over the long term to establish whether it makes any difference to the quality of care.  Workers can attend training, but nobody ever checks if they have learnt anything or put it into practice.

Change in culture – a harder one to crack, given all the media attention to ‘Savile’ which clearly highlights the role of organisational cultures that allow abuse to occur.  A first step to change any culture requires strong leadership, from the top (Mr Cameron).  Are the right people at the top, are they truly ‘leaders’ or bean counting managers? We need more of the former rather than the latter.

The right people in the workforce – Finally we have to ask are we recruiting the right people into the care sector, whether as carers or managers?  Clearly there are many good carers/managers out there, but we need a lot more, however, this has to be based on suitability not availability.  Caring for people is a demanding, and rewarding job, but, carries little status and is seen as something ‘anyone’ can do.  From my professional experience I’d say the best carers/managers are those who have a deeply ingrained respect for others, and who genuinely like people.  This is not something that can be taught, but they are the characteristics required to develop professional, and caring, managers of services and carers.  Recruitment of the right people is central to turning the system around, however, we will only be able to do that if the most vulnerable, and those charged with providing care, are afforded the respect they deserve from both government and wider society.

Our current system of care provision leave many  people mistreated and without support.  Arguably where government regulation of services are insufficient or weak, a strong philosophical, moral, and ethical framework maybe required to guide the response of society in meeting any responsibility to ensure vulnerable people are not mistreated.  Where both are weak those most vulnerable will continue to suffer.

However, its’ not just about government regulating, we all have a responsibility to try and change things. I wonder do these  revelations  ‘expose’ our indifference also?

 “(F)or a while we may pause to express outrage.  But we then move on to the urgent business of our daily lives.  Spot checks and hit squads may arrest the worst practice… But they will not do much about a society that has hardened its heart………….” (Independent.co.uk, 16.02.11)

What is it about a culture of an organisation that makes the unacceptable acceptable?

Di Galpin

Whether it’s Mid Staffs,Savile, Rochdale, Winterbourne View or Hillcroft Nursing Home how do we turn  ‘culture’ around when it leaves people hurt and abused?

And I scream from the top of my lungs what’s going on’ (Linda Perry)

Given all of the latest revelations in the cases above it is hard not to shout ‘what’s going on?’  We keep hearing about a ‘culture’ where normally sensible strong characters feel utterly powerless to change ‘what’s going on’.  This has to be addressed if we want to live in a society we can all feel safe in.  My focus on a daily basis is on trying to support frontline staff in doing their professional best to protect those most vulnerble in society from abuse. However, it is not just their responsibility.  I have been critical in this blog previously regarding governments approach to safeguarding adults at risk of harm, arguing ‘big society’…

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Why do ‘ organisational cultures’ seem to allow the unacceptable to become acceptable?

Whether it’s Mid Staffs,Savile, Rochdale, Winterbourne View or Hillcroft Nursing Home how do we turn  ‘culture’ around when it leaves people hurt and abused?

And I scream from the top of my lungs what’s going on’ (Linda Perry)

Given all of the latest revelations in the cases above it is hard not to shout ‘what’s going on?’  We keep hearing about a ‘culture’ where normally sensible strong characters feel utterly powerless to change ‘what’s going on’.  This has to be addressed if we want to live in a society we can all feel safe in.  My focus on a daily basis is on trying to support frontline staff in doing their professional best to protect those most vulnerble in society from abuse. However, it is not just their responsibility.  I have been critical in this blog previously regarding governments approach to safeguarding adults at risk of harm, arguing ‘big society’ alone is not enough and that we require an active state to stand up and say ‘no’ to abuse, making it clear it is not acceptable in a modern society. I feel this even more now as I read and hear about ‘cultures’ within organisations that not only ignore abuse but seemingly facilitate its continuance. Many, like myself, have left the ‘caring’ professions because our voices have gone unheard when we have complained, often made to feel we are at fault for raising concerns.

Wider society, government and professionals sometimes  leave vulnerable people maltreated and without support. Whilst we need to rightly focus on practical matters, to work out what went wrong with the system, we also  need to relocate the debate in a much wider frame of reference to try and establish the philosophical, ethical and moral framework’s required to transform societal indifference toward the most vulnerable to one of care and respect.  I have recently undertaken  research to begin to understand the factors that lead some to be  abusive in their practice,  i.e. toward older people in hospitals, to try and work out what changes are required to improve the situation.  Following recent events my focus will now be on ‘culture’, especially organisational culture, to work out how we use it to empower and protect, rather than walk away in fear and shame.

What do you think?

(Re: understanding ‘what’s going on’ in the abuse of  older people in hospital settings – read more in the the Journal of Adult Protection)

Di Galpin

The names of places where the most vulnerable in society are cared for belies the reality of ‘care’ for many, names like ‘Winterbourne View’ and ‘Hillcroft’ are inaccurate and misleading,  ‘Guantanamo Bay View’ might be more representative of the care some will receive

Yet more dismal headlines, again!  This time it’s Hillcroft Nursing Home, it’s a simliar story to many others, elderly people  in care home abused by staff.  Am I shocked ……. sadly no.  What I am shocked at is the complacency of this government on this issue.

In 2010 the Royal Medical Colleges concluded inadequate hospital care for older people condemed many to death.  In 2011 The Health Service Ombudsman  suggested the NHS was inflicting pain and suffering on older people, and was indifferent to older people.  In 2012 Bingham  suggested the  treatment of older people in care is now so bad in many cases it meets…

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Hillcroft Nursing Home: Whilst for Cameron it’s about an ‘aspiration nation’ for older people in care it’s ‘humiliation after humiliation’…..

