The Cornwall and Orchard Hill scandals show the need for a faster pace of change in the way people with learning difficulties are supported. Helen McCormack reports
Austere places with outdated regimes was how the Healthcare Commission described the homes for people with learning difficulties run by Sutton and Merton Primary Care Trust, south west London.
Inspectors had gone into Orchard Hill, the largest and soon to be last long-stay hospital in England, as well as 10 campus homes and a residential home run by the trust. They were scathing about the culture of “institutional abuse” they found in the facilities that house 186 people with learning difficulties including 93 in Orchard Hill.
The practices at Orchard Hill were said to belong more to the 1970s, when talk of closing long-stay hospitals first began, and parallels were drawn with the scandal uncovered in Cornwall last summer.
Inspectors examined 15 serious incidents of sexual and physical abuse carried out by staff and other residents in the past five years.
The incidents – including the rape of one woman by a male employee – were the reason the new chief executive of the trust, Caroline Taylor, called inspectors in after she was appointed in November 2005.
Focus will now turn to the Healthcare Commission’s audit of all NHS and private residential services for people with learning difficulties in England not registered by the Commission for Social Care Inspection. Between 160 and 200 services will be inspected by March.
Many, including the Valuing People director Rob Greig, believe that similar cultures to that found in Sutton and Merton could be present in other NHS campus accommodation, which is earmarked for closure by 2010.
The government estimates there are about 3,000 campus beds but Greig admits that nobody knows for sure. The problem lies in assessment and treatment beds, he says.
“Some people go in and two to three years later they are still there. The audit will be very helpful in getting a clearer picture of how many we are actually talking about”.
The exercise is headed by Fiona Ritchie, lead on learning difficulties at the commission. She says that where institutional abuse does exist, the problem lies in making staff and management realise that it is wrong.
“One issue that is similar in Cornwall and Sutton is that staff didn’t see that they needed to change. They thought services were OK. You need to realise why you need change.”
In the report into Sutton and Merton, staff were oblivious to the fact that their actions might prompt concern as they wrapped blue paper-towels around residents’ shoulders before mealtimes and gave out drinks at set times regardless of whether residents were thirsty or not.
They were heard referring to women over the age of retirement as “girls” and talking about “the children”. One member of staff told inspectors that people with learning difficulties were “babies”.
Outdated restraint techniques – including a splint being attached to a woman’s arm all day to prevent her putting her hand in her mouth and a man being strapped to his wheelchair – were common. Inspectors found that staff were afraid to try “new ways of working that might represent risk”.
The improvements already made by the trust have been praised by the commission but charities have cast doubt over whether the hospital will close by its target date of April 2009.
Care services minister Ivan Lewis (pictured left) last week signalled the government’s intention to move commissioning powers for learning difficulties from the NHS to local authorities where that has not already happened. In the meantime professionals and residents face the challenge of changing cultures built up over many years.
Shaun O’Leary, head of learning disabilities at Sutton and Merton PCT and assistant director of the service at Sutton Council, believes meeting clinical and social care needs while working within a trust is about “balancing out” the requirements of “driving up poor healthcare standards” and those of Valuing People.
For Lezli Boswell, new chief executive of Cornwall Partnership NHS Trust: “The biggest barrier to change is what change itself looks like.” Boswell, brought in six weeks before the Cornwall report was published, advocates, among other techniques, placing staff in multi-agency training to quicken the process of reform, but says the speed at which change can occur depends on leadership.
Andrea Rowe, chief executive of Skills for Care, agrees. She wants to see NHS staff receiving mandatory training in social care skills, but says: “We have got to have leaders who will not tolerate abuse and put clear markers down of what is acceptable and what isn’t acceptable”.
Whistle-blowing procedures have also been questioned at the PCT. Before the resident in Sutton and Merton was raped, the manager of the care home where she lived raised concerns about the employee. The care home manager told inspectors that his concerns were dismissed by the HR manager, who said he risked disciplinary action if the complaints persisted. The HR manager denies this, inspectors said.
The Healthcare Commission has, since the publication of the report, said that the care home manager’s dispute with HR has not been taken further and emphasises that the rape was not foreseeable. The rapist was jailed for six years last September.
Deborah Kitson, chief executive of the Ann Craft Trust, a charity working to protect people with learning difficulties from abuse, says ensuring staff feel valued is key to facilitating confidence to whistle blow, especially for young or newly trained staff.
The report found advocacy services in the trust to be patchy – the raped resident had no advocate at the multidisciplinary meeting convened after the incident – and one inspector observed advocates’ recommendations being disregarded.
Rick Henderson, director of Action for Advocacy, says that this attitude is all too common in the NHS. He backs local authorities leading on commissioning – and says councils have proven to be “much more au fait” with the advocacy system, which is “much less accepted” in the clinical sphere.
While the transition to social care settings might improve quality of life, there is concern at Skills for Care that there is one arena that will fall out of the audit’s scope: domiciliary care. Rowe warns that while a lot of abuse has been exposed in the residential sector, what has been uncovered in people’s homes in the domiciliary care sector is the tip of the iceberg.
Long stay hospitals
● 1968-9: Ely hospital inquiry sparks calls for closure of long-stay hospitals
● 1971: Scandals lead to white paper for people with learning difficulties. There are 59,000 adults and children living in long-stay hospitals.
● 2001: Valuing People white paper sets out targets to close long-stay hospitals by April 2004.
● 2003: Closure deadline extended to March 2006.
● 2005: 450 people at 15 long-stay hospitals.
● 2006 Report into Cornwall Partnership NHS Trust. Budock long-stay hospital closes.
● 2007 Five long-stay hospitals with 115 residents, including 93 at Orchard Hill, still open.
● The Simon Heng Column
● Healthcare Commission report into Sutton and Merton PCT
● Healthcare Commission / CSCI report into services in Cornwall
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