Category Archives: Abuse

The CQC and Embarrassing Toilet Incidents

So the Care Quality Commission (CQC) is once again left feeling like the bloke who leaves a giant stool in his in-laws loo just as the flush stops working. They’re not just flapping around in a panic with their trousers around their ankles. They’re tripping over, hitting their head on the bath and suffering the acute embarrassment of the in-laws calling the ambulance out. 

I’d seen the trailers for last night’s Panorama so knew what to expect. Fiona Phillips flashing her Jimmy Choo’s as the celebrity face of Alzheimer’s and doing a bit of crying. Sorry Fiona, perhaps a little harsh but I do have issues with slebs doing ‘issues’. That’s for another blog.

It was of course revolting television and very hard to watch, even when forewarned is forearmed. The online world is rampant with a thousand calls for action, more respect for elderly people, and Telegraph readers demanding instant dismissal of all care home staff not carrying a Surrey passport. 

But while it’s good and right to howl loudly from the rooftops, we also need to take a step back and ask how we as a society put a stop to this. It would be lovely to think that the extended family will take over when Grandad starts leaving the gas ring on and tries to make toast with a chocolate digestive.

But the nuclear family is long gone in this corner of the world, and those care industry shareholders won’t be giving up their yachts and racehorses anytime soon. So for now at least we’re left with bodies like the CQC and our Safeguarding Panels to protect vulnerable people from the living nightmares we seem to be seeing and reading about every other day.

Still emerging battered and bruised from the ashes of Winterborne View, the CQC now have their old friends Panorama to thank for yet another death by spycam. They didn’t emerge with a lot of credit last night. It would be all too easy to point the finger and join in with a bit of quango-bashing, but in fact I come to praise Caesar, not to stick a knife in his guts.

They have the unenviable task of inspecting just about anywhere in the country that has a roof, paid staff and vulnerable people sitting indoors. They deserve to be cut some slack for that at least, but what concerned me last night was the sheer panic in the face of what was bound to be another incendiary device going ‘BANG!’ in the face of a horrified public.

They declined to appear on camera with Fiona Phillips. Now Fi is hardly Jeremy Paxman in a designer two-piece so why the reluctance? Our national care inspectorate reduced at once to the status of dodgy car dealer chased around by that bald bloke in a parka who makes shows about dodgy car dealers. 

But perhaps with the benefit of past experience, their ‘Panorama Statement’ was robust, reasonable and said all that needed to be said. A media-trained representative could and should have offered that content to the Panorama cameras. More dignity, more transparency, and much less cowboy builder.  

And then there was their slightly embarrassing Twitter campaign emerging almost as soon as the credits were rolling. Their output of Tweets is normally so rare I’d forgotten I even follow them, but last night? A slightly embarrassing flurry of ‘It Wasn’t Me Guv’ postings, and a link to their most recent report on Ash Court

To paraphrase the report: “Ash Court is lovely. I’d send my Gran there.” It contained enough typos to suggest the authorship of a chimp with a bad caffeine habit. Unprofessional, but let’s put that down to the inspector’s report-writing fatigue and almost certain overwork. More importantly, why the apparent whitewash? Well there is that notorious tendency of care homes to get the decorators in as soon as they have a whiff of an ‘unannounced’ inspection, and would we really expect care staff to be stood in front of a clipboard-wielding inspector abusing a frail, elderly woman while chatting away in Spanish and watching Corrie? You can’t punish what you can’t see. 

I don’t write public statements for the CQC or for anyone else other than myself and my business. But I might have asked this of those who will invariably point the finger at the inspoectors: “Did anyone from the CQC actually abuse vulnerable people at Winterbourne View or Ash Court? No. Did anyone at CQC have anything to do with building 60-bed three-tier monstrosities which are more about battery farming than any semblance of residential care? No.”

Their management of the latest care industry furore was undoubtedly poor and unnecessarily defensive. They need to learn lessons. They almost certainly need more inspectors on the ground, and less twonks in suits. But there’s a whole heap of reasons why we’ll keep on hearing, reading and seeing these horrors, and the answers won’t come anytime soon. So for now we need a care inspectorate thrusting it’s face into dark corners shouting “Oi! You!” and not running around panicking over an obstinate plop.

If you can’t be bothered reading his profile, Connor Kinsella is Lead Trainer with JCK Training and writes about himself in the third-person. 

