What the BBC and the CQC tell us about abuse of vulnerable patients
An undercover investigation by BBC Panorama (‘Undercover Hospital Abuse Scandal’ – 22 May 2019) revealed abuse of vulnerable patients at Whorlton Hall, an independent hospital for adults with learning disabilities and complex needs/autism. Whorlton Hall was previously part of the Castlebeck Group (which also ran Winterbourne View) and the Danshell Group. In 2017 it received a ‘Good’ rating from its regulator, the Care Quality Commission (CQC), despite previous complaints.
Journalist Olivia Davies worked undercover for two months at Whorlton Hall. She found a culture of intimidation and threats of violence towards patients. ‘Paul’ was subjected to excessive restraint in retaliation for calling the police. Claire was restrained and taunted about her family. Another patient, Alex, was taunted and threatened by male care workers who knew about her fear of males, which a care worker described as ’pressing the man button’. According to experts this amounted to psychological torture. Some workers admitted to past violence against patients, and explained how to inflict pain unnoticed. Inappropriate behaviour and sexualised language were also used freely in front of patients. One manager told staff to ignore restraint guidelines and to falsify records. 16 staff have been suspended and the hospital has now closed. This shows how difficult it is eradicate abusive behaviours, and also the limits of CQC inspections.
This follows an interim report published by the CQC (21 May 2019) into the use of restraint, prolonged seclusion and segregation for people with a mental health problem, learning disability or autism [https://www.cqc.org.uk/sites/default/files/20190521b_rssinterimreport_full.pdf]. The CQC investigation – requested by the Secretary of State for Health and Social Care – only started in January but raised enough concerns to warrant an interim report.
89 providers identified 62 patients in long-term segregation. The CQC carried out 15 visits: 8 led to reports of concerns and 3 to safeguarding alerts. The CQC saw 39 patients (the youngest being 11), some of whom were only included because of the CQC – they had been ‘missed’ by their providers. 31 out of 39 patients had autism. For most of them, there was no effort at reintegration and a belief that their quality of life was better in segregation. They led highly restricted lives and were discharged late because of a lack of suitable community placement. Sadly, the report flagged well-known concerns about lack of staff trained in learning disabilities, the unsuitability of mental health wards for such patients and the excessive use of restraint or CCTV surveillance. According to the CQC, the system is ‘not fit for purpose’.
The investigation will now expand to more settings (low secure & rehabilitation mental health wards, and adult social care services) and will report in March 2020. In the meantime, the CQC makes five recommendations, which have all been accepted by the Secretary of State:
- Independent in-depth review over the next 12 months for each person in segregation on a ward for children and young people or for people with a learning disability and/or autism
- Expert group to consider key features of a better care system
- Urgent consideration to strengthen the system of safeguards
- All involved in providing, commissioning or assuring the quality of care of people in (or at risk of) segregation should consider the implication for the person’s human rights
- CQC to review and revise its approach to regulating and monitoring hospitals that use segregation
We have been here before. Many reports in the wake of the Winterbourne View scandal reached conclusions that were strikingly similar to those, earlier this month, of the CQC. All providers of care to vulnerable individuals need to review the standards delivered in their facilities as the spotlight is being shone by regulators and the government in this area, and appropriately so.
Geneviève Rich, Associate Solicitor, BLM