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.
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.