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Hope and Despair
Hope: we celebrate excellent practice
This has to be my first point. I know how demoralising it is for an empowering provider, working with people and families so creatively, to be ‘lumped in’ with the shameful actions of a few. And there are such useful tools out there to support best practice, from CQC guidance to the MCA code of practice. Indeed, by reading this article, or sharing other QCS materials with your staff, you are living your complete commitment to best practice.
Despair: appalling cruelty still exists
Yesterday I learnt about the abuse of people with learning disabilities in two ‘care’ homes (using the word ‘care’ loosely) in Devon, closed by CQC in 2012. I appreciate that this is some time ago; reporting restrictions have only now been lifted, following the passing of sentences. But I do fear that cruel treatment of the most vulnerable may still happen.
My knowledge of this case comes from the Crown Prosecution Service website and the media. But I understand that 13 people who were paid to care for people living with learning disabilities have been found guilty, mainly of committing False Imprisonment.
At least one resident had lived previously in Winterbourne View and experienced callous cruelty there, including having his jaw broken without explanation. You might expect that those commissioning his subsequent care would scrutinise how he was treated. You might also expect that a provider being paid up to £4,000 a week for each resident would ensure that the person’s wishes and feelings were at the heart of their care planning . You would be mistaken.
Restraint used as punishment
The residents describe being sent to ‘the quiet room’ or ‘the garden room’ as a punishment. The Guardian reports the prosecution as saying that residents were sent to these rooms at the two homes, for “trivial reasons: staring at a staff member, facial twitches, asking questions repeatedly, missing a hair appointment - could all be triggers for residents to be sent to the rooms.”
Describing his experiences in an isolation room, a man identified only as AC said: “It was a room that was disgusting and cold. At night, the door was locked. It had a CCTV camera, a smoke detector and a punctured mattress – it was an airbed but it had a puncture in.
“It was cold, damp. If you wanted to go to the toilet, there was no toilet in there. There was a window but it was locked. No curtains. They made the room as bad as possible and as uncomfortable as possible.
AC, who has epilepsy, added: “It made me feel terrible in a way... an animal, basically.” See: https://www.theguardian.com/society/2017/jun/07/care-home-directors-convicted-over-devon-learning-disability-regime
As well as frequently being sent into these rooms, residents also reported being punished by being excluded from activities, refused meals, or forbidden to see their relatives. Family members confirmed being told not to visit. Care plans were rudimentary and lacked any detail or personalisation, while medication appears to have been used to restrain, including to prevent future conflict. Indeed, the recording was so poor that it was impossible to know how often, or how intensely, people were being routinely restrained, but at least one person suffered a possible fracture that was not recorded at all.
Restraint and the MCA
The MCA defines restraint as: The use, or threat of use, of force to make someone do something they are resisting, or restricting someone’s freedom of movement in any way whether they resist this or not. Restraint is legal, as you know from previous articles, provided it is necessary to prevent harm to the person and a proportionate response to the likelihood of harm to the person and how serious that harm would be. In the same way, deprivation of liberty is authorised and lawful, provided it meets the ‘acid test’ as well as meeting the conditions above.
But in these homes, staff were oblivious to the MCA, or DoLS. And the arbitrary, cruel and unnecessary nature of the restraints and deprivations of liberty could never have been lawful, since they were so far from meeting the necessary conditions. Staff seemed to think the way they were behaving was normal; they did not define the use of the ‘quiet’ and ‘garden’ rooms as restraint, much less as deprivation of liberty – or, as it was defined in the criminal proceedings, ‘False Imprisonment.’
Responsibility and good governance
The Guardian quotes the Devon police as saying, “This case has been very complex and, in many ways, is the first of its kind in this country, dealing with not just those workers directly involved with victims, but all the way up to owners, directors and senior managers, who allowed a culture of abuse to exist.”
The Crown Prosecution Service said: “The directors and managers at the Atlas care homes created a culture of abuse – unlawfully detaining residents in very poor conditions for long periods of time.
“This case has been groundbreaking in that the directors and managers of the homes and not just the staff that implemented their policies have been held to account.”
CQC has information on its website about what good governance looks like:
Part of this guidance says: "Providers must have effective governance, including assurance and auditing systems or processes. These must assess, monitor and drive improvement in the quality and safety of the services provided, including the quality of the experience for people using the service.”
Monitor the ‘quality of the experience’
The mother of Ben, who had been so badly and inexcusably treated in care settings, reports how he has moved to a ‘wonderful’ care provider, who works with Ben and his family, to enhance Ben’s life. Incidentally, this provider needed to check that he had the right person, since the happy and cooperative young man he was getting to know seemed the opposite of the ‘challenging’ and difficult person they were expecting. There’s a message there. But the real message is that the empowering ethos of the MCA encourages putting the person and their happiness where they ought to be: at the heart of their care.
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