Monday, 16 December 2013

Integration - Merger or Acquisition?

Vic Citarella, Director of CPEA Ltd, draws on business leadership lessons to make some timely observations about integration in social care and health

Policy makers are convinced that integration of social care and health is a good thing, despite the weak evidence base. For example, a lot of hope is vested in the eventual success of the current drive to integrate through the effort of pioneers.

While there is something of an act of faith in all this, we all instinctively know there is something right for the customer in being more joined-up. In fact, some of us have been working at it for over 30 years! So maybe now is the time - austerity being the parent of innovation - we may actually see the system change.

But in what direction?

We all have different ideas of what integration looks like. And of course, it being a way of working, it is not an ‘end’ in its own right, but only ever a means to an end.

So, let’s turn our attention to describing what good integration looks like. Why? Because it appears that this is how we will be measured and what will ensure that a trickle of their own money keeps dripping in the direction of our customers.

In thinking about this, I have been taken with what the business sector has to say about merger and acquisition (or M&A as it is usually known). This is neither to suggest that this is something to aspire to or avoid - but rather to learn from. It is of note that in pure business M&A can be an end in itself, if it meets the primary purpose of making money, whereas in a public service it is always a means, as the purpose is service (usually).

With that explained, three recent observations:

First I heard Professor Jon Glasby speak at an ACCORD Group event in Birmingham recently. He had this warning about M&As in our sector, saying that they:
• Only partially achieve stated objectives
• Do not save money
• Reduce morale and productivity
• Struggle to reconcile ‘cultures’ and that this is a major cause of failure
• Stall development for at least 18 months
• Never achieve true ‘regime change’

Sobering agreed, but the professor went on to give an upbeat message about focusing on outcomes, with his suggestion that the best way to do this was by asking just three questions - where are we now, what do we want to achieve, and what do we need to?

Second, an advert on the rear cover of the CASS Business School magazine In Business caught my eye. It said: People are the key to successful M&A, in bold to catch the eye. I read on and will quote what the advertiser had to say in full as it warrants our attention:

People are the key to any merger or acquisition. Without their commitment, energy and ideas, a deal won't succeed. We help our clients build and execute an integration approach that recognises the cultures of both organisations while creating the change necessary for the new organisation to flourish. Using proven change management and communication strategies, we work with our clients to manage the process from the pre-deal stage through integration.

What to make of that? Well what went through my mind, as a 'workforce' person, was to say spot on. I took the magazine, making an entry into Evernote to translate this into the language of social care (and health). Business Opportunity!

Third was this from The Texas CEO Magazine. Here Randy E. Pruett blogs about ‘Mastering Employee Communications and Commitment During M&A.’ This is worth a read on a number of levels - it states the obvious, it’s readable and nothing to do with social care and health, it’s timeless and relevant and it shamelessly re-uses some leadership classics:

1. Martin Luther King didn't say ‘I have a strategic plan’!
2. In truth, the only person who likes change is a wet baby
3. Three people who were at work on a construction site. All were doing the exact same job, but when each was asked about his or her job, the answers varied, rather tellingly. The first replied, “Breaking rocks.” The second said, “Earning a living.” The third answered, “Helping to build a cathedral.”

You just have to admire Randy packing all those and lots more goodies into one blog. Read it if you are thinking about integration.

The lesson from these three observations is that we must ask ourselves whether we are talking in a particular context about M&A or something else. If not then we must articulate quickly and together what we do mean by integration, as the default position is likely to be organisational change and we all know what that entails.

Meanwhile, there are pitfalls and prizes, that while they may not be researched well in social care and health in the UK – are familiar in other sectors and countries, and we can profit by paying attention to them.

Monday, 11 November 2013

Pause for a social care blog

Vic Citarella writes a non-blog

Making a commitment to writing a regular blog is an onerous and self-inflicted duty. There is so much to write about and so little time. Crafting rough ideas gets put off and blogs remain unwritten. Various prompts in Evernote, Google Tasks, and actual note books mount up. Every so often (today) these demand consolidation into one entity – an inventory of blog topics. It serves to postpone the real blog and replace it with the new task of making sense of the list.

