Regulator to review care system after Winterbourne View abuse scandal

Dame Jo Williams, chair of the Care Quality commission, pledges rethink of residential care for people with learning difficulties following exposé of abuse at Bristol hospital Like many viewers, Dame Jo Williams admits she cried while watching the BBC Panorama programme that exposed a regime of callous abuse of people with learning disabilities at a private hospital near Bristol . As a former chief executive of learning disability charity Mencap, and someone who, as a social worker, helped such people get out of long-stay hospitals and establish purposeful lives in the community, she felt the shock particularly keenly. But Williams now chairs the Care Quality Commission (CQC), the body regulating the care sector in England, which is being blamed for failing to detect and stop what was going on at the hospital, and critics will have little sympathy. Since the programme was broadcast last week, the CQC has been inundated by hostile telephone calls and emails, including some wishing equivalent ill-treatment or death on its 1,600 staff. The regional director who appeared on the programme has required police protection. “I’ve been around a long time, but I was very surprised that the public would seek to take their anger out on someone who put themselves forward to apologise,” says Williams, 62, who within 24 hours of the broadcast had described the CQC’s failure as “unforgivable” and issued an unreserved apology. It seems clear that the programme will have a profound, possibly cathartic, effect on the way in which society cares for people whose intellectual capacity and behaviour present particular difficulties. At a meeting on 8 June, the CQC will bring together experts, including former users of services, to discuss how it should set about the task, agreed by ministers in the aftermath of the broadcast, of vetting 150 private and NHS units similar to Winterbourne View, the hospital at the centre of the storm. This will not be simply a check for any similar problems. “Root-and-branch” inspections of that kind are being undertaken hurriedly at 30 units run by Castlebeck, the private sector operator of Winterbourne View, under a separate programme. Rather, the wider assessments will take a fundamental look at the very culture and purpose of residential units for learning-disabled people, questioning a system that had left most Winterbourne View “patients” warehoused for at least a year while supposedly undergoing assessment and treatment at a cost each of £3,500 a week. “It felt like those people, staff and people who were resident there, were locked away together and a sub-culture developed which was led by someone who clearly had no training, but importantly didn’t seem to regard the people as individuals. And, well, they were robbed of their humanity,” says Williams. While stressing that she in no way seeks to minimise the CQC’s culpability in the affair, she admits to feeling that responsibility should have been shared more evenly among the regulator, the local authority and NHS commissioners of care and, particularly, the provider. “Am I resentful? I don’t know whether that’s the right word,” she says. “I probably was very surprised by the lack of balance, I think that’s what I’d say.” The CQC is carrying out a thorough audit of what happened to the alerts raised by Terry Bryan, the former charge nurse at Winterbourne View, who tried to blow the whistle to the authorities and ended up going to Panorama in frustration. Williams has since spoken to him – she describes him as “extraordinarily reasonable” and “prepared to be very helpful to us” – and he has accepted an invitation to join the 8 June meeting. Initial findings from the audit indicate that Bryan raised his concerns with his manager on 11 October last year and discussions were subsequently held with South Gloucestershire care commissioners, resulting in a letter to the CQC on 29 November saying that a formal safeguarding meeting involving all agencies would be held. However, that meeting, which led to Castlebeck agreeing to take remedial measures, did not happen until 1 February this year, by which time Bryan had twice sought to contact the CQC but had received only automated replies to his emails. In an interview with the BBC’s Politics Show West on Sunday , Bryan said the abuse filmed secretly by an undercover Panorama reporter was far worse than anything he had witnessed or reported. “I saw bad practice; I saw bad attitudes; I saw chaos among the staff team – that’s all.” Nevertheless, Williams says that Bryan’s emails, or the gist of them, should have been relayed to the CQC inspector responsible for Winterbourne View. They should have triggered action by the inspector. Although the audit of events remains uncompleted, and it is too soon to draw conclusions, she thinks “there may never be a rational explanation; we all make mistakes”. The case has raised questions about both the CQC’s remit and its resources. Many commentators have been surprised to discover that the organisation has no brief to take up individual complaints about care, referring them instead to the provider, the commissioner and the ombudsman in that order. Asked to explain the difference between a complaint and whistleblowing, which the CQC says it does take up, Williams struggles. She accepts there may be a need to look again at the distinction and how it is explained to the public and media. But she stresses that if the system is working properly, an inspector will be told that an individual has contacted the CQC to complain about a care service on their patch, even though the CQC will not itself pursue the complaint, in order to inform the inspector’s general view of the service. On resources, critics have seized on the fact that the CQC’s annual budget of £164m is 30% less than the combined funding of the organisations it succeeded in 2009, even though it is being expected to do more. As well as NHS trusts, care homes, care agencies and dental practices, the body is due next year to start regulating GP practices. According to Williams, each of the full quota of 900 inspectors – and until recently there have been up to 130 frozen vacancies – handles a mixed portfolio of some 50 different provider units and makes judgment calls, based on evidence of relative risk, about when and how often to visit (almost always unannounced, contrary to widespread belief). “People have said to me: ‘Why aren’t you making a great fuss about more resources?’” she says. “But any claim for additional resources in the current climate, in any climate, has to be based on hard data and evidence about where a shortfall is and what we need to do to address that shortfall.” Might she make a great fuss if the CQC’s current analysis of its resource needs produces such hard evidence? “We might, absolutely.” Even in the unlikely event of the CQC receiving a big boost to its budget, Williams emphasises that the primary responsibility for safeguarding the welfare of people in the care system will always rest with the care provider. “My challenge to every provider who watched that programme is: ‘How do you know that the people you are offering services to are getting a service that protects them, promotes their welfare and helps them develop and enjoy a quality of life?’” She admits that she did consider resigning over the programme. “Of course I have considered it,” she says. “But in a strange sort of way, it makes me even more determined to try and give CQC the best oversight and leadership I possibly can.” Morale in the organisation was “very, very low” after the broadcast, Williams says. “People felt under the cosh. But they want to understand what’s gone wrong and we will certainly be looking at that from an executive point of view, and from a board point of view, and then making whatever changes we have to to ensure that we learn from this.” Learning disability Disability Social care NHS Health David Brindle guardian.co.uk

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