Review of autism home abuse condemns out-of-area commissioning failings

Report into National Autistic Society home identifies ‘lack of rigour and failures of judgement’ by commissioners from across the UK

A CQC inspection in June 2016 rated the home 'inadequate'

A review into the abuse of adults with autism at a home in Somerset run by the National Autistic Society (NAS) has called for an overhaul of the monitoring of out-of-area care placements.

Mendip House, which closed in October 2016 following a highly critical inspection, was part of an NAS ‘campus’ home to adults with severe autism placed by 30 local authorities and clinical commissioning groups from across the UK.

The review by the Somerset Safeguarding Adults Board (SSAB) said Somerset County Council (SCC) “had to invest in an expensive and labour-intensive enquiry because of the lack of rigor and failures of judgement of commissioning professionals”.

“Had the National Autistic Society addressed long standing concerns and the commissioners undertaken essential reviewing and monitoring, the workload of SCC and the Enquiry Team would not have been as extensive,” it added.

The review criticised the failure of the Care Quality Commission (CQC) to identify problems at the home earlier through its inspections.

It drew comparisons between Mendip House and Winterbourne View, the private hospital near Bristol where BBC Panorama exposed abuse of people with autism and learning disabilities.

It said: “There were over 30 different placement authorities across Somerset Court and although concerns were raised with SCC’s safeguarding team about other Somerset Court dwellings on at least four occasions between 2014-2016, not one identified concerns about Mendip House. Five years after the scandal of Winterbourne View Hospital this is remarkable.”

Commissioning failings

The review said commissioners continued to “act as place-hunters rather than agents of individuals with autism or stewards of the public purse with the means to control fee levels”.

It recommended that the Department of Health and Social Care, NHS England and the Local Government Association consult on the regulation of commissioning, including the “expectation that commissioners must notify the host authority of prospective placements”.

The consultation should look at the role of a ‘lead commissioner’ to “assume responsibility for coordination when there are multiple commissioning bodies of a single service”, and “assert a new requirement to discontinue commissioning and registering ‘campus’ models of service provision”.

Somerset council plans to require commissioners of services in the county to fund “essential monitoring and reviewing processes”, fund residents’ access to local health services, particularly community health services, and to identify a lead commissioner.

History of concerns

The review criticised the NAS for failing to share findings from its own investigations with the CQC.

The CQC and a senior NAS manager received allegations of abuse at Mendip House from whistleblowers in November 2014. The outcome of the NAS investigation raised concerns about the staff culture in the home.

In addition, a provider audit in October 2015 identified 43 areas for improvement but this was not reported to the CQC at the time.

The review also said the CQC should have been more proactive in identifying problems at Mendip House through inspections.

“The regulator acted once the harm was alleged to have occurred – without reference to the history of inspecting Somerset Court dwellings. The CQC’s decision to act after the whistleblowing is not good enough.”

The CQC eventually acted in May 2016 after two staff members raised concerns about unacceptable staff behaviour. It carried out an urgent focused inspection at Mendip House and was “satisfied that the staffing arrangements were adequate to keep people safe and ensure continuity of the service”.

It then decided to carry out comprehensive inspections of all Somerset Court locations in June and rated Mendip House ‘inadequate’ in all of its inspection criteria.

The CQC proposed to cancel the home’s registration, but the NAS decided to close the service of its own accord.

Residents reimbursed

Reported incidents of mistreatment included an employee making one resident crawl around on all fours, while staff threw cake at the head of another.

Almost £10,000 was reimbursed to Mendip House’s six residents after an audit of case files found residents had been funding meals of staff accompanying them during outings since 2014.

The review was particularly critical of practice in staff supervision sessions, stating it “beggars belief that staff were asked to sign a declaration each time they had a formal supervision session to confirm they had not witnessed any abuse”.

“There was recorded evidence that often a whistle-blower would themselves resign, while the alleged perpetrators were given warnings following disciplinaries and retained or recycled within the service,” it added.

Councillor David Huxtable, Somerset council’s cabinet member for adult services, said: “The report makes important recommendations for change that would bring more clarity on the responsibility for placing authorities to monitor the care being provided to the people they place.”