Cataloguing the blogs-to-do is a discipline shared here and now:

• First making the abnormal normal – is this something about the engineering aspect of social work (can’t remember)
• Next the revolving doors of interim management – definitely a blog in that note
• Then one about Frontline for Adults – a possible blog that asks if a new cohort of social workers can be ready in time for the Care Bill when it becomes an Act? (There is more than one blog here. Possibilities include ones about speed and exclusivity but probably best left to others)
• Observed practice –  a blog querying what this might actually entail in residential care. (This is something that needs writing)
• On the list is the Ageing Workforce – there because people have been harping on about it forever. It was ever thus and perhaps not the prophet of doom portrayed is the potential thrust
• Blog about the Archive – no recollection what this might have been about
• Assessing for Practice – that somebody was doing this well warranted inclusion
• An old favourite is Call a Social Worker, a Social Worker – strike from the list as probably already written (check the archive – ah ha the archive)
• Learning Labs – a blog about using IT in social work. (Food for thought?)
• Micro-researchers – no idea how this got on the list (a visual blog?)
• The last one is itemised as Coventry has Form. The note to self (or social care) reminds not to be complacent, nor frozen and of the vitality of celebration. Places are characterised by the lasting effects of events - there are enduring implications for the workforce. (As the social care workforce is a favoured topic maybe this is the one that should be written?).

But not just now as there is work to do.

Tuesday, 22 October 2013

Self neglect – Jackie Hodgkinson asks: when does a social worker say enough is enough?

Self neglect is a term that social workers are very familiar with. It often causes concern for both professionals and concerned neighbours and family. I can recall, within my social work career, many individuals who chose to live at home, in a condition that was considered by professionals as unacceptable. Was this their informed choice and was it in the best interests of the individuals? This depends on who you ask?

What is unacceptable? And who are we as a wider society to define how someone should or should not live, often those individuals had been what were considered as “eccentric” or “a bit different”. Using the definition of mental capacity as defined within the Mental Capacity Act 2005 would deem these individuals to have capacity to make what we may consider as unwise decision. Within society we make judgements based on how vulnerable we perceive a person to be.

Champagne lifestyle

If a young executive chose to spend their salary on a champagne lifestyle and then could not pay the bills at the end of the month would anyone pass judgement on this choice? If that person was a 79 year old man with motor neurone disease who enjoyed betting on horses and sometimes didn’t leave enough money for 3 meals a day, home care providers would instantly contact social workers with a safeguarding alert or his neighbours would be stating that he should be in a home! And asking how can we let someone live in this way.

The public expect that the adult social care department should protect all from harm and danger, regardless of the capacity of the individuals to choose how they live. Social work teams receive many phone calls from families or friends stating “it is a disgrace how you let people neglect themselves you should do something to stop it”. This implies we have the power to impose services and support on any unwilling recipient. A greater awareness of our statutory duties and the limitations of these perceived all-embracing powers is required to educate the wider public regarding when we need to intervene.

There needs to be more publicity on positive risk-taking, where social workers actively promote the human rights of the disadvantaged. We often see the potential in individual’s strengths or protective factors within them or their lives, where others see only problems.

Risk averse

In these risk-averse times, it is important to hold onto the concept of choice and respect for decision making. In my opinion as a social worker, it’s intrinsic to what social work should be about and is core to social work values. This requires a recognition at all levels of management and within wider society.

The Department of Health official definition of self neglect is the inability to understand the consequences of that failure. That definition of self-neglect excludes the individual who makes conscious and voluntary choices not to provide for him or herself. The person who denies themselves certain (accepted) basic needs as a matter of personal preference and who understands the results of that decision is ruled out.

Self-neglect implies a lack of wilful intent. Self-neglect is an act of omission. There is no perpetrator. Unlike perpetrator related abuse and neglect, self-neglect is not treated as a wrong-doing or a potential criminal act. Capacity is a highly significant factor in both understanding and intervening in situations of self-neglect. Decision-making autonomy by those who have capacity is widely recognised and respected. There is strong professional commitment to autonomy in decision making and to the importance of supporting the individual’s right to choose their own way of life, although other value positions, such as the promotion of dignity, or a duty of care, are sometimes also advanced as a rationale.

Research into self neglect

SCIE Report 46: Self-neglect and adult safeguarding: findings from research, examines the concept of self-neglect. The relationship between self-neglect and safeguarding in the UK is a difficult one, partly because the current definition of abuse specifies harmful actions by someone other than the individual at risk.