Talking Out of One’s Arse: The News Media and Armchair Psychology

Daniel Bartlam was yesterday sentenced to life imprisonment for killing his mother. Apparently inspired by screen violence in the guise of horror movies and TV soap storylines, he’s inevitably been dubbed the ‘Coronation Street Killer’ and provoked the now customary howl of online indignation. So far, so predictable. But along with the indignation has come a digital tidal wave of armchair diagnosis. The cod psychology inspired by this case features ‘inner worlds’, ‘trauma’,  the effect of pre-watershed television violence and, most alarmingly, the possibility of child abuse as a mitigating factor. But one feature all these armchair theories have in common is the almost complete lack of history, evidence or narrative around either Bartlam or the offence itself.

Shortly after the sentencing of Bartlam, The Guardian’s Comment is Free section ran an article titled Why Children Kill Parents. Accompanying the piece was the now familiar and rather haunting photograph of Daniel Bartlam. Philippa Perry, the writer of the piece, is a psychotherapist and author of a book called Couch Fiction.  She apparently specialises in work with adult survivors of childhood abuse. If she had any specific experience working with violent young people, or even ‘children who kill parents’, it didn’t appear on her author profile. At the time the piece was first published* her profile also mentioned that she was married to well-known artist Grayson Perry.

I was puzzled from the start. If The Guardian wanted a companion piece and online discussion around the Bartlam case why not find someone from the world of forensic child and adolescent psychology? And what was the relevance of the author’s marital status? This seemed the editorial equivalent of asking me to write a ‘pop-science’ piece on quantum mechanics because I use a mobile phone, or inviting Frank Lampard’s ex-girlfriend onto Strictly Come Dancing because well, she used to be Frank Lampard’s girlfriend.

To her credit the author made no attempt to ‘diagnose’ Bartlam, and presumably did her best to quickly bang out a few hundred words at the request of The Guardian’s CiF editor. She more or less stuck to her area of expertise which is helping adults who’ve been abused. But is that telling us anything about ‘Why Children Kill their Parents’? And more pertinently, did the author have anything to say about a case where there is absolutely no reported evidence of abuse as an explanatory factor?

No, of course not.

But what alarmed me even more than the article itself was the swarm of armchair psychologists, usually hiding behind silly avatars and even sillier acronyms, gathered online to spout thousands of words on everything from John Bowlby’s Attachment Theory to how the victim should never have bought her son an iMac. In keeping with the article itself, abuse was a constant theme from our cohort of keyboard shrinks despite no evidence whatsoever that this was in any way connected to the case.

At this moment in time nobody but those closely involved with the Bartlam case knows anything about this boy nor the circumstances of the offence beyond the bits and scraps reported by the news outlets.

For the online media (of which The Guardian is only one example) to be spreading and encouraging ill-informed or completely non-informed speculation as to how a 14-year old boy can become a hammer-wielding murderer is more than just pissing into a very strong wind. It is harming those personally involved in the case, harming our understanding of violent young people, and spreading even more ill-informed psychological rubbish than is already the case. 

And that’s a mighty big case.

*The Grayson Perry reference has now been removed from the author’s Guardian profile. 

Winterbourne View: A Tale of Boiling Frogs, Perfect Storms and the David Brent Analogue

Last Tuesday was quite a day. It started at midnight with a growing sense of resentment over a TV programme and the realisation that I wasn’t going to get any sleep. It continued into the dawn with the sound of my hammer-blow two-fingered typing on an already delicate laptop, and finished with the very weird sensation of listening to myself on Radio 4’s The World Tonight.

Thanks mainly to a tweeted recommendation from The Guardian’s Patrick Butler, my very brief attempt to explain the horror of Winterbourne View quickly went viral, carried along on a tide of national revulsion prompted by secretly filmed footage of a ‘hospital’ for learning disabled adults.

An imagination already heavily influenced by Star Trek and further excited by sleep deprivation pictured banks of overstrained iPlayer servers burbling, shaking and belching out smoke before exploding in a shower of tape.  Either Captain Kirk had asked the computer too many illogical questions, or Panorama had just touched a very raw public nerve.  Through a thick media fog of Cowells, Coles and talent show titbits, the British Public were for once actually noticing learning disabled people.