‘Very sorry’

NAS chief executive Mark Lever said: “We want to run the best possible residential services for autistic people, where they are safe and can thrive. We are very sorry that in May 2016 it became clear that we had failed to achieve this for the people living at our Mendip House care service, who were not shown proper care and respect and were mistreated by a group of our staff.

“We welcome the SAR report’s recommendations addressed to national agencies aimed at improving and monitoring the safety and quality of care placements. All of us who provide and commission care services need to make sure we have the right staff and robust systems in place as well as being prepared to take swift action if there are any signs that standards are dropping.”

Andrea Sutcliffe, the CQC’s chief inspector of adult social care, said: “We share the [safeguarding adults] board’s concerns over the outdated design of services like Mendip House: these days we would be unlikely to register a new service like this, and we are monitoring those services that already exist ever more closely.

“I am sorry that we did not do more when concerns were first raised with us instead of accepting assurances from the council and the NAS that those concerns had been dealt with.”

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8 Responses to Review of autism home abuse condemns out-of-area commissioning failings

  1. John Burton February 9, 2018 at 12:25 pm #

    What are we to make of these people? Are they a bunch of well-meaning amateurs who’ve no idea of what they are managing or inspecting? Or of how to organise anything? Or any self-awareness and memory of what they’ve said in the past? Or of how to select and supervise staff doing an extremely demanding job? Or of the possibilities of collusion and cover-up? Perhaps they missed the Winterbourne View scandal . . . well, no, because it seems they had a lot to say about it at the time and joined in with the great and good to pontificate and mouth platitudes, sit on boards and committees, advise government, and get nowhere with the real issues and change nothing.
    Or might they be a bunch of over-paid, secretive, pompous hypocrites, adept at covering up their own mistakes with acres of bureaucratic blather.
    Isn’t it about time we faced the fact that the CQC simply doesn’t work? And that all this talk from organisations such as NAS is self-aggrandisement and hot air. Why did the CQC give an abusive regime a clean bill of health? Why was no one prosecuted? Why haven’t we heard this being discussed at the CQC board meetings? There are of course many other failures like it.
    As the current CEO of NAS said in October 2012: “This kind of abuse has no place in modern Britain.
    “Organisations should ensure they have a culture where abuse is never tolerated, and this needs to come from the top. Where there are failings, the people at fault must be held to account.
    “Careful recruitment, regular inspections, the right staff training and a culture of mutual respect and support are essential in making sure that these kinds of revelations stay firmly in the past.” He was talking about Winterbourne View.

  2. Ruth Cartwright February 9, 2018 at 1:59 pm #

    Well done to the whistle blowers in this case. This shows the danger of many authorities seeking to ‘dump’ people with residential care needs, placing them out of area with little follow up or monitoring. It is often not clear how commissioners select a placement (cost rather than adequacy of care presumably being a large factor). Nor is it clear what qualifications the commissioners have to carry out their task (a social work or social care background would be good). Little seems to have changed since Winterbourne View with few attempts being made to find suitable, person-centred local placements for people, enabling their families to keep up with them and make sure they are receiving appropriate care.

  3. J Morgan February 9, 2018 at 2:29 pm #

    Autistic UK, the only User Led national organisation for Autistic Adults, has been trying to raise issues such as this with the NAS, CQC and NHS for years. Whilst it is nice that they finally sit up and take notice when an abhorrent place such as Mendip House is exposed, generally the replies have been non-committal and have been largely ignored at Local and National Governmental levels. No policy or campaigning, including large petitions seem to have made a difference before it gets out into the Public eye.

    The next part of this overhaul of ‘out of area’ services must include the Adult Autists worst nightmare; The Treatment and Assessment Units, where unsympathetic and largely untrained Psychiatric Doctors ignore Autistic behavioural and sensory needs and turn capable, competent adult autists into drugged zombies to manage ‘unwanted’ behaviour.

    No notice is given to environmental and sensory issues which cause this breakdown of self control as Psychiatric Hospitals and ATUs are not geared up to Autistic Adults and treat those with mental health problems as psychotic or ‘unmanageable’, not as Autistic.

