Signs of hope

Grant Wetherall looks for ways to prevent abuse taking root and flourishing in the future

The Orchard Hill abuse scandal, as did previous inquiries into Ely Hospital (1969) and Longcare (1998) and last year’s Cornwall revelations, suggests that better advocacy and pictorial and sign language communication systems may well have raised the alarm sooner.

The Healthcare Commission report says: “The overall model of care promoted dependency, and the views of people with learning difficulties were seldom heard and few staff had any specialist training in ways of communicating with people with learning difficulties.”

If we had learned the lessons of Ely, Longcare and Cornwall, we would know that the lack of advocacy and communication systems were pivotal reasons why abuse was allowed to take root and flourish.

Sutton and Merton PCT should take into account the preventive role played by advocacy services. Advocacy can create self-confidence and self-esteem in people with ­learning difficulties, thereby reducing the incidence of abuse as well as supporting individuals when a complaint has been made or abuse disclosed. The training and support roles of advocacy should be acknowledged and its involvement should be routine if an allegation of abuse is made.

The Longcare report warned that “people with learning difficulties are particularly vulnerable if they have communication difficulties or if they have no active relatives or friends in the local community”. Advocacy ser­vices can ensure that information is available in an accessible form and that service users can contact an advocacy service if they need support. But advocates must have the right communication skills.

If no advocacy service is available locally, the PCT should set up user groups for disabled people comprising parents, service users, carers, local Mencap representatives and other disability groups. Such groups can be influential in improving the day-to-day services and everyday lives of people with learning difficulties.

Such a reduction of dependency on staff and the empowerment of service users can be achieved by teaching communication systems such as Makaton, TEACCH (Treatment and Education of Autistic and Related Communication-Handicapped CHildren) and Picture Exchange Communication Systems (PECS) to service users, staff and carers.

Setting up such “augmentative communication systems” will not work unless the PCT creates a signing and symbol environment where the staff are ultimately responsible for promoting this daily. Makaton has already produced resources that would support this work.

Finally, appointing a designated staff member with communication skills would go far in implementing these programmes and signal the trust’s intent to stamp out abuse.

Grant Wetherall is a team manager in Northern Ireland. As a social work student on placement with Ealing Mencap he went undercover to help expose abuse at the Longcare homes. Go to

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