The names of places where the most vulnerable in society are cared for belies the reality of ‘care’ for many, names like ‘Winterbourne View’ and ‘Hillcroft’ are inaccurate and misleading,  ‘Guantanamo Bay View’ might be more representative of the care some will receive

Yet more dismal headlines, again!  This time it’s Hillcroft Nursing Home, it’s a simliar story to many others, elderly people  in care home abused by staff.  Am I shocked ……. sadly no.  What I am shocked at is the complacency of this government on this issue.

In 2010 the Royal Medical Colleges concluded inadequate hospital care for older people condemed many to death.  In 2011 The Health Service Ombudsman  suggested the NHS was inflicting pain and suffering on older people, and was indifferent to older people.  In 2012 Bingham  suggested the  treatment of older people in care is now so bad in many cases it meets the definition of ‘torture’.  Just for clarity Amnesty International has outlined the techniques used in ‘torture’, these include isolation, enforced trivial demands, degradation, threats, displays of power (i.e. controlling food and hydration, physical assault).  For some older people in care today, whether in the public or private sector, that is their care, torture.

 No wonder from a European perspective research suggests older people’s experience of ageing in the UK falls behind that of many of it’s European counterparts (WRVS,2012).

Older people’s experience of ageing in the UK can be improved, and it is all of our responsibility to try and acheive this.  However, we first need a coherent strategy to bring about the change desired by many who work with older people.  Government in the UK tend to address issues associated with an ageing population in individual ‘silos’.  Research from Europe suggests those countries taking a joined up approach where government consider how factors such as income, health, age discrimination and inclusion interact , the more successful policy approaches are likely to be to improve the experience of ageing.  However, any policy needs first to have a strong ethical foundation founded on a clear understanding of, and agreement to, promoting older peoples equality and human rights.

If you want to read more see my article in the Journal of Adult Protection

 p.s here is my very first blog written in Feb 2012……and still I’m saying the same things about the same issues, I wonder how those poor residents of Hillcroft Nursing Home feel about the ‘dignity code’ mentioned in that blog?

(This blog was written several months ago, since then 3 care workers have been charged and found guilty of abuse)

Megan, Rochdale and a serious loss of direction in our professional moral compass

Whilst the cases of Megan Stammers and the five Rochdale girls  might appear very different the underlying issue of underage sex, and those in authority being well aware of this fact, pose very serious questions of a number of professionals across a whole host of organisations (social services, education, health, the police, CPS).  

Who did what and when will come out in due course, and if it is anything like previous serious case reviews the ‘blame’ will not lay at any one door, but at many, with structural and organisational issues at the fore.

For me the response of the agencies and professionals involved also needs to be viewed from a values perspective,   particularly in the Rochdale case.    I cannot believe front line workers were happy with the situation, my gut feeling is that their concerns will have been somehow downplayed at a higher level by those above them.   From practice experience I know how easy it is for those not in face to face contact with individuals on the ground to move a social workers practice in a direction the worker is unhappy with,  it’s much easier leaving people in a vulnerble place when you have never met them face to face.  However, regardless of how mature we might think a 15 year old is, or whether a 15 year old is making a rational choice to engage in consensual sexual activity, the last time I opened a law text book it told me that an adult having sex with someone under the age of 16 years was illegal.  Why is this disregarded, and if ‘we’ choose to disregard this law what others laws should we ignore, who makes that decision, and on what basis?

Two weeks ago I sat with a group of qualified social workers in a classroom and we had a debate about professional values and ethics. I used the well known ‘torture’ scenario.

You have a terrorist who says they have planted a bomb in a city in the UK and  it will explode in 4 hours and many thousand will die. If you torture the terrorist you have a chance of finding the bomb  and saving many thousands of lives, would you torture?

The response from the group was similar to every other time I do this exercise,  the minority say no they would not and the rest, yes they would torture (or get someone else to do it, I have been asked on occasion could it be painless torture!) .  Whatever the answer the students are taking well known philosophical positions on values.  The first answer is taking a ‘deontological’ approach i.e. torture is intrinsically evil and cannot be justified under any circumstances.  The second answer is taking a ‘consequentialist’ approach i.e. torture may generally be a bad thing, but under these circumstances it is justified because  the suffering it will cause is out wieghed by the suffering it will prevent.

Deontological theories are based on the idea that there are certain things we should, or should not do, irrespective of the consequences.  Whilst, there are several deontological approaches the one we are probably most familiar with, in terms of practice in health and social care, is based on the concept of human rights, and a duty to respect the rights of others. The concept of inalienable human rights is in fact a classically deontological idea.

The alternative to a ‘deontological’ approach is ‘Consequentialism’. This is a collective term for a group of moral theories which are based on the idea that what determines rightness or otherwise of an action is whether the consequences of that action are favourable or unfavourable and for whom. Therefore, in this approach we tally up the good and bad consequences of actions and see whether the good consequences out-weigh the bad. This probably is the approach most used in the public sector, the greatest happiness for the greatest number principle which is usually how resourcing decisions are made.

Going back to our example regarding torture, what might your response be?  Some believe it would be justified to sacrifice the rights of one person for the sake of many. However, others feel concerned that if you were to ignore an individuals’ rights this time this might lead to the ‘slippery slope’, where  the disregarding of rights could become common practice.  So, for example,  accepting a 15 year old having sex with an adult is okay, leads to accepting its okay for 14 year olds, or 13 year olds, or ………..

I take  no moral stance on the age of consent and there are many factors to be taken into consideration, however, from a professional values standpoint it is about adhering to the law, and the danger of what happens when ‘we’ decide to ignore it.  My gut feeling is , disregard for this law has become such common practice,  that when agencies are presented with some cases of underage sex they go onto automatic pilot rather than looking at the case on an individual basis.

We all know professional values are important, whatever approach yon take, its adhering to them that’s the hard bit because what ever we do there will always be consequence for others from the decisions we make.