The perceptions of people who neglect themselves have not been extensively researched, but where they have, emerging themes are pride in self-sufficiency, connectedness to place and possessions and behaviour that attempts to preserve continuity of identity and control. Traumatic histories and life-changing effects are also present in individuals’ own accounts of their situation

What can we social workers take from research? Evidence demonstrates that self neglect is reported mainly as occurring in older people, although it is also associated with mental ill health in both older and younger individuals. Social workers when assessing levels of risk need to take into consideration both the inability to care for oneself as opposed to the unwillingness to self care. The other key determinant is the individual’s capacity to make the decision and understand the consequences of this action. The social work response will vary, dependent on these key risk determinants. Professionals will have a tolerance to someone who chooses to self neglect as a life style choice, perhaps that is how they have always lived. I once assessed an older person who chose to eat out of date food to save money even though they had £500.00 in the bank. Professionals, understandably, have a greater level of concern regarding those individuals who have made life style choices but due to onset of mental impairment struggle to understand the consequence of those actions.

Comprehensive risk assessments are core to all interventions. A balanced approach is required to ensure we are not foenough is enough.

cused simply on keeping people safe at all costs; all risk assessments should be person-centred, taking into consideration previous lifestyle choices. They should promote independence, choice and autonomy. They should also be reviewed regularly. Care plans should be lifestyle sustaining. Potential harm has to be balanced with potential benefit. Working in a multi disciplinary team, virtual or otherwise, enables us to gather evidence to make those decisions about when statutory intervention is required. We should check things through a mental capacity lens frequently. The profession needs to engage with the public about people’s rights, the wider duty of care and when

Jackie Hodgkinson is an independent social work practitioner and trainer

Sunday, 22 September 2013

Mentoring – a personal support to Registered Managers

Richard Banks (CPEA Associate) reflects on developments from the Skills Academy

Tuesday 17th September a meeting called by the National Skills Academy for Social Care to think through how mentoring might be part of how Registered managers are supported. Mentoring has been a successful part of number of leadership programmes and in particular schemes for black and ethnic minority managers.

It was helpful to check the differences between a number of related methods of supporting managers such as supervision, coaching and counselling. Throughout the meeting we returned to the sad reality that many Registered Managers get little or no proper support and that any fine differences between methods such as mentoring and coaching would be difficult for them to get concerned about.

Not magical

However there is no doubt that Registered Managers, who often report a sense of isolation and difficulty in gaining perspective on their life, would find mentoring helpful. Mentoring may be described as where a person can ‘take part in a voluntary mutually beneficial and purposeful relationship in which an individual gives time to support another to enable them to make changes in their life or work’ (Mentoring and Befriending Foundation). As with other proposed improvements we will need to incorporate it into whole system thinking. Certainly we will need to avoid that tendency, too often held in social care, which introduces a single improving component as offering magical solutions to the wide and complex needs of our sector.

That whole system question remains how we act to establish the entire social care workforce including Registered Managers as respected professionals that are properly remunerated. It was rather disappointing that the recent Cavendish Report on the health and social care work force did not extend its remit and recommend action on registration. Professional registration alone would not create the needed improvements for the social care workforce but it would be an important component of that change. As is being found in Wales, Scotland and Northern Ireland where registration is being planned for and being introduced. An important part of registration is the use of a code of conduct that covers both the individual staff member and the expectation on employers to provide supervision and management support. Cavendish did make a recommendation on this; saying the ‘Department of Health must review the progress of the social care compact: and substitute a formal code of conduct for employers if a majority have not acted upon it by June 2014’. Progress is being made here, lead by Skills for Care, with

Personal compatibility

The Skills Academy will progress thinking about the use of mentoring and I hope the sector will assist in supporting that work. It particular helping to prevent the potential of mentoring being constrained or over burdened by setting training requirements, endless consideration about who might be allowed to do it and unnecessary bureaucracy. There was debate at the meeting on how far a mentor from outside of the sector could assist a Registered Manager. Given the need for social care to engage with the general public I would urge that opportunities to look outside the sector ought to be actively considered. The over riding issue should be the compatibility of the two people and the capacity to bring new ideas and different perspectives. One way to think about this would be to apply the ideas of personalisation. All the reasons why personalisation is a good thing for those people we support apply in similar ways to mentoring. Registered Managers can identify just what sort of support they want, when is the right time and the sort of person they could trust with their hopes and fears.

