Social workers must “assertively challenge” providers and colleagues to ensure adults at risk get the protection and support they need, the author of the Winterbourne View serious case review (SCR) has said.
Speaking after her SCR exposed the collective failure of the regulator, commissioners and safeguarding agencies to identify and expose abusive practice at the learning disability hospital in south Gloucestershire, Margaret Flynn told Community Care the case highlighted the importance of “concerned curiosity and vigilance” to good safeguarding.
Social workers performed two key roles in the case: as care co-ordinators reviewing the support received by patients, most of whom were detained under the Mental Health Act, and in a safeguarding capacity, responding to the 40 alerts received by South Gloucestershire Council from 2007-11.
Flynn said both groups were severely hampered by the “partial information” that Castlebeck Ltd, which ran Winterbourne, conveyed to agencies about the frequency and nature of serious incidents, including the high levels of restraint used on patients.
‘Undermining safeguarding process’
However, the SCR criticised care co-ordinators for conducting “ineffective” reviews of patients that failed to bring to light concerns about abuse or poor care, and that reviews were driven, arranged and chaired by Winterbourne View, “thus undermining the safeguards of the process”.
It also said that South Gloucestershire safeguarding staff were not sufficiently challenging of police decisions not to investigate injuries to patients or of delays in Winterbourne View’s investigations of incidents that were the subject of safeguarding alerts.
“There has to be some very assertive challenge, not just of the provider itself but also of colleagues across the sectors,” said Flynn.
“There were clear failures of professional judgement,” she added. “But we can’t lose sight of Castlebeck’s failings. They were not honest. They reassured a number of professionals that things were in hand.”
Improving reviewing skills
The inquiries highlighted the need to improve practice in reviewing placements, said Ruth Allen, chair of the mental health faculty at The College of Social Work.
“Reviewing placements is a core task for health and social care practitioners and we need to think what skills are required to do that and whether people have those skills; often they don’t,” she said.
She said effective reviewing could become more important if more and more health services are contracted out to the independent sector under the impact of the government’s NHS reforms.
“We are lkkely to see more private providers and I think that’s a challenge to safeguarding, so we will need to think about the skills that people have to keep people safe.”
Besides the provider, Flynn’s strongest criticisms were directed at the NHS commissioners who placed people at Winterbourne View, mostly using contracts supplied by Castlebeck, and without visiting the hospital, or seeking information on the outcomes it produced.
“To purchase a place on the basis of reputation is inadequate,” she said. “Most of us, if we were spending £3,500 a week, would want to know that it was well spent.”
“They should have known what was happening to each person.”
She said adult safeguarding boards needed to be “much more demanding of NHS colleagues”, concerning what is happening in health services such as Winterbourne and the levels of scrutiny that commissioners are putting in place. “For too long the NHS has been scrutinising their own policies,” she added.
Flynn also called on care services minister Paul Burstow to throw his weight behind the SCR’s call for a “commissioning challenge” to find suitable support packages for the 51 former patients of Winterbourne, many of whom have been transferred to other hospitals.
“Let’s do something for these 51 people,” she said. “Can’t we do something with £3,500 a week to make it possible for people to live ordinary lives with extraordinary levels of support?”Mithran Samuel is Community Care’s adults’ editor.
Winterbourne View ‘a case study in institutional abuse’