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Training humanity

24 Sep 2020 - 3 Comments

I spent most of yesterday crafting a blog post that I couldn’t bring myself to write. There have been too many words said, and too many promises broken, too many times. I woke today and knew I had to record something, to witness this.

I’ve been trying to limit my time on twitter lately due to finding reality so overwhelmingly hard to accept. Yesterday I popped on and found scores of tweets about ‘Yew Trees Hospital’ e.g

No need to be distracted by the term hospital, this is an institution of the kind that we were meant to have closed decades ago.

Don’t be distracted by the name cygnet either, it wouldn’t be possible to find a less appropriate name, cute baby swans, and anything you associate with them, fluff and warmth and beauty, are not to be found here.

The bizarre spin on this is that Cygnet, as Ian Birrell calls them ‘profiteers of misery’ [check out all of Ian’s reporting on this firm for the full picture] supposedly reported the abuse to CQC and requested an unannounced inspection.

This melts my head, a profit making care business, reports abusive staff in its employee to the healthcare regulator, rather than stepping in and addressing the issue themselves. How does that even happen? How can they leave people trapped in this ‘hospital’ while they know they have concerns about the care being provided to them? How?

If you can bear to you can read the CQC report here. Inspectors start the report:

Some staff did not protect patients from abuse and improper treatment. We reviewed close circuit television (CCTV) footage which showed staff physically and emotionally abusing a patient. Staff who witnessed the incident did not raise or report their concerns to anyone at the hospital. We reviewed 20 further episodes of CCTV footage, saved between May 2020 and July 2020, which we requested from the hospital. Out of these 20 episodes, we identified in 8 (40%) examples of inappropriate staff behaviour, including physical and emotional abuse. No staff reported or raised concerns about this practice.

It goes on, and it is grim grim reading.

A couple of weeks ago I live tweeted a debate in the Northern Ireland Assembly. This debate was in response to a motion calling for a public inquiry into the abuse uncovered at Muckamore Abbey Hospital. You can find all the tweets here if you’re interested.

I’ve seen very little awareness of what happened in Muckamore Abbey in my twitterstream; in fact at the time a few people responded to my tweets saying they’d not heard of what had happened. If you’d like to know more you could start by reading Margaret Flynn and her team’s 2019 review of safeguarding at Muckamore, which must win an award for the most understated title of the year: A review of safeguarding at Muckamore Abbey Hospital – A Way to Go [that page on the Belfast Health and Social Care Trust website helpfully says absolutely nothing about what the review found but does link to a document and an easy read summary].

There is also a helpful BBC article which includes a timeline of the recent abuse reported at Muckamore Hospital (although it does not go back to November 2012 when two staff members were charged with assaulting patients).

You can find the Hansard transcript of the NIA debate here. You can search the page for Muckamore and it will take you straight to it. After a warning from the Deputy Speaker about ongoing criminal investigations, Paula Bradshaw, MLA started by saying:

I propose the motion not on my behalf or on behalf of the Alliance Party but on behalf of the parents and loved ones who have campaigned for many years for a public inquiry into Muckamore Abbey Hospital in their quest for truth and justice. I pay tribute to the families, whose dedication and determination have brought us this far. This is an extraordinarily difficult and sensitive issue, as the Deputy Speaker pointed out. We cannot applaud enough their efforts to get us this far.

In her review of safeguarding at Muckamore, Dr Margaret Flynn stated:

“Our overarching observation is Muckamore Abbey hospital is a ‘high-risk setting’ — there are high risks for patients who are placed at MAH. We think of hospitals as healing environments, we think of hospitals as places where we stay for a limited period and then we are discharged — this is not the experience of patients at Muckamore Abbey hospital.”

The motion is about an inquiry into what turned Muckamore into a high-risk setting rather than a healing environment but it is more fundamental than that. In supporting the motion, I am asking MLAs to make a commitment to never again place vulnerable people in high-risk settings. Therefore, the motion is not about bricks and mortar or even one location. It is about how we care for vulnerable patients and how we ensure and commit to their loved ones that they are being cared for appropriately.

It is clear from what the families said in various reviews and reports over the years that Muckamore was felt to be a place of out of sight, out of mind. Some cases of the denial of information about the care of family members, particularly about serious incidents, were and are alarming. It could take days for families to be informed about those incidents, and it could, and still can, take years for complaints to be investigated properly. The Assembly must commit to never allowing that situation to develop again.

We heard during the debate that Belfast Health and Social Care Trust installed CCTV two years before the most recent abuse because:

In 2015, the number of adult safeguarding investigations was far too high. Installing CCTV was considered a way to protect vulnerable adults. If the reports were true then, it appears that abuse soared after CCTV was installed. I have to ask the question: how was that possible?

The recent Muckamore review into leadership and governance in the Belfast Trust seems to portray the CCTV operation as a complete fiasco. I cannot describe it as anything but a fiasco. It appears that nobody knew for over a year that the CCTV cameras were even turned on. If people do not know if the cameras are turned on in hospitals and care settings, are they really fit to play a leading role in delivering health and care services? Those are serious questions that need to be answered.

One consequence of staff not realising the CCTV was turned on, is that it captured their abuse and the police now have hours of footage that they are processing for their investigations.

The Minister for Health Robin Swann said:

Even though the trust installed CCTV in the hospital and entered into a contract for its ongoing maintenance, no one seems to have been aware that the cameras were operational. Footage was recorded, stored and even deleted without anyone looking at the images. Indeed, they only viewed this material following the persistence of a parent who was desperate to get to the bottom of what had happened to his son. When the trust finally did look at the images from the CCTV, they revealed thousands of incidents of poor practice and the abuse of the most vulnerable in our society.