Monday, 12 August 2013

CQC – A New Start

Janet Pearson, CPEA Director attends a consultation meeting: CQC – A new start

CQC has been re-invented, with the aim of being a strong independent regulator on the side of the people who use services. It’s moving away from the previous pass/fail approach to one of helping services to improve, ensuring that they are safe, effective, caring, responsive to people’s needs and well led. Sir Mike Richards is Chief Inspector for hospitals and Andrea Sutcliffe was appointed for social care recently, while a third Chief Inspector for general practice will also be appointed.

CQC has been consulting on how it inspects the NHS and independent acute hospitals and as a result anticipates new legal powers to award ratings for hospitals and re-introduce them for social care. The reformed regulator’s new approach to regulation will therefore be based on:

• Registration – a more rigorous test with named accountable leaders

• Surveillance – continuous monitoring to identify failures and risk of failure using local and national information sources and qualitative information from people(hopefully including Healthwatch)

• Expert inspection teams, with longer inspections for hospitals possibly spending 5 days on site rather than the current 1 day format and more time talking to people

• Simple clear standards based on three levels - the fundamentals of care, expected standards and high quality care

• Ratings to help people choose between services - outstanding, good, requires improvement and inadequate

In terms of the new legislation, the new regulations become law in April 2014 and changes to inspections for adult social care, mental health and learning disability services, including ratings will commence in 2014 – 2015 (and 2015 – 2016 for community health care and ambulance trusts). Inspections of acute hospitals are commencing ahead of the legislation and 10 trusts have already been identified for early inspections.

The model of three levels of care will apply to all services though specific expected standards will be drawn up for different service areas when the Chief Inspectors are in post. At this stage CQC are consulting on the suggested Fundamentals of care - based on the Francis Review of Mid Staffs NHS Trust:

1. I will be cared for in a clean environment

2. I will be protected from abuse and discrimination

3. I will be protected from harm during my care and treatment

4. I will be given pain relief or other prescribed medication when I need it

5. When I am discharged my ongoing care will have been organised properly first

6. I will be helped to use the toilet and to wash when I need it

7. I will be given enough food and drink and helped to eat and drink if I need it

8. If I complain about my care, I will be listened to and not victimised as a result

9. I will not be held against my will, coerced or denied care and treatment without my consent or the proper legal authority.

The fundamentals read as a ‘bill of human rights,’ however missing in many people’s eyes is the key point of person centred approaches, of people being treated with dignity and respect and working in partnership with professionals to co-determine treatment and support plans.

At the consultation strong views were expressed about obvious omissions of user and carer involvement and that the focus of questions was not right. The audience was not confident that CQC is really listening. CQC was however interested in opinions regarding the length and frequency of hospital inspections and whether these should be announced or unannounced.

The new ratings will be based upon standards found at inspections.

The three levels are represented in the diagram below.

More details on the consultation can be found in the CQC report – A new start.

Monday, 1 July 2013

Past my sell by date

Guest blog from Penny Moon, Chief Executive of

Opportunities to become an ambitious international business woman are tumbling about my head. Unfortunately they exist now not only in a world ruled by a language that escapes me but represent a new experience I am reluctant to undertake. I had been looking forward to finally achieving my adolescence, a time of irresponsibility, kicking over the traces and throwing caution to the winds. Sex, drugs and rock and roll seem to have passed me by in the 60’s and now in my 60’s I was hoping to steal a moment, only a moment please, but I suspect it is not to be.

More to the point I have no interest in learning this language of computers, twitter, facebook, who is that interested in me quite frankly? I would much prefer to learn Italian with its gentle rolling expressive notes

‘Mama Mia, Spaghetti Bolognese, arrivederci…’ the Lord knows I am nearly there already and what is more I got my Latin ‘O’ level and can still quote from The Iliad ‘Pyrrhus rushed in with all the vigour of his father; neither the guards nor the gates themselves could withstand him…’ After all is said and done I am a language teacher, yes French actually believe it or not, ‘bonjour, ca va’ the accent rolls of my tongue, the superficial fluency screamed at my knees by my small and bitter teacher, whilst the vocabulary has disappeared into some cosmic cloud no doubt where all communication dissolves now into one big wordless grin.

This is what I would like to think anyway. It is amongst my many theories that are patently untrue like if I go out in the rain, will I shrink?

