Winterbourne View - an Autumnal reflection

The Care Quality Commission (CQC) report speedily produced in the aftermath of the exposure by May's BBC Panorama programme of appalling care standards at Winterbourne View (an assessment and treatment centre) unsurprisingly found the care home guilty of “systemic failings” and not meeting 10 of the 16 essential standards. And, more astonishingly, actually found standards were worse than the abuse originally reported in the undercover operation.

CQC’s Director of Operations, Amanda Sherlock, said: “This report is a damning indictment of the regime at Winterbourne View and its systemic failings to protect the vulnerable people in its care.” One could be tempted to displace “Winterbourne View” in Sherlock’s statement with “CQC”.

Two troubling features (above numerous others) arise from this CQC report. First, how did inspectors previously fail to notice that over 60% of the basic standards required were not being met – and then were only stung into action by the media exposé? And second, the CQC and Sherlock has decidedly suspect form on all of this.

The CQC’s defence of its previous ignorance of poor standards is not that its three inspection visits between 1 December 2008 and 15 December 2009 were in any way sub-standard (after all one did pick up on the fact “there are no warning notices to show where oxygen cylinders are stored within an establishment”). Nor was it the worrying fact that it hadn’t visited the home at all for 533 days before the Panorama broadcast. No, that wasn’t the issue. The CQC routinely relies substantially on homes and services evaluating their own performance, but the provider (Castlebeck Care) “had failed in its legal duty to inform us of injuries to, or absences of, patients.” So, the real issue was that Winterbourne View staff didn’t tell the CQC how rubbish Winterbourne View truly was. How else could they know?

But while the CQC, like a regulator scorned, has given the impression that it was duped but responded robustly to right those wrongs, there is a bit of form here. On 23 November 2010, Radio 4’s File on 4 programme broadcast concerns about a certain care regulator and its handling of a home run by the now (go figure) disgraced provider, Southern Cross, who suspended 12 staff following a police investigation.

The transcript of the interview between BBC’s Fran Abrams and the CQC’s good practice mouthpiece reveals a somewhat clanging echo:

ABRAMS: Why didn’t you go in? Why didn’t you do something?

SHERLOCK: We did go in when we found out that service standards were deteriorating. What our review of this case has demonstrated is that this home were remiss in informing the regulator when serious incidents were occurring.

So, in essence: "This home also didn’t tell us it wasn’t any good!" No shit, Sherlock! And this at a time when the CQC is reducing its inspections to homes and services. Or, in the weasel words of the regulator: “some level of planned regulatory activity with the registered provider”. But that doesn’t necessarily mean an inspection visit (sorry, “crossing the threshold”).

No inspection system can ever be perfect. But the CQC needs to stop blaming everybody else. Indeed, in this interview Sherlock points the finger – not at any of the operations of which she is director – but, er, us: Joe Public.

ABRAMS: But you’re going to be relying very heavily, aren’t you, on self-assessment by the homes?

SHERLOCK: This cannot be the sole responsibility of the regulator. In my experience, if there is a poor home in a community, then the community know about that, and what we need to be better at is ensuring that that information and that local knowledge is passed to ourselves as the regulator so that we can intervene and we can avoid dreadful tragedies and poor standards and unacceptable standards of care.

Trouble is, in Winterbourne View’s case, the CQC were told: whistles were blown, concerns were raised. And the CQC responded by doing precisely nothing. Dame Jo Williams, The CQC chair, at least admitted that this was “unforgivable”. For once, no weasel words and a CQC sentiment with which to concur.

Winterbourne View - a personal view

Unsurprisingly, the words “appalling” and “shocking” have been widely and rightly used to describe the abuse of people with learning disabilities at Winterbourne View in Bristol, uncovered by this week’s BBC Panorama programme. But what is, perhaps, more appalling and shocking is how unsurprising it is that such systematic abuse is uncovered.

The Care Quality Commission (CQC) has apologised for its “failure to act more swiftly”. Regulation is not, nor can it be, perfect. But, seemingly, the CQC graces itself with little favour. First, its “light touch” inspection regime means that places such as Winterbourne View where very little has caused the CQC concern in the past (perhaps a worry in itself) would not even be inspected once a year.

Second (and I will expand on this point on a later post), the very quality of the light-touch inspection process appears weak. Read the previous three inspection reports and you only get a sense that all the inspectors are interested in is records, policies and procedures. People don’t seem to be part of it (unless it’s the manager or senior being available to dig the relevant leaflet or policy). The inspection reports are thoughtlessly designed, bureaucratic, poorly written and jargon-filled. I can imagine relatives and staff struggling with phrases such as “the occlusion of windows” let alone the people who matter most: those who actually live there.

We get no sense of the quality of life being experienced, the quality of relationships between all those who live, work or visit the place. Maybe if the inspectors had concentrated more on speaking to the service users (or so-called patients as this is a hospital setting) then they might have picked up on the appalling and shocking abuse that has clearly been taking place over some time and has developed into fairly standard practice. CQC set itself up in a blaze of “putting the service user at the heart of inspection”. If these reports are typical then that heart has been ripped out in favour of inspection findings that centre on “no warning notices in place to show where oxygen cylinders are stored within the establishment”.

I’m sure warning notices are important. But what about warnings about the care? What about the relationships? What is a day in the life of someone living there like? For inspectors not to find out this basic care stuff is also, I suggest, appalling and shocking.

hay fever

Any Friday off has got to be Good. But this Good Friday was especially so as we packed ourselves off to Hay-on-Wye ("the town of books" just over the Herefordshire border in Wales) for the opening of an art exhibition at the Globe at Hay. It is the first showing for the talented artist Horace Panter (at the moment best known as bass player in The Specials). Horace's work is inspired by icons and his bold and bright approach is gently tempered by an absorbingly simple vulnerability. Impressive stuff. If you can't check out his paintings in person (the Hay exhibition runs until early June and a London exhibition awaits) then do visit his website: www.horacepanterart.com

The connection with us? Our director, Graham, has just started working on adapting Horace's excellent book on his life with The Specials - "Ska'd for Life" - for the stage. To mark the occasion our shop will be stocking a limited number of signed copies of Horace's book - watch this space.

And we're talking with Horace about commissioning a piece to be used to promote awareness and raise money for those working in disability hate crime. It's an area close to his heart as he spent many post-Specials years working as an art teacher with special needs children. Once again - watch this space...

the ageing ska legend as artist...