CQC finds leadership gap in learning disability hospitals

Leadership and governance need to be stronger in learning disabilities hospitals and care homes, the Care Quality Commission has said.

The CQC has published the first five reports from the pilot inspections taking place following the Winterbourne View scandal. The first five inspections were of hospitals that provide assessment services.

The early reports said leadership needs to be stronger to ensure services are safe and meet essential standards.

Terry Bryan, the former nurse at Winterbourne View who blew the whistle on the abuse of residents there, said it is these frontline practitioners who can really make a difference to residents’ lives.

“The public thinks the CQC should be going in and sorting everything out, but that’s not how it works,” he told Community Care. “There’s only so much you can see on a spot-check visit, it’s down to management to keep an eye out every day and make sure staff feel able to come forward if they see any problems.”

Findings so far also suggested a lack of understanding about what safe, person-centred care looks like, the CQC said.

Bryan said the implementation of person centred care was incredibly difficult in larger hospitals and care homes.

“It doesn’t matter how much training your staff go through, it’s hard to be person-centred when you have a large number of people and resources are short,” he said. “I don’t know if there’s anything to be done about that, apart from changing the model of how we look after people.”

Bryan said supported living was an alternative that worked with many challenging people.

CQC chair Jo Williams said she believed larger institutions were able to integrate this person-centred approach.

“The size of an institution isn’t the issue,” she told Community Care. “It’s about what’s central to the way they work. We would expect that the service is centred around the individual and they’re part of the decision-making process, regardless of how large a hospital or home is.”

In a joint response to the inspections, Mencap and the Challenging Behaviour Foundation said: “While these are just the first reports from the CQC’s review of services for people with a learning disability, they reflect our very serious concerns about poor practices at specialist assessment units, like Winterbourne View, for people with a learning disability.

“We expect that all the reviews post-Winterbourne will provide a strong justification for moving away from institutional care to local services for local people. It is crucial the government then does all it can to drive these changes through and thereby reduce the likelihood of such abuses happening again.”

The CQC plans to continue this series of inspection and to publish fortnightly reports during the start of 2012.

Meanwhile, PricewaterhouseCoopers has published its recommendations for Castlebeck, the care provider in charge of Winterbourne View, following a review of its operations.

Castlebeck said: “The action plan is designed with one simple objective in mind – to ensure that we are delivering the best possible service to the people entrusted to our care in a safe environment.”

The PwC report said Castlebeck’s management structure is to be completely overhauled to maximise accountability of each individual unit and ensure best practice in the corporate and clinical governance in every one of our facilities.

Key new appointments have been made, including a new director of nursing and patient safety, a group medical director and a group head of governance, risk and compliance.

There is also to be increased investment in staff and staff training across Castlebeck and an improved whistleblowing policy.

New activities programmes will offer more personal choice for people in Castlebeck’s care, the provider said, revealing that it has reviewed its advocacy capabilities and following a national tendering process awarded contracts to two independent external advocacy organisations.

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