The fact that this situation was able to arise is probably indicative of another conclusion of the leadership and governance review. The report also found that, for years, at the top of the Belfast Trust, there was scant evidence of any corporate curiosity about the facility. It did not feature in the trust’s annual reports and was not regularly visited by board members. Despite being the largest facility of its kind in the region and despite it being widely known that this type of facility carries an inherent risk of abuse given the vulnerability of its patients, it was not in their line of sight. It was, as Members have reported, a place apart from the rest of the trust. When that lack of interest collided with the failure of managers in Muckamore to escalate issues, a perfect storm was created whereby abuse was able to go unchecked. I cannot find words to adequately describe the scale of this betrayal of trust, this scandal.

An inquiry was unanimously supported in the NI Assembly and the persistence and dogged determination of families to ensure these failings were addressed was acknowledged. Yet again I’m left wondering why it’s left to family members, for whom the stakes are highest, whose loved ones are trapped in these institutions, to push for improvement.

These two instances of abuse and neglect, at Yew Trees Hospital and Muckamore Abbey Hospital, should not surprise us. We have known for decades that abuse happens in closed spaces. We know that institutions are dangerous, we know that there is insufficient commitment and drive to getting people support to live in their communities.

What good work is happening is considered exceptional, when of course it should be the bare minimum. The NI debate heard of the work of two long retired doctors, Amanda and Oliver Shanks, who ‘were involved in work in Muckamore Abbey and saw the urgent need to help residents there come into the community and be part of it’. The result of that need was the establishing of Kilcreggan Homes in the 1980s, we know what works but still people are trapped in institutions.

In my WCMT Fellowship report I introduced the concept of performative scrutiny. It seems to me that we’ve now more investigations happening than ever before, but very little change as a result of them. I can’t help think that this is due to a need to be seen to be responding, rather than getting to grips with what is really required:

It feels to my mind that we’ve embraced the concept of performative scrutiny. What I mean by this that we’re performing, we are undertaking actions to enable people to feel like something is happening, so there is a lot of activity, without actually applying any meaningful scrutiny to the lives and deaths of learning disabled people.

I am at a loss to understand what hundreds of reviews summarising information but not actually interrogating available evidence or making findings of fact are adding. If anything, all of this activity feels like a distraction.

We know why people are dying prematurely, we know the causes of their deaths, we know about differences in life expectancy. We know about apathy, discrimination and bias. If we accept that we have a wealth of knowledge, then why are we conducting reviews or investigations? What is their purpose and how do we evaluate whether they are successful?

The bereaved families who I met with were united in their wish that meaningful investigations took place and changes made to improve the health, and prevent the premature death, of learning disabled people.

Oliver Lewis yesterday suggested there needs to be a public inquiry into the failings at Yew Tree Hospital.

I’d go further and say that a public inquiry into the lives and deaths of learning disabled people, and the abuse and neglect they are subjected to is long overdue in England. Yew Trees Hospital is just the latest example. The government could look to recent work by Justice in framing this When things go wrong: the response to the justice system.

I also can not comprehend how CQC can rate Yew Trees Hospital as requiring improvement, uncover such systemic abuse, and rate the effectiveness as good. Just how? What do they think effective care provision looks like?

So, what has all of this got to do with training humanity? The constant call in these situations is for a quick fix, of more training.

Truth be told, we know training doesn’t really work. Not on its own. The CQC report on Yew Trees Hospital includes the staggering finding:

Staff did not recognise and report abuse. In 45% of the episodes of CCTV multiple staff witnessed abusive and inappropriate behaviour and did not report a safeguarding concern. This was despite records showing 96% of staff received safeguarding training.

96% trained, 0% humanity.

Personally I don’t think you can be trained to be human and there is something so horrendously wrong with our society that certain groups of people are considered less than fully human, and their lives subjected to such abuse. Today’s news headlines, tomorrow’s profits.

I don’t know where i’m going with this blog post. I wish I had a pithy ending and some optimistic promise of a bright new world. I don’t. I just wish we’d sit with the discomfort of what we already know, and I think the least learning disabled people deserve is a public inquiry to share their experiences, and have them put on record.

All thoughts very welcome.

3 Comments

  • Sue Hammond / September 24th, 2020

    There is a view that people are attracted to occupations (paid & unpaid) that appeal to inherent flaws in their character. So people who like to eat become cooks, and those who get pleasure in controlling others may become nurses and carers. I can almost hear the reactions of many wonderful carers from here – but there is no escape from the horror stories coming from a whole range of NHS and care placements. I find it difficult to accept these actions as somehow average. It’s not that I have many solutions. But people as a whole need to know that CCTV is available and definitely on, and it may be that some personality assessment needs to be added to the recruitment processes. We are in a place where kindness is more important than previous experience.

    Reply
  • ian stronge / September 25th, 2020

    There have been so many enquiries, the better ones more revealing than box-ticking, and then the many recommendations for putting things right.
    After the event.
    Is there no one worldwide who has done research into how the places that do care well manage to do so?
    And to keep on doing so?

    Reply
  • Dinah Murray / September 26th, 2020

    People need to have their own cameras and their own means of communicating – NOT CCTV – being watched all the time is ghastly, it is also not effective as it just drives abuse to be concealed if it is known about. We need to get the people ways to get information out of and into the ‘homes’ they are in. We (NAT + a NHS Trust) are developing a super user friendly internet signpost app, to help achieve some genuine inclusive practice and some real opportunities to share and bear witness – all tablets are also cameras and ways to connect with others

    Reply

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