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.
Safeguarding and the CQC: is the method destroying the mission?
The Social Care Workforce now has many well-documented accounts illustrating clearly how our expanding inspection regime – here the CQC – can so easily become clumsily destructive, and then draconian in self-defence. This is a familiar theme with wasteful, sometimes tragic, consequences: institutions may start a mission, with apparent good sense and intent, only to betray it by the increasing rigidity of their method. History is littered with depressing and shocking examples.
The evidence is mounting that, particularly in welfare services, increasing regulations and inspections beyond a certain point usually becomes counterproductive: we spawn a tick-box culture where inspectable compliance to regulators often displaces core work and attention with clients. Larger organisations have the resources and PR mind-set to create a good ‘shop window’, to game the system, or to outsource the inspection requirements to an agency.
Smaller organisations are not similarly equipped for this compliance-parade, so are more liable to closure or punitive measures.
The CQC’s mission – to assume probity, competence, safety and compassion – is unarguable. But its method all too often is achieving something very different and often highly contentious.
Formal and formulaic inspections in welfare activities are often coarse in their judgement despite, and because of, their dense procedural complexity. They are easily corrupted, too. We need something much more intelligently flexible. Yes, whatever we devise will be fallible – but can be much better than what we have now.
I have my own egregious experiences of how destructively unwise and corruptible the CQC can be: my much-loved small GP practice was closed down after I challenged their method and culture.
If you are interested in this please look at my Home Page (http://www.marco-learningsystems.com/pages/david-zigmond/david-zigmond.htm). Articles 73 and 74 tell the story. Correspondence with the CQC is found in Section G.
The CQC is simply appalingly bad they just passed SPFT as outstanding for Care when you only have to google the failures, bullying and cover up at the Trust, they also tweeted that their had been 100% positive feedback free m patients families and carers,……what zero complaints ? Too deceive vulnerable so, our Country is beyond sick.
CQC don’t investigate individual complaints, they wait until a “trend” emerges. Fat lot of good that is if your son or daughter is not in the same situation as other service users. If residential care is bad, then supported living is potentially so much worse. One support worker “supported” my son to buy him a meal, another on at least two occasions “supported” my son to buy a Sunday Times in Lidl, and then they went back to my son’s flat where they spent the rest of the day, and gave his Sushi and Pasta for his sunday main meal!!
Awful. I have issues with safeguarding and there policies in general and that everything seems to be regulated behind closed doors and I think this is wrong.
The CQC I also have concerns about them because who keeps an eye on this regulator for faults they need inspection also.
This cannot carry on it has to stop now.
There is a very high attrition rate of inspectors. This is because people are drawn to inspection work because they do care but then find the CQC does not enable them to work in way to express this care effectively in their work. It is not unlike the NHS and other public bodies in some ways in that it rewards those who are ‘compliant’ with career progression while punishing those who dissent from the party line by sidelining them and stifling their progress. In this way those that ‘succeed’ within the organisation are by default complicit in it’s stagnation and the prevention of innovation and creative thinking. Self serving career minded individuals lead the service and inevitably make little positive difference to anyone other than their own. Group think, compliance and survivorship bias will be the ruin of the CQC and all that it purveys.
A disturbing but sadly not surprising article.
The CQC are a clear example of a so-called regulatory body giving a false sense of security to the general public/powers that be, when really what they perform are tick-box exercises undertaken by bureaucrats (probably earning more than most of the staff they inspect) – or freelance ‘consultants’ fitting in visits/reports between their day jobs. As a former manager of a non-residential therapeutic day service for vulnerable adults, I experienced three unannounced inspections within the space of two years. All given the highest ratings so not sure what triggered two more after the first, except the fact that the service was easy to get to, being in east London and open convenient hours. We were suspicious of a very cosy relationship with commissioners.
What I saw were checks on staff HR records, duplicating those undertaken by auditors; reviews of all staff and client policies duplicating those reviews done annually by commissioners; cursory inspections of client facilities and brief interviews with clients. Not informative or helpful to the staff running the service in any way. Just an additional and compulsory cost for the organisation. Neither the staff nor I saw an evidence of ‘digging deep’.
I hope this article can prompt some urgent, serious and open discussion about the role of this body.
Thank you John.
I keep in touch with “the lads” twice weekly.
I look at what I can do rather than what i can no longer do for them .
I have seen deteriation in health , social intergration , self esteem . C in particular has been de- skilled in many ways.
I see nothing more than a political agenda as for as we were concerned .
A big concern is CQC were hand in hand with comissioners at DCC . They are said to be independent. This is not true .
Proving this is the hard job. The money was in the pot from DCC for supported living not residential care. Money is all it comes down to. People’s lives and happiness dont come into the equation.
I am very greatful we had the opportunity to meet you.
Sending my regards