Now that the media hoo-ha has died down, political knees have been jerked in some way or another yet to be fully determined, and we’re all moving on from abuse to hair transplants, I’d like to acknowledge the time and effort spent on the replies to my article.  Many readers must have spent a great deal of time and effort crafting carefully worded, insightful analyses of the problems at Winterbourne View and beyond, and perhaps we can take a closer look at some of these points before last week’s headlines become this week’s cat litter.

Boiling Frogs and Perfect Storms
Taken as a whole readers’ comments seemed to indicate a ‘top to bottom’ failure of care, not only of learning disabled adults but of the elderly and mentally ill, with the failings at local, regional and governmental levels all adding their ingredients to the perfect storm: catastrophic failures of care.

Several readers were highly reluctant to point the finger at individuals, or as one contributor put it, the ‘coal face workers’. They argued that the type of care worker portrayed on the programme were more often than not the product of poor frameworks put in place by their managers, their managers managers, their managers managers managers and so on up the line toward government itself. 

I have some reservations about removing all aspects of individual blame from institutional abuse, but that’s a big subject and deserves an argument of it’s own which I’ll post tomorrow.

In the meantime Phil Wolsey deserves special mention for introducing me to a new terminology: ‘boiling frog culture’. This is a more than capable analogy of how ‘bad culture’ can gradually pollute even the most enthusiastic individuals. Unless you’re squeamish about amphibians it’s well worth looking up, but let’s just say Phil’s analogy describes how Happy Frog becomes Braised Frog very quickly and without the hapless creature ever really noticing.

David Brent et al
Plenty of you talked about governmental failings, budget cuts and their relationship to an ever descending level of care and the lacklustre response of the Care Quality Commission. We’ll get on to this bigger picture shortly, but Dee asked a very pertinent question: Where were the managers at Winterbourne View?

I’ve been around long enough to have been both a manager and one of the managed, so this was a question I never really asked during the programme but inspired more than a few thoughts on front-line care management once I read Dee’s comments.

Contrary to the plot formula of Casualty and Holby City (i.e Managers/Bad Guys vs. Nurses and Doctors/Good Guys) a functioning system needs managers. They’re a soft target. They come into management in a variety of different guises, several of which loom particularly large in my memory.

First up, there’s the Hapless Incompetent.
The HI is prematurely promoted beyond their own ability by high turnover organisations desperate to keep the more capable of their shop floor staff within that organisation, curiously forgetting that a very competent ‘shop floor’ carer isn’t necessarily a skilled manager. Although several of you argued that pay is not a major issue for many care workers, a larger salary may prove a very attractive inducement for staff members who have traditionally been low paid, and who among us would turn down the chance of a few extra quid even if we had the self-awareness to recognise our own limitations?  If we add in a lack of support or training for our new appointed HI, the results are sadly predictable.

There’s also the David Brent Analogue
The DBA is the bright and breezy new member of staff who, barely in possession of an ID badge, commences the grand corporate scheme. The nameplate is on the door, the office décor is beige with a bit of pastel relief, and daydreams are filled with the fond thought of spinning endlessly around in that faux leather reclinable. In my admittedly anecdotal analysis, these are often people who cannot bear to spend any more time than is absolutely necessary with the smells, sights and sounds of the care environment. The DBA hides away behind a desk updating Facebook, laughing at cat videos on YouTube and finding as much opportunity as possible to get invited to meetings, especially when the coffee and biscuit stash is looking a little light in the top drawer.  Knock on the door? No problem. Up pops the Excel spreadsheet, cue furrowed brow and a hard stare at the monitor. “Come in.”

I’m sure you’re thinking of many more caricatures to add to this collection (comments please – that could be fun!) but my third category of manager is the one I like to think I’ve had the pleasure of working with many times over the years. I can’t think of a smart or even stupid moniker to describe them, but if we could come up with a sexy sounding mnemonic that included the words Teacher, Leader, Strategist and Exemplar, we might be getting close.

These are the managers who balance the spreadsheet and working parties with the needs of both their staff and service users. They are not only visible but actively demonstrate the sort of communication skills and leadership which, I believe, form the best possible training for less experienced staff. They answer questions, spend time with people, observe the often subtle dynamics of an environment, mould and rectify where necessary, and are still capable of getting the admin done and the duty rota up on the intranet. They encourage good practice but stamp hard on the sort of culture so obviously in evidence at Winterbourne View. I’m quite sure they are still out there in numbers, but for how much longer?

