By Mark Harvey and Rob Mitchell, principal social workers
I (Mark) was sitting in a traffic jam when the news broke about the independent review of deaths of people with learning disabilities or mental health problems in contact with Southern Health NHS trust, and I cried.
The report looked at more than 10,000 deaths over four years. It found too few had been investigated – in the case of learning disabilities just one per cent. Families were often left out of investigations. There were also multiple criticisms of the trust’s leadership and board. Lessons were not learnt.
I’d followed Connor Sparrowhawk’s story and knew this was the most likely outcome of the report, yet hearing it was still shocking.
The value of lives
The findings suggest the value of human life has a hierarchy in our health service, with our most “vulnerable” too often near the bottom.
We’ve seen multiple scandals involving people with learning disabilities. Ely in the 60s. Cornwall in the 00s. More recently, Winterbourne View and the Death by Indifference report. Shamefully, the list is far longer.
Now we have the Southern Health report. This time the spotlight was not on the care provided but on the attention given to loss of life among this group. Again, the damning findings suggest some lives are seen as worth more than others.
What has social work collectively done to challenge this discrimination?
The uncomfortable truth is social work’s voice has been largely absent from this debate. With the welcome exception of the Adult PSW network, our profession’s national bodies were silent when the Southern Health news broke. When a response from one did arrive (a week later), it mainly showed they’d very little to say.
Yes, the Southern Health report doesn’t mention social work explicitly. However, thinking “phew, it wasn’t us then” would be a mistake. There are plenty of lessons for our profession.
Remember, many of the people covered in this report would’ve had a social worker involved in their lives at some point. Certainly nearly every adult with a learning disability in NHS assessment and treatment units will have had one involved in their pathway to these services.
So when we read these report findings – too few deaths investigated, families marginalised and left out – we should reflect on our own role in delivering care and the way deaths are scrutinised.
Checking our practice
For starters, when planning care, where are the social workers? Are we sitting in the corner of multi-disciplinary team meetings, quiet (often despairing), but invariably compliant with decisions? Are we getting ready to deliver a professionally designed care plan rather than a personalised one?
With family involvement, are we stepping up to welcome, encourage and enable people and their families to be part of processes? If social workers are doing our jobs right, we should never be seen as a profession that marginalises and fails to listen – even when the words said are difficult to hear.
When people linked with our care die unexpectedly are we asking why? Are we looking to learn and respond? If no lead agency deems it appropriate to investigate, are we asking why not? Remember, with adult safeguarding, social workers are trusted with a process embedded in law that allows us to ask questions (including difficult ones), check decisions are appropriate, and learn properly from what we find.
The wider agenda
Of course, the Southern Health report also sits within broader concerns around learning disability care, particularly the failure to meet post-Winterbourne View pledges to move people out of institutional care.
This agenda is now largely NHS-led. Social work has been comparatively silent. Why? The Justice for LB campaign has asked that very question over the past few years, as have a handful of social workers.
We will need to become much more engaged. Not least because the government is going to pilot moves to give every person in or at risk of admission to an assessment and treatment unit a named social worker who is independent and able to challenge clinical teams.
When this idea was floated, People First England, an organisation led by people with disabilities, said: “The disabled people we asked laughed a lot at the idea that social workers support people”.
That statement will hurt social workers reading this. Whether it’s a fair reflection or not, is irrelevant. What matters is that this is the perception of an organisation led by the very people who face the prospect of dying too young, who often have their capacity questioned if they make decisions professionals don’t like, and – as we’ve seen – can have a ‘do not resuscitate’ order slapped above their hospital bed all too easily. Their views count.
We need to speak up
So, as a profession we better start speaking up and make sure we do a good job of the named social worker role for starters.
Our day-to-day practice must also be part of the wider solution. Working alongside every person with a learning disability in a way that respects their right to be a citizen. Ensuring the value of self-determination, human rights and freedom are upheld as a given. Applying the very laws entrusted to us in a way that protects human rights, especially in the absence of personal capacity and freedom to direct care.
And learning, and wanting to learn, from things that have gone wrong. So read the Southern Health report, record it as CPD, and discuss it with your colleagues. Then adapt your practice and do something about it.
There are some great social workers doing great things but we should always reflect and learn. When reports like Southern Health come out we must remember our values and ask: where are the social workers and what are they doing? For so many people this isn’t just about rights to choice and control. It is about life and death.