Post-Winterbourne: 2 in 5 providers weren't compliant for safeguarding or welfare and care
During the British Institute of Learning Disabilities, Alan Rosenbach from the CQC reported their findings of a Winterbourne-inspired set of inspections. The findings weren't fantastic but it's getting better....
13th March 2013
The British Institute of Learning Disabilities (BILD) held their 2012 conference towards the end of last year and we thought it might be useful (and interesting) for you to consider your services' provision in light of what Alan Rosenbach (Special policy lead to the CQC chief executive) spoke of in relation to the CQC's national learning disability inspections programme – particularly what they did following Winterbourne.
His report was very clear on what providers and staff should be doing and the figures reported means that none of us should be complacent about the quality of provision – if we take their findings and extrapolate them out, then 2 out of 5 of our instances of provision are not compliant with some of the most basic expectations for people with learning disabilities today.
After Panorama's expose, the CQC started a programme of inspections at 150 different locations. The inspectors included family carers, people who had experience of the services, experts, CQC inspectors and professional advisers. The places inspected covered a decent range of type of provider; simply categorised as care homes, assessment and treatment and rehabilitation. The inspection also only concentrated on safeguarding, care and welfare.Across the 150 places, around 40% were not compliant - roughly 2 out of every 5.
38% were not compliant when it came to care and welfare. Their care plans weren't sufficiently person-centric, families and individuals found it hard to access these plans, activities weren't sufficiently meaningful to promote independence, advocacy was often of poor quality and again, not person-centred and finally, people were staying too long in assessment and treatment. In one service, one service user had spent 17 years in an assessment and treatment service.
When it came to safeguarding, 34% were not compliant. It was found that staff didn't recognise abuse (!!), there were delays in reporting issues, safeguarding report outcomes weren't always learnt from or monitored, 27 locations didn't tell the local authorities about concerns and some places had abusive practices culturally ingrained and institutionalised.
Good providers were great at de-escalating challenging behaviour so that it didn't become a restraint or deprivation of liberty issue; poor providers didn't train the staff properly, monitor incidents properly, didn't learn from what had happened and an 'alarming' use of seclusion was used without recognition that this was a form of restraint.
Following this, the CQC has recommended a few things staff should make sure they are doing (and some of them really sound obvious but apparently they need to be restated):
- Service users need to be involved with their care planning and activity planning.
- Use positive behaviour reinforcement – i.e. reward and give attention to good behaviour, rather than leaping to punish bad behaviour. Restraint should be your last recourse and (depending on your particular service users, of course) shouldn't really ever be needed.
- When restraint does need to be used, you must record why, where, when, who and how so that you can avoid creating the same environmental stimuli that leads to the challenging behaviour.
- Staff must properly understand deprivation of liberty safeguards and the appropriate application for their setting.
For all three of the CQC, providers and commissioners, they need to make sure proper and appropriate quality assurance systems in pace ( i.e. checking you're doing what you're actually supposed to be doing by making sure everyone understands how and why they should be doing their job).
After the inspections, 1 service was closed, 71 have undertaken further work (it's not entirely clear what these means – presumably, work on practice, culture and training to become compliant), 34 were checked again, 24 are now compliant (great!), and 10 reports were still in draft stage at the time of writing.