The care industry is in a state of flux. Not long ago we ‘enjoyed’ a flourishing bureaucracy and seemingly limitless funds for both the public and private sectors to hire yet another Assistant Director of Stationery or a Strategic Bogroll Supplies Officer. But if what I hear on my courses is anything to go by, we now seem to be plummeting quickly from a state of gross over-management to hardly any management at all. Budget cuts are ridding the care sector of many highly capable front-line managers and I’d be grateful for any heads up on whether the Strategic Bogroll Supplies Officer is still in post, but I can hear the ticking of the attention-span clock so let’s move on to the bigger picture of governmental failings that so many readers highlighted in their comments.

Big bins or small homes?
Rob described recent budget cuts at his place of work and the inevitable impact on the quality of care his clients will receive, which he anticipates will lead to growing frustration and greater levels of challenging, disruptive behaviour.  He also raised a question echoed by Alison Giraud-Saunders from the Foundation for People with Learning Disabilities. In the aforementioned Radio 4 interview, Alison pointed out something about Winterbourne View that had brushed my subconscious only to disappear amid the full body blow of the images on display.

Why on earth, in 2011, are learning disabled people being housed in large, secure institutions, and why was there no mention of the role of the commissioners and care managers responsible for sending people to this so-called hospital?

Let’s not kid ourselves that people with autism and learning disabilities cannot (at times) be difficult, aggressive, and very challenging to work with, even within the finest establishments with dedicated, caring support staff. But with very few exceptions this is not a group of people who warrant detention behind electronically controlled doors.

I worked for many years in secure psychiatric units where patients who had usually committed serious offences were assessed, cared for, treated and detained at the same time under the auspices of the Mental Health Act. These were people suffering from personality disorder or severe mental illness.

People with Learning Disabilities, Autistic Spectrum Disorders or Acquired Brain Trauma make a negligible impact on crime statistics, and even those presenting ‘challenging behaviours’ are generally more likely to injure themselves or perhaps those who attempt to prevent them banging their head off a wall or throwing themselves from a window.

There are a number of much smaller units which manage to combine the safety and security of both staff and residents with a pleasant, homely environment. I’ve worked with the staff and visited the homes. They have houseplants, pleasant décor, and even the odd dog. They have well trained staff who understand the bizarre, the obsessive and the repetitive along with the quieter subtleties of predicting and avoiding challenging behaviour. As far as I can see, nobody to date has done a comparative study of the effect of Laura Ashley soft furnishings on challenging behaviour against the Gulag Archipelago-look of  Winterbourne View, but I know where my hypothesis money would be.

‘Economy of scale’ is of course the reason why large units like Winterbourne View have become so popular with care commissioners and those responsible for placing bums in beds. If you’ve been following the Southern Cross debacle or work in the elderly care sector, the bigger v smaller theme will be already familiar.

The Bigger Picture
It would seem from both readers’ comments and my recent experiences in the training room that a laceration of care budgets will not only force the vulnerable into bigger, cheaper but infinitely unsuitable establishments, but will also expose the raw meat of a rapidly diminishing work force. I see up and down the country how both front-line staff and their often very able managers are being faced with redundancy or re-application for jobs. I hear of closures of key services such as day centres, employment schemes and transport services leaving their former patrons festering amid a fog of endless Jeremy Kyle repeats on ITV4.

And then I remember David Cameron on his pre-election televised lectern.  I remember his preaching the importance of looking after “the vulnerable, the poor and the needy” which, on the evidence so far, is a little like General Mladic professing his undying love for Bosnian Muslims.

Perhaps if there’s one message coming from the rainbow of opinions and comment posted on this site and beyond, it’s this. And it’s a very simple message. There are lots of very good care staff out there, but a few very bad ones. There is good management (at both a local and more strategic level) and of course, weak and ineffectual management. Put these together in the wrong combination and what do we get? Not just Winterbourne View, but Sutton and Merton, Cornwall and many other less well known examples. Has the bravery and persistence of whistle blower Terry Bryan and the subsequent Panorama bombshell made any difference to the likelihood of such horrors happening again?

In a week where a news story about cruelty to learning disabled people eclipsed even the mating habits of Premiership footballers, I’d like to think so. Perhaps we’re not all quite as shallow as we think.

Winterbourne View: Why does this happen?

If Twitter has become the new barometer of the public mood, there were an awful lot of furious people watching TV last night. Most were effing and blinding at Britain’s Got Talent, or rather the lack of it, but for quite some time during and after the screening of Panorama on BBC1,  indignance, rage and even tears appeared to be the order of the evening.