    Perhaps the CQC and the NAS would like to add this to their list of areas of concern and act on the wishes of Autistic Adults nationwide.

  4. Anonymous February 9, 2018 at 8:06 pm #

    I worked for this particular case representing a well known Local Authority. All the issues raised were confirmed and my client was quickly removed and placed in a suitable placement. What I learnt from this case is that we need to ensure that the commisioners and social care reviews are done comprehensively and timely. Alot of these issues were not addressed because of missed reviews and lack of monitoring by the placing authorities.

  5. Julie Butcher February 10, 2018 at 2:49 am #

    How is it that ‘trusted services’ manage to employ people of such low emotional intelligence and absolute lack of integrity and morals to ‘look after’ and ‘care’ for one of the most vulnerable and weakest groups in our society ? Is it a question of funding, trying to squeeze the most from the resources to spread the money
    as far as it will go ?
    Cheap doesn’t mean cost effective, it just means cheap !!! Always the same old outcome with these cases, where the person who’s job it is to safeguard against this type of heartwrenching abuse, offers their sincere apologies and then continues to collect their £100.000k plus sallery. Nice work, well done !!

  6. F.CLIFFE February 10, 2018 at 12:37 pm #

    C.Q.C not fit for purpose,another sad case of systematic indifference.

  7. Anonymous February 15, 2018 at 10:41 pm #

    Only a few days ago, my wife and I had been looking at NAS care provision as being the only alternative to the Camphill Community to care for our vulnerable autistic son. And then this story broke. How was the flag-bearer for the autistic people in the UK able to let this happen? John Burton’s post sums it all up. We are sick to the back teeth of incompetent, highly paid professionals NOT DOING THEIR JOB. Words, words, words. Toothless, ineffective internal and external quality control. Staff standards being allowed to deteriorate until their output becomes feral and bullying, akin to Lord of The Flies. The NAS apology on their website fails to answer the basic question of how these animals were selected to care for vulnerable people in the first place. The CEOs management-speak platitudes after this disgraceful episode do NOTHING to improve our low confidence level regarding previously highly respected NAS output. It was clearly misplaced as Mendip House shows. All of you: DO YOUR JOB!

  8. jim February 16, 2018 at 10:49 am #

    the N.Ireland equivalent of the CQC known as RIQA is no better. i raised concerns with RIQA as a carer of a young autistic woman that a facility the local authority thought appropriate for us to send her to for respite [or short breaks as they now call it] was not safe nor suitable for an autistic person with learning duisabilities. I highlighted the fact that the Trust deemed the facility to be safe and ‘adequate’ to meet the needs of autistic young adults. My concern was that the facility was a 21 bed unit with permanent residents [mostly male] with just one respite bed available for all the young autistic and learning disabled adults it was sending in on respite from one area. I told the RIQA that the disparity of capacities within this facility was huge in that they had some residents who were severely learning disabled and others who were mild to moderate and some of the latter had forensic histories. The Trust never told us about the forensic histories but when we found out and challenged its service managers they would not deny it nor would they specify what type of forensic histories they had. RIQA had inspected this unit and found it met standards!

    When I wrote to RIQA about the safegaurding issue etc and the need to accommodate an autistic person with severe learning disabilities in a unit with those of similar capacities in a small more personalised environment it simply wrote back and assured me that the standard was ”adequate” to meet the needs. No mention of the concerns over the client mix and forensic histories. Not surprisingly we never sent our daughter there nor would we ever, and ended up having to fight the Local Trust to get direct payments to fund our own bespoke short breaks arrangement that is still under threat of cuts by the Trust [ or known as local Council in England] in my opinion some Council or Trust managers don’t like the carer or service user getting the better of them and can be quite vindictive in their subsequent dealings. So as far as I am concerned regulators like the CQC or RIQA can be ‘blinded’ by the Councils or Trusts and should do far more unannounced inspections and listen to the opinions of carers and service users more so than the professionals in the facilities they are inspecting or those that commission them [Trusts will often act in their own financial interests before that of the service users]