Was Dignity given any expression at Winterbourne View Hospital?

Was Dignity given any expression at Winterbourne View Hospital? Margaret Flynn Cumbria, December 2013

Lest we forget… • It is devastating to be abused – the scale is unknown • Abuse steals lives and collapses everything that is familiar • Abuse comes in many guises and is well served by disbelief, eligibility criteria and poor/ belated service responses • It is easy to trick, befriend and steal from silent or silenced victims • All kinds of organisations can generate a culture of perverted loyalty – rendering abuse under-recognised/ reported • Our histories can get in the way of reporting • Disadvantage does not self correct and legislation does not eliminate abuse • Mutually loving relationships have a protective role

Remember “The Dignity Challenge” ? • Have a zero tolerance of all forms of abuse • Support people with the same respect you would want for yourself or a member of your family • Treat each person as an individual by offering a personalised service • Enable people to maintain the maximum possible level of independence, choice and control • Listen and support people to express their needs and wants

And… • Respect people’s right to privacy • Ensure people feel able to complain without fear of retribution • Engage with family members and carers as care partners • Assist people to maintain confidence and a positive self esteem • Act to alleviate people’s loneliness and isolation

We know that… • If there hadn’t been a whistle blower, then an undercover reporter employed as a support worker at Winterbourne View Hospital for five weeks during early 2011, it would have taken a long time for the crimes and abuses exposed by the BBC to come to light, if at all • The exposure of Winterbourne View Hospital in Undercover Care: the Abuse Exposed has emptied of meaning notions about hospitals being places of healing • It is unlikely that the SCR has identified all the crimes and abusive acts to which patients were subject • Castlebeck Care (Teesdale) Ltd was not starved of funds. It is not known how much was spent on patient treatment

And we know too that… • Castlebeck (Teesdale) Ltd noted thatWinterbourne View Hospital was one of the best performers in the group i.e. the company benefitted financially to a substantial degree • Business opportunism doesn’t have to comply with government policy

Winterbourne View Hospitals has taught us about such fictions as… • Hospitals for adults with learning disabilities and autism solve problems • The disciplines of LD nursing and psychiatry are equal to providing mental health and physical health treatment to adults with learning disability and autism • Quality assurance systems safeguard people • Institutional care for adults with learning disabilities and autism went with the closure of the long stay hospitals

“Think local, act personal…”?! • The company that owns Winterbourne View, Castlebeck, is itself part of a group called CB Care Ltd, which is itself owned, via Jersey, by Swiss-based private equity group Lydian, backed by a group of Irish billionaires. The process of private equity ownership is that all the money gets whipped out by the bankers and offshore owners as soon as possible. So…while CB Care makes healthy operating profits these disappear in interest payments, leaving the group with hefty annual losses and…liabilities exceeding assets by £14 million…The Care Quality Commission…confirmed that for private providers there is “no provision to require insurance under the Health and Social Care Act.” So while private equity owners scoop up the profits, it looks like taxpayers could end up having to pay for private care fiascos.” Private Eye, “Passing the ‘Beck”, No. 1327 16-29 November 2012, p31

Winterbourne View Hospital has taught us to question “certainties” such as • what is written into contracts will be implemented… • NHS and LA commissioners know what they are purchasing… • decisions about contract renewals are based on hard data… • commissioned services will take the actions required by the regulators… • patients subject to the provisions of the Mental Health Act will have the minimum restrictions imposed on their liberty in line with the purposes for which the restrictions are imposed… • clinical governance and elaborate QA systems keep people safe and healthy • Employees will be brought up short by the recognition of shared humanity

THE SEVEN COMMON CORE PRINCIPLES VALUE THE UNIQUENESS OF EVERY INDIVIDUAL • Our histories matter - ambiguity is familiar to health and social care professionals –– checking back over records and talking to people, especially relatives, matters • Obsessive attentiveness to people’s health and wellbeing matters

UPHOLD THE RESPONSIBILITY TO SHAPE CARE AND SUPPORT SERVICES AROUND EACH INDIVIDUAL • We want credible commissioning – where NHS and LA Commissioners know what they are buying • We want relationship centred support in our own localities vs emergency place-hunting • We want spotlights on the administratively invisible -those who are stateless and “stuck” in Assessment and Treatment Services (A&TS)/ hospitals - as well as on self – funders and Direct Payments Recipients • We want spotlights on the successors of A&TS. Are A&TS threatened by the time-limited work of the Winterbourne View Joint Improvement Programme?

VALUE COMMUNICATING WITH INDIVIDUALS IN WAYS THAT ARE MEANINGFUL TO THEM • Empathic and mature staff who are sensitive to people’s subjective experience, histories and aspirations – for some, this began with traumatic sexualisation/ 52 week residential schooling/ remote “corporate parenting” • Acknowledgement of the perspectives and experience of patients/ residents/ clients/their families/ employees • Understanding what people’s behaviour tells us

RECOGNISE HOW AN INDIVIDUAL’S DIGNITY MAY BE AFFECTED WHEN SUPPORTED WITH THEIR PERSONAL CARE • Concerns require more than sporadic and tentative discussion and “leave it with me” responses • What is the experience of patients and their relatives who make complaints about their experience of care? • Credible reviewing processes are essential

RECOGNISE THAT AN INDIVIDUAL’S SURROUNDINGS AND ENVIRONMENTS ARE IMPORTANT TO THEIR SENSE OF DIGNITY

VALUE WORKPLACE CULTURES THAT ACTIVELY PROMOTE THE DIGNITY OF EVERYBODY • Trained and supervised staff with effective Registered Managers who work to a known purpose and determine the nature of professional practice

RECOGNISE THE NEED TO CHALLENGE CARE THAT MAY REDUCE THE DIGNITY OF THE INDIVIDUAL • An over-reliance on “monitoring” and “self-monitoring” has to end - both have poor track records in revealing operating difficulties • A culture of respectful challenge has to replace unquestioning deference • “Sanitising language” and “therapeutic” vocabularies can get in the way of understanding All of which point to the necessity of a culture of watchfulness and humane inquiry which doesn’t lapse into formula

Was Dignity given any expression at Winterbourne View Hospital?