It isn’t often I start throwing metaphorical chamber pots at the television but if you haven’t yet seen ‘Undercover Care: The Abuse Exposed’ and don’t have too many throwable items nearby, this is surely a ‘must see’ piece of tele-journalism. It will have you foaming at the mouth.  Here we have documentary evidence of cruel, callous staff supposedly offering care to vulnerable adults while actually doling out little more than institutionalised torture, bullying and assault.

Why does this happen?
It’s heartening to see the collective hive of Twitter so furious at the treatment of people who get precious little attention from anyone apart from those of us actually involved with learning disabled people or, like me, providing the training to help facilitate their care. But is it enough to simply tweat indignance  about what we see on a secretly filmed expose? After all, by the time you’ve read this Panorama won’t be ‘trending’ anymore and we’ll all have gone back to ranting about BGT, Sepp Blatter, or Jeremy Kyle.

We may see some commentary in the left-leaning media as to how savage cuts to health and social care budgets are the inevitable precursor to many more instances of barbaric, privately run institutions like Winterbourne View. Well I can’t disagree with that point of view, and we’ll return to that theme later. But to really understand how ‘care staff’ come to be filmed aiming drop-kicks at learning disabled patients or acting out Nazi Officer fantasises in the faces of frightened young men, we need to dig a little deeper and go back a little further.

‘A Degrading and Odious Employment’     
About seventeen years ago I published a research paper with a nurse colleague of mine called Chris Challoner. We had both worked in secure hospitals for some time, myself in medium secure units and Chris at Broadmoor Hospital. We were fascinated by the schism between two very different ideas of the term ‘nurse’.  

The more public perception of the nurse was (and probably still is) the idea of the ‘angel’. The little girl who’d been given a toy uniform for Christmas with a big red cross on the front and a plastic stethoscope. She (for this remains a largely gendered profession) couldn’t wait to become a nurse. Having got her treasured qualification she guiltily scoffed chocolates on the Medical ward, the box of Quality Street left by just about every grateful patient as they left for home having enjoyed the tender ministrations of those ‘lovely’ nurses.

And then there was us lot. Much more testosterone, no nice uniforms, key-laden lanyards swinging from belts and certainly little in the way of a lifelong yearning to look after dangerous psychopaths behind electronic doors. We’d just sort of drifted into it, and with a bit of overtime it paid the bills. And our patients never left us chocolates.

Myself and Chris wanted to test whether nurses working in secure environments really were the sort of right-wing, Daily Mail reading lock-up merchants of the stereotype that abounded at the time alongside the notion of the ‘sandal wearing tree hugger’ found in more normal, open psychiatric units.

We were testing a stereotype and achieved what research nerds would know as a ‘null hypothesis’ – there was no statistically measurable difference between the secure unit nurses and those who worked in more ‘therapeutically inclined’ environments, at least on measures of responses to our standardised measures of political and therapeutic attitudes. But we did find out a few other things that didn’t show up in our number crunching, and which, I think, have a direct bearing on the horrors seen on last night’s Panorama.

Firstly, while doing a little research on the history of psychiatric nursing, we came across this little gem:

The evils arising from the generally indifferent character of attendants, and from the deficiency as to the resources they ought to possess, are so great that few things would benefit the insane more than devising some remedy for them.

Very topical. But this was written in 1847 by a Dr. John Connolly, Medical Superintendent at one of the Victorian Asylums, pioneering mental health reformer and a chum of Charles Dickens. It has often been said that psychiatry attracts both the best and worst of the medical professions. Mental health has never been a fashionable specialism, but does attract the intellectually curious doctor as well as those who got a medical degree but weren’t quite bright enough for a scalpel. And to some extent, the same could be said of some of those attracted to psychiatric nursing.

But Panorama featured a private hospital catering for a group of people whose care tends not to attract even the academic curiosity inspired by Bipolar Disorder or Anorexia. As a registered hospital, Winterbourne View provides secure care under the Mental Health Act for people with autism and other learning disabilities. Care doesn’t get much less glamorous than this. It’s a neck of the therapeutic woods which doesn’t attract the starry-eyed little girl with a plastic fob watch pinned to her nurses outfit.

