John Burton, a social care consultant and writer, gives his personal response to the recent Safeguarding Adults Review on Mendip House. John is the author of Leading Good Care, JKP, 2015 and What’s wrong with CQC?, Centre for Welfare Reform, 2017. (973 words)
I’ve been reading the safeguarding review of Mendip House, a care home for adults with autism in Somerset. (Safeguarding Adults Review. Mendip House by Margaret Flynn, January 2018.) The home was owned and managed by The National Autistic Society (NAS), regulated by the Care Quality Commission (CQC), and the residents were placed there by local authority commissioners from all over the UK but none from Somerset itself.
Mendip House has been described as “Winterbourne View without the cameras”: a thuggish gang of staff assaulted, taunted, and stole from the residents; managers were weak and complicit. Whistleblowers told the CQC and the senior management of The NAS, but—as at Winterbourne View—they were repeatedly ignored or fobbed off. The NAS made ineffectual internal investigations but did not alert the CQC or the local safeguarding service as they should have done. The placing authorities failed to monitor the care, safety and welfare of their residents, or whether the high fees were value for money. Whistleblowers left while the perpetrators of the abuse were ticked off but remained in post. In other words, no one did their job properly or considered the residents who remained at the mercy of a horrible regime.
To the public it must be barely credible that such places still exist. The families of the residents trusted the national autism charity to provide the best care, especially since the NAS chief executive was a respected and leading figure in social care, sitting on many a government and professional body, and speaking up for people with autism. After Winterbourne View, he declared: “This kind of abuse has no place in modern Britain. Organisations should ensure they have a culture where abuse is never tolerated, and this needs to come from the top. Where there are failings, the people at fault must be held to account.” Likewise, we were treated to many a brave word from the regulator (CQC) that admitted that it had failed the people who had been so badly abused at Winterbourne View, and immediately inspected 150 health and social care establishments for people with learning disabilities and set up a whistleblowers’ hotline.
In 2016, the CQC’s Chief Inspector of Adult Social Care said: “The scandal of Winterbourne View highlighted the devastating impact inappropriate care settings can have on people with a learning disability” and “We know what good looks like . . . We are determined to ensure that these services can deliver the quality of care that people with learning disabilities, their families and carers have every right to expect.”
In May 2014, the Chief Inspector had earlier claimed the CQC’s “new approach is succeeding in digging deeper into what providers are doing . . . we are getting underneath the skin of the service with the way that we are doing these inspections. So people are feeling much more confident about the judgments that they are making because they are taking that much more rounded view of what’s happening.”
A couple of months earlier in 2014, the CQC had reported that Mendip House met all the standards for care, including “safeguarding people who use services from abuse.” So much for “getting underneath the skin of the service”. Later that year, and again the next year, staff members contacted the regulator and their senior managers with very serious allegations of abuse. The CQC left it to The NAS to investigate (ineffectually as it turned out) but was not informed of the outcome.
It wasn’t until two-and-a-half years later that the CQC, forced into action by two more whistleblowing allegations, concerns from the local authority and the charity’s internal investigations, at long last inspected the home and reported that it was—so obviously—“inadequate” on all counts. Soon afterwards, NAS closed the home. (Margaret Flynn’s review rebukes the CQC for their delay in acting, as she did in her review of Winterbourne View, as “not good enough”.)
While it was leaving Mendip House to continue with its appalling abuse in Somerset, the CQC was intent on closing a warm, caring, little family care home in County Durham at the other end of the country. Five men with a variety of learning disabilities had lived together for many years, supported by the skilled attention, good care and love of a committed couple. They were truly part of their neighbourhood and were all local people. Some had elderly parents who were included in the life of the home and their sons were enabled to support them with shopping, laundry, and various jobs. This was the very model of a stable, caring home—a valued part of its community. But the CQC rated it as “inadequate” and, with the collusion of the local authority, the home and the couple who ran it were “deregistered”, and, against their wishes, the men were re-assessed as in need of “supported living” instead of residential care. Since then, several of the men have deteriorated physically, mentally and emotionally. They have lost their home.
In both cases, Mendip House and this little home in the North East, the regulator has failed and the consequences for about a dozen people and their families have been devastating. They have been treated as if they didn’t matter: as if, in spite of all the grand proclamations to the contrary, neither their misery nor their happiness mattered. To the CQC, The National Autistic Society, and the commissioners they are nobodies. These are the people that the CQC was set up to protect and support. In reality there are thousands of residents of care homes and their families whom the CQC is failing, and I have the feeling that we will hear a lot more about an accumulation of failures in the coming months. That is perhaps why the Chief Executive of the CQC is planning to “step down” in the summer.
John Burton is a social care consultant and writer. He is the author of Leading Good Care JKP, 2015 and What’s wrong with CQC? Centre for Welfare Reform, 2017.