One of the notable benefits of the findings of the serious case review into the Winterbourne View scandal is new guidance in supporting staff with challenging frontline roles. Whilst the media attention and public approbation was focussed on the conduct of care and support staff, questions have arisen as to the responsibility of line management to assuring safe and respectful care for the service user. As a line manager, it is never enough to delegate care duties to your team without assuring the understanding of the rationale behind that care.
Working with people with learning disabilities should never be a mechanical process, since it is, by nature, person-centred and individualised. This creates a need for the person delivering the care and support to reflect on the interventions they use and to have a sound therapeutic base for their activity. In every episode of care, the aim is to support the specific, holistic needs of the service user. We are not ‘bathing’; we are ‘supporting Michael to bathe’. We do not undertake ‘feeding’; we ‘enable Susan to eat and drink’. Without this, the relationship between the carer and service user is flawed and in extremis can lead to the type of dehumanising behaviour seen at Winterbourne View.
In the role of line manager, it is sometimes difficult to instil such continued good practice in staff teams who are working in time-limited and narrow confines. Good care takes thought, time and patience, but where staff numbers are low and demands are high, how can you ensure that good practice flourishes? You may have staff with limited academic ability, whose first language is not English or who came late into the care profession from other industries. It may be that the induction to the workplace dealt with the necessary health and safety information but did not explore the more subtle ideals of person-centred care. In some cases, by affording choice and independence to the service user, you may be asking for staff behaviour and practice that challenges their personal beliefs or even affects them emotionally.
None of us has the facility to be there alongside our staff teams for every moment of the day, but infamous cases demonstrate how poor practice can escalate among groups of workers without strong guidance and leadership. The collusion of team members around abusive behaviour also illustrates the nature of group pressure, where even unwilling participants felt powerless to change what they knew was wrong.
There are ways to develop and grow good practice in staff teams, even in challenging circumstances. It is vital that the standard is set by an enlightened organisational culture; recent cases have indeed proved the adage that ‘The Fish Rots from the Head’. By ensuring protocols and policies are written from a client-centred viewpoint and embrace the rights of, and respect for, the service user, an organisation can define the moral and ethical background of the workplace and highlight the expectations for the professional conduct of employees.
However it is incumbent on operational managers that they underpin organisational values with their own practice and conduct and provide an example to the staff they lead. One way to address the individual conduct of members of a staff team is to provide opportunity for them to reflect on their own practice as part of their personal professional development. Supervision has been long held as an effective means of managing people in such environments, as care services and the opportunity to discuss work practice and issues is valued by supervisor and supervisee. However, recent consideration of how badly things can go wrong in high pressure care environments has led regulators to consider extending the type of supervision available.
The supporting information and guidance published this month by the Care Quality Commission on Clinical Supervision offers a valuable tool for operational managers in addressing this issue. Clinical Supervision, for many years the practice of health professionals, is regarded by the regulator as an important element for staff in frontline services;
‘In services for people with a learning disability or autism, the staff who care for the people using the services should have access to appropriate forms of support, including clinical supervision. This applies to all staff, including those who are not professionally registered’ 
Clinical Supervision allows staff the opportunity to reflect on their work practice, their behaviour, emotions and feelings towards what they do. It goes further than management supervision as it explores the moral and ethical issues that arise from providing person centred services and allows managers to identify areas of need. In a confidential setting, workers are encouraged to discuss and challenge their responses and attitudes to the work that they do and managers are able to guide, support and develop reflective and thoughtful work behaviour.
As a practitioner and a manager, I have many years’ experience of clinical supervision and have seen first-hand the benefits of giving staff time and space to explore their feelings and understanding of the work. For nurses and associated health professionals, it provides valuable learning time and helps them to see their strengths and weaknesses in a positive way. For managers, it guides their decision making around the on-going development needs of the service and allows them to plan appropriately for recruitment and training.
The CQC guidance offers reading and advice on how to use Clinical Supervision in the workplace and I commend it to any manager in a high-risk and challenging service. We ask a lot of our workforce when we support people with learning disabilities. We expect empathy, patience, understanding and positivity from the same people we ask to work unsocial hours for relatively low reward. Respect your staff teams and give them the theoretical background to the practical tasks you ask them to do. Let them explore the ideas and concepts of good quality care in their own time and in their own style and reap benefits from a more enlightened and equipped staff team.
 Supporting information and guidance: Supporting effective clinical supervision; Care Quality Commission, July 2013 HMSO