Even a few decades before Dr. Connolly’s scathing attack on ‘attendants’, another Medical Superintendent was waxing lyrical on the same subject:

Although an office of some importance and great responsibility, the role of the attendant is held as degrading and odious employment, and seldom accepted but by idle and disorderly persons

John Haslam’s observations probably weren’t featuring in the 1809 equivalent of a Job Centre. The typical interview of the time was a quick twirl in front of the asylum boss to prove you were a) a bloke and b) a big bloke with muscles.

So hospitals dealing with learning disabilities and challenging, aggressive behaviour have hundreds of years of historical form in recruiting nurses/attendants who are more adept at ‘decking’ aggressive patients than providing any semblance of ‘care’.  But two questions remain to be asked. Has anything changed, and what other reasons are there behind such appalling abuse?

A Question of Management
Our research was partly inspired by the ground-breaking 1979 documentary ‘The Secret Hospital’ which investigated the systematic abuse of learning disabled patients at Rampton maximum security hospital. Older readers may remember the horrifying story (among others) of a male patient with a particularly large penis who provided ‘entertainment’ for the nursing staff by way of a snooker table and a cue. If you didn’t see the programme you can guess the rest as I’m already traumatised by last night’s revelations.

As a separate but recent finding on the sometimes appalling state of elderly care in hospitals has shown, the NHS is certainly no grinning standard bearer of quality care. But last night’s damming evidence did make me think of the private sector organisations with whom my company now refuses to work. In these organisations we see ridiculously high staff turnover, with the few minimum wage staff who actually show some signs of competence being quickly  promoted to management as a kind of ‘golden handcuff’. They leave behind a floundering workforce struggling with the demands of what are often difficult and challenging circumstances, often with a limited command of English and barely a passing awareness of the cultural norms and unspoken rules so important to working with vulnerable adults and challenging behaviours.

For our blacklisted companies (several of which were started by entrepreneur property developers suddenly made aware of something called ‘Supporting People’. Kerr-ching!) the level of training required to work with challenging adults is often summed up by the following management-speak: “Oh shit, we’ve got an inspection next month. Somebody book a course for Christ’s sake!” If anyone from CQC happens to be reading this, no. We cannot infer client abuse or malpractice from the comfort of the training room, but on at least one occasion my classroom suspicions have been proved well founded. 
Fortunately, for every vision of Gothic Bedlam I come across in my travels, there are many more examples of very fine care providers who do actually commit to training and prioritise the support of staff who do what is a bloody difficult job. So why the difference?

Let’s return to the research study for a moment.  Our data gathering involved travelling to various different NHS units. Acute psychiatry, drug and alcohol and secure units all came under scrutiny.  We met the managers of each unit to discuss the purpose of the study, meetings which, with hindsight, told us more about the attitudes and therapeutic orientation of our sample than the wads of questionnaires and measuring tools we brought.  The managers ranged from the bright and enthusiastic sorts who exuded a culture of care from every pore, to the sort of indolent, world-weary pen pushers who, then as now, are so sadly common in NHS management.  We were there to measure the effects of therapeutic environment on our nurses, not the impact of management culture. But as we debriefed and analysed our data after each visit (let’s just call it having a pint before anyone asks) the parallels became obvious. The attitudes and therapeutic orientation of the nurses in each unit were far more a reflection of the management of that unit than the environment itself. In research nerd language, positive management correlated positively with positive patient care.

The Outlook?
So we reach a conclusion that those among us requiring the most complex, skilled care are being left to the support of those who, often through no fault of their own, are most poorly equipped to deliver that care. This is not a mitigation for the water torture, assault, bullying and abuse of vulnerable people, but in my mind at least it’s a hell of a lot more satisfying to try and understand why these disasters happen than to simply press the ‘disgusted and appalled’ button on my Twitter account.  

We’ve been left with a legacy  of front-line care donated by a New Labour obsessed with installing layer upon layer of Blackberry wielding apparatchiks constantly on the look-out for the next strategy group or working party to fill that long post-lunch window. We’re left stripped of the coalface people not wearing suits, who are now in turn getting their P45’s leaving an ever dwindling workforce to deal with problems of mental health, autism and learning disability showing no signs of declining in either quantity nor complexity. Companies such as Castlebeck will be invited, along with the property developers and former used car dealers, to pick up the slack. So-called care providers will carry on using celebrity detox as a front to their profit-yielding minimum wage efforts at managing some of the most vulnerable, difficult and disturbed people in the health care system.

Thank you, Panorama. You may just have stopped the rot for a little while. Not for long, just a little while. 

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