Category Archives: Winterbourne View

Physical Restraint: The Story Behind the Stats

As Mind publishes survey data and calls for a ban on face-down restraint, The Stuff of Social Care looks at the issue from the point of view of those doing the restraining

It’s been a long time since I last took part in physical restraint, but for many years I did work in environments where the need to prevent harm was part and parcel of a nurse’s working day.

For the most part we relied on the first resort. Talking, listening, reasoning, observing. Using a rapport that may have been built up over a period of time, and developing skills that were fundamental to working with highly distressed, agitated people. For most of my nursing career I was lucky enough to work in well-staffed forensic units where staff and patients knew each other well, and where the very thought of an agency or locum nurse was unimaginable.

But at times the last resort was unavoidable. Most of the trained, professional staff I worked with would much rather not use physical restraint. Like me, they would loathe the idea of holding down another human being to inject them with powerful drugs. But when all else has failed, or extreme harm was imminent, or where leaving a severely psychotic man or woman unmedicated would almost certainly leave them more terrified, confused and at risk than they already were, then I for one would not lose any sleep restraining that individual.

By the time I had qualified as a nurse, physical restraint had gone from the often chaotic bundle of arms legs and torsos of my student days toward a set of techniques called Control and Restraint (C&R), a Home Office approved means of managing physical aggression. I along with my colleagues attended regular training in C&R. We turned up at sports halls in trackies and trainers spending hours and days learning and practising the management of physical aggression.

A major (and rather unpopular) part of the training involved role-playing ‘the patient’ and being subjected to the procedures oneself. C&R was based on a 3-person team immobilising the patient. It used a certain amount of discomfort and even short bursts of pain to contain violent people, a fact which we as the role player would be only too well aware. Some of the techniques we learnt involved immobilising the patient face-down on a floor or bed. The reasons for this were that a) the person on their back can fight back much more effectively than if they are face down, and b) saliva and teeth make very potent weapons when they belong to a person who really, really doesn’t like being held down on a floor by several nurses. A key part of the 3-person team was the ‘head’ man or woman, whose job was to ensure minimum discomfort for the person on the floor and protect their airway.

But apart from the actual physical techniques, a fundamental of the training was that physical restraint was absolutely a last resort once every other strategy had failed, or where danger was imminent.

There are those who believe that physical restraint of the mentally ill is little more than state-sponsored thuggery, or who wonder whether restraint is necessary at all. Well, physical restraint is a necessary part of mental health care at times. That’s an undeniable fact, but it’s easy to see why and how restraint gets such a bad press, and why bodies such as Mind need to spend time, money and effort surveying it’s use.

We need go little further than Winterbourne View to acknowledge the presence of thugs masquerading as care professionals. From the very first emergence of the lunatic asylum, the opportunity to get paid for wielding power, authority and physical dominance over others has always proved attractive to a certain type of psychopath.

But there are much deeper and wide-ranging reasons why physical restraint may be over-used or abused. Mental health care certainly needs a sensible, contextualised and much broader discussion about physical restraint per se, and the reasons behind it’s use and misuse. The ‘face down’ issue is perhaps something of a narrow lens, and when 22% of staff report not having had face-to-face training in the last 12 months, we need to ask why that is.

I have a few observations. Questions about restraint are far from being a solely modern phenomenon, but for those whose 7.5 hour shift seems incomplete without a dose of adrenalin-pumping action and a ‘good decking’, current conditions have never been better.

Beds are disappearing. Only the very sickest of the sick have access to hospital treatment. The most distressed and disturbed are funnelled into smaller and smaller pockets of in-patient chaos, often provided by companies with shareholders and profit margins to maintain and gladly filling the gaps left by the running down of NHS in-patient psychiatry.

I would hope that such critical care would be delivered by the sort of skilled, well trained staff I described earlier. This all too often isn’t the case. Many of our most severely ill patients are being cared for by agency and locum staff with bare minimum training, a lack of experience and often poor communication skills. Many will barely know the names of the people in their temporary care.

This is where the ‘jump on, grab a limb and for f*** sake make sure they’re still breathing’ model of managing potential and actual aggression is practised today much as it was in the dungeons of Bedlam.

Right at this moment, someone, somewhere is in a psychiatric unit posing potential or actual danger to themselves or others. People with mental disorders can and do become violent, and staff are needed to contain the violence and minimise that risk. Hopefully they are with staff who can reassure, listen and diffuse aggression with empathy and skill. They are trained to use restraint safely and appropriately, and to be able to make decisions as to when and how it is used.

Mind’s survey results suggest this is all too often not the case.

A Longer View of Winterbourne View

Thanks to a few sleepless nights of keyboard bashing and the odd complementary tweet from The Guardian’s @patrickjbutler his employers have kindly (and perhaps unwisely) invited me on to their new Social Care Comment site. Here’s my take on the aftermath of the Winterbourne View scandal.

There have been many initiatives, reports and government level strategies in recent years but few, perhaps none, have hammered at the ramparts of care for learning disabled adults with the force of BBC’s Panorama expose Undercover Care: The Abuse Exposed.
Broadcast on 31 May this year, Twitter exploded almost immediately in response to some of the most unwatchable scenes on television in many years. As the blogosphere and online communities followed not far behind in an eruption of public horror, it was clear that that the care of society’s most vulnerable people had hit a watershed. My own blog posts on the subject and the comments of many both on my own site and countless others made me realise I wasn’t alone in being unable to sleep that night and getting up out of bed to bash seven bells out of my laptop.
But the media bandwagon rolls on and even those most horrified by those scenes are once again tweeting about X-Factor or the bedroom antics of Premiership footballers. Those of us who work in social care might suspect that the status quo has resumed. The sadists within our ranks have resumed their water-boarding, and the senior executives of companies providing care can once again get back to a nice round of golf. So what, if anything, has changed in 133 days?
As a social care training provider my colleagues and I meet hundreds of support staff from local authorities, charities and other care providers up and down the country, and strange as it may seem in the few months since that edition of Panorama I’m left with a glass which is, if not quite half full, is certainly far from empty.
Firstly, we can look to the already well publicised structural changes that have taken place. Both Castlebeck and the Care Quality Commission (CQC) have not just been caught with their trousers down, but suffered the acute embarrassment of being caught in a very intimate moment by an elderly relative popping round for a surprise visit. “Coo-ee, the door was open and… oh dear!”
But my recent experience of running training for care staff perhaps tells us about more than the closure of poor quality homes and a rapid increase in CQC inspections. A public who once knew, saw or heard little about learning disabled people and assumed that it was still the NHS and local authorities providing for them now seems to have woken up to the fact that much of our social care system is now run at a very tidy profit by executives who think more of feeding a racehorse than meeting the needs of a young woman with autism.
Thanks to the Winterbourne View scandal and the subsequent demise of Southern Cross, we now seem now more capable of demanding the sort of excellent, small-scale services where individualised care is more than just an empty mission statement written on a dusty wall plaque. We might even argue that the average man or woman in the street is now much more aware that the care and support for their vulnerable relatives is worth a good deal more than a healthy bottom line, particularly when that comes at the price of shoddy management, poor staffing and a training culture which means little more than the annual fire lecture. 
But no television documentary is ever going to completely rid social care of the occasional rotten apple who, through a combination of individual inadequacy and limp supervision, will quickly go on to sour the rest of the fruit bowl. But we can hope that in the aftermath of Winterbourne View we can all blow the whistle and perhaps get those who could and should have been listening to realise that Panorama wasn’t just a one-off. We’re all watching now.  

Connor Kinsella is an author and training consultant at JCK Training 

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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