On the other hand - truth be told - I am enjoying LinkedIn and meeting other professionals, discussing therapy, yoga, philosophy. Not many people have an interest in these matters and we can ‘therapeutically’ nerd away at the use of metaphors, the history of Mindfulness and meaning of Chi.

What you might ask has this to do with social media, the language of communication in this day and age, useful and not useful all at once, can get you into trouble with the lack of subtle nuances, the softening of a phrase with a twinkling eye…yes all that non verbal communication...80% is unavailable in the short hand of tweets and texts which can whip up emotions in a moment, promise the earth with its set phrases and shorthand leaving the door agape for horrifying possibilities of misunderstanding.

My extraordinary variety of accounts in all these areas, doubled or trebled accidentally with an endless array of passwords makes me sob into my computer.

And don’t get me started on my phone. It took me a year to stop calling it a blueberry. Only realised as younger folks looked politely away to avoid my ignorance, ‘done it again Pen...shape up now’ is my ancient chant to myself. The phone at present, which I can finally receive emails on, has taken to calling people (and no, not just my last call before you raise your eyebrows) without me asking (no that is a metaphor, never managed the voice thing) switching itself on and off, sometimes into SOS during conversations and it is probably right.

I look forward to running a retreat, teaching yoga and meditation, wandering on lonely (yes lonely) beaches with the wind whipping my hair and cackling now and again. Yet I suspect the next social media course will drip into my brain and I will be a whizzerooni soon (anyone up for a bet on that?). Sooper International business woman here I come and off to John Lewis for a pin stripe suit, better get out in the rain again as they probably don’t make them my size!

Sunday, 23 June 2013

Health+Care Exhibits Integration

Last week I and a number of CPEA Ltd colleagues went to big Health+Care event at the Excel Centre. Seminars, exhibitors and networking from right across both the health and social care worlds. The emphasis was on integration and commissioning but there was something for everybody – safeguarding, home care, residential, meals, telecare – you name it.

A couple of things struck me along the way:

First the exhibition was a microcosm of the true market place out there for customers – the health services of all types well displayed and social care providers more reticent. People need to see and hear about the choices available. They need to understand how they interact and how one option can prevent the need for another. People need the space to test and taste what is offer before they make decisions. Critically they need to be engaged in the value and emotion of services and not just the cold facts of how they work. This is how we can all make best use of our money both individually and as communities.

Second Health+Care demonstrated complexity and gave some indication of the type of approach that can be used simplify things for customers. Provision across health and social care is characterised by its plurality. The economy is a mixed one and likely to get more so. However fragmentation is not inevitably a bad thing if opportunities are made and taken to collaborate. Some of the networking witnessed and partaken in at the exhibition will serve me well. I noted how thoroughly this aspect of the event was enabled by layout, timing, presentation and a number of navigation formats. Again there is a lesson here in how our real health and social care markets can develop and learn from commerce.

So a welcome addition to our calendar at CPEA Ltd. There are reasons for optimism about the way forward for health and social care commissioners and providers if this type of message can be replicated locally and in the market place.

Monday, 20 May 2013

Social work goes into hospital

A couple of weeks back I was in and out of our local hospital on daily basis as my father was poorly. Learning to use the rear exit for easy access to the car park I noticed this sign which I snapped and tweeted, 'Hospital #socialwork - life in the NHS portakabin'.

Whilst not trending as such it created two separate flurries of activity – considerably more than my normal response rate

Was it because social workers are amusingly ‘way out’ or because their offices are actually frequently located in a portakabin in the car park? Both interpretations brought about knowing chuckles from tweeters across the land.

It did strike me though that if we are to secure the benefits of integrated health and social care (as intended in the Care Bill) then social workers should be:

• located at the heart of hospitals not outside in temporary office accommodation in the car park

• included in the governance of hospitals at practice management level to advocate for patients, argue the corner of the profession and make the case for resources

• have access to the excellent support facilities of a hospital – administration, equipment and training budgets

Over the years I have been involved with hospital social workers in several major hospitals and they were always led by a ‘Principal’ grade located on site. My guess is that is no longer the case. Perhaps it would not be too ‘way out’ to reconsider professional leadership of hospital social work as one feature of the integration agenda that will help realise some of the benefits for the users of hospitals.

