In the wake of the Winterbourne View scandal, the Care Quality Commission employed 27 adults with learning disabilities as ‘experts by experience’ in the teams inspecting 150 learning disability hospitals and care homes for care and welfare and safeguarding outcomes.
Between them, Laura D Broughton and John Woodhouse have been involved in 26 of those inspections. Although they use services, neither have lived in residential care – Broughton lives independently supported by social care charity Choice Support and Woodhouse lives with his family. At first, Broughton found inspecting institutional care challenging, particularly her first inspection, which was of an assessment and treatment unit.
“Sometimes I found it difficult to understand why people were sectioned, but not having the experience of being in these situations was good. It meant I could objectify it rather than feeling that I was there. To begin with I was so shocked that I didn’t know how to handle it, but it got better.”
What service users told learning disabled inspectors
“I should have a care plan but I don’t know what is in it.”
“There is nothing to do here, I want to go back to where I used to live.”
“I don’t know why I came here or how long I am going to be here,” said one service user. The reason had been explained to them although there was no information provided in an easy-read format. Care staff said they would go through this again with the patient and inspectors observed them doing this.
One person said that they were bored and lonely at the hospital and staff treated them “like a kid”. They did not do any cooking but would like to and they wanted to go out more often.
Some staff were taken aback that they were being questioned by her and the language of one member of staff disturbed her when they said that to communicate with some patients staff have to “try different things, like you do with a baby”.
“The idea that just because someone is non-verbal that they should be referenced like that was too much. We may have our difficulties but we have a right to be treated as grown-ups,” Broughton says.
During another inspection, this time of a hospital where people were sectioned, she was shocked by its locked doors, “it was like going into a prison”.
Woodhouse focused on speaking to the users. “It varied from service to service as to whether they were happy. It was interesting to see people’s perceptions on the same thing, because sometimes one user was happy with a service that another was unhappy with.”
There were common problems uncovered, such as inaccessible information, which was often on a noticeboard where no one saw it, was difficult for service users to understand, or was out of date, or a lack of complaints procedures.
“In some places the users seemed happy with the service, but they didn’t know how to complain if they were unhappy and there were some places where the users might not feel safe to complain,” says Woodhouse.
On the whole, both were happy with the services they inspected. Sceptics might think using experts by experience is a ploy by the CQC to claw back some credibility, but Broughton and Woodhouse clearly know their own minds.
Contribution to inspections
And it is also obvious that they bring something extra to an inspection: Broughton picked up on a couple of things, seemingly minor but important in her eyes, that went unnoticed by other inspectors. For example, she says: “One place had handrails on the stairs but only on one side. Because I have a weakness in my right side I would have needed rails on both sides.”
Both agree that service users probably felt more at ease talking to them. Woodhouse says, “In one place a service user started talking to me and the staff were astonished because they didn’t think he would talk to anyone. He wasn’t that happy with staff which was why he was more comfortable talking to me.”
Images: Gary Brigden
- CQC recruited the experts by experience through a consortium of smaller and user-led organisations led by Choice Support. It also uses experts by experience in its routine inspections and special reviews and is increasing their use.