Lessons from Orchard Hill and Cornwall. Choice Support provides learning disabilities services and has an active anti-abuse policy. How does that work, asks Graham Hopkins

In light of Orchard Hill how can service providers be sure they are best protecting service users? National charity Choice Support called in expert help, as Graham Hopkins found

What is striking about the reports into abuse in services for people with learning difficulties last year in Cornwall and recently in south London is that staff didn’t understand what they were doing was abusive. Or if they did, they didn’t know how to challenge or change it. They were submerged in a negative culture.

It is the role of management to set, monitor and develop an organisation’s culture. Lack of management involvement results in cultures being condoned rather than shaped. In the wake of Cornwall, one national charity did some soul-searching.

“We asked, are we sure we are doing everything possible to ensure that the services we provide are safe?” says Sarah Maguire, director of organisational development with Choice Support, which provides services to more than 450 adults with learning difficulties, including supported living, outreach support and small registered care homes. “The answer was we thought that we were, but were not sure.”

It was an answer that proved arrogance – a key risk indicator – was critically absent from its management, and mirrored in its strong, well-developed ethos, believing that people with learning difficulties should be in control of their lives.

So how could they be sure? “Although we are a large organisation, with a good reputation for quality and innovation, we recognise that often there are smaller specialist organisations that are more skilled and knowledgeable in their area of speciality,” says Maguire.

So, in December 2005 they turned for help to the experts in preventing and combating the abuse of people with learning difficulties: the Ann Craft Trust, Voice UK and Respond. These charities, part of the adult protection alliance, were  commissioned jointly to carry out a “root and branch” review of policies and procedures, systems, safeguards and practice; to  train key staff, and review and monitor service users’ subsequent experiences. Specially commissioned adult protection training was attended by 107 managers – with further training planned on sexuality issues.

“We agreed there were three areas that should always be considered when developing best practice with regard to protection,” says Deborah Kitson, director of the  Ann Craft Trust. “The organisation and the culture that it encourages; staff, including managers; and service users.”

Maguire adds: “We invited an external assessment of our policies including adult protection, sexuality and personal relationships, intimate personal care and  whistleblowing. We are also making accessible versions of these with service users’ participation.

“By looking at the issues of protection more widely than just ‘meeting requirements’, we have already enhanced the protection of service users and minimised the risk of abuse.”

During the review it was highlighted that a protection committee with an independent external expert member was needed. “To their credit, Choice Support is setting up its protection committee,” says Kitson.

Maguire adds: “It will enable us to develop a clearer picture of the effectiveness of our training, policies and procedures, and plan changes in accordance with those findings. Already we have introduced new reporting and outcome forms. These will also be used by the committee to address future work.”

Despite lax external monitoring that, in part, permitted Cornwall and Orchard Hill to perpetuate abuse and bad practice, many organisations still feel over-regulated. “The thought of further self-imposed scrutiny and the associated costs are reasons for a reluctance to undergo the process that Choice Support embarked on,” says Kitson.

However, Maguire is defiant: “Just over a year on, and following the Healthcare Commission’s inquiry into abuse in services provided by Sutton and Merton PCT, we feel it has been worthwhile. “

And the answer to the question we set ourselves – are we are doing everything possible to ensure our services are safe? – is, while sadly unlikely that abuse will ever be totally eradicated, yes, we are doing everything possible to ensure safe services.”

Lessons learned
● Be honest with yourselves – is your practice the best it can be?
● Promote the involvement of advocates, family and carers in planning and delivering services.
● Bring in expert, outside help – they can see through the mist.
● Evaluate whether all the regulation and training has made people with learning difficulties feel safe.

Contact the author
Graham Hopkins

This article appeared in the 1 February issue of the magazine, under the headline “Outside looking in”