Monday, 22 April 2013

‘Cavendish Review’ – does the NHS nut fit the social care bolt?

Richard Banks, senior associate at CPEA Ltd, considers the remit of the Cavendish review of health and social care settings and offers some personal notes and thoughts.

Jeremy Hunt, the Secretary of State for Health, has asked Camilla Cavendish, Associate Editor and columnist at the Sunday Times, to lead a review looking at both NHS and social settings. The review will consider:

• recruitment
• training and development
• leadership, management and supervision
• engagement and support
• public confidence and assurance

The remit of the review does cover care staff in social care as well as those described as Health Care Assistants – but as is often the way, the Department of Health managed to appear to add social care as bolt-on to an NHS project. There are, of course, some shared issues but some important differences in particular that most social care staff work in private, voluntary or direct employment settings and not in the NHS. There are also differences in how you might go about communicating with the 1.7 million people working in more than 49,700 different adult social care settings in England.
Care and support are about values

Issues about the social care workforce are closely linked to the overall policies toward the provision of support to people who have disabilities or needs related to being older. The Government in England have avoided tackling the fundamental funding and policy issues of the aging population or the growth in the numbers of people with disabilities. Despite occasional protestations to the contrary government clearly see the aging population as a burden not as evidence of a successful welfare system or as an exciting opportunity to reconfigure attitudes toward older people as an active part of society. Attitudes toward adults with disabilities have become distinctly nasty, as they have been caught up in the government’s attempts to smear anybody using benefits. When looking for failures in values in a service a start at the top of a hierarchy is a reasonable place to begin. The government has not taken any action that communicates its value of people who require social care support. The last few years have seen an increase in the confused and overlapping requirements and initiatives from government and government funded agencies for and about adult social care. It is clear that most of these are political activities designed to give the impression that something is being done while avoiding any real commitment. The effect is an increasing state of confusion and risk of individuals and organisations being driven into cynicism.

Really good social care is often almost invisible.

The purpose is to care and support a person to live their life as they choose. So a really skilled social care professional should not ‘stand out in front’ of the work they do. This particular social care attitude and related behaviour will be alien to our self-aggrandising politicians. Rather than bombard the social care workforce with ill-considered attempts to manage them from Whitehall might it not be better invest in them as professionals? Registration of social care staff would go some way to start that change. I hope the Cavendish review will examine the progress being made in other parts of the UK on this and use that experience to inform English policy. Not surprisingly given the poor conditions they work under, individual social care staff often appear to have low self-esteem. When asked about their work the response is generally prefaced with ‘Well I just...’ they then go on to describe a complex mix of psychological insight, knowledge, practical creativity and skill. This low self-esteem may well suit those who continue to underfund and apportion blame but it does nothing to sustain or learn from good creative care. The National Institute for Health and Care Excellence (NICE) and the Collaborating Centre for Social Care has hopefully been set up to do this. The centre needs to find a way to set its own agenda with the social care sector; rather than be pushed by short term Government directives. The big tasks will be to create a coherent set of messages about excellent practice and find ways to get that information to the sector. The test of effectiveness will be use by carers, social care staff and their organisation.

Does Cavendish remit avoid strategic questions about resources?

It would be unfair to view the Cavendish Review yet another attempt to divert attention away from the woeful failure of government to provide leadership and get some integrated policy across departments. However the remit does avoid strategic questions about workforce policy and resources. The questions asked by Cavendish are important but have been answered before (in the Sector Skills Agreement and related work from Skills for Care) what is required is concerted action to provide coherent government policy with intelligently managed resources to match. Hopefully that is where the recommendations of the review will focus.

Richard Banks April 2013

Contact: CPEA Ltd 07947 680 588

Friday, 22 February 2013

CPEA and The Corporate Neglect Report

CPEA’s Margaret Flynn and Vic Citarella have written a section for the 'Corporate Neglect Report', a briefing paper by Former Care Services Minister Rt Hon Paul Burstow exploring how corporate bodies could be held criminally responsible for abuse and neglect that takes place in hospitals and care homes. As the authors of the SCR into Winterbourne View Hospital, CPEA’s Margaret Flynn and Vic Citarella discuss their experiences; we include the section from the report below.

In early 2011 staff at Winterbourne View Hospital in South Gloucestershire were secretly filmed by a journalist for the BBC’s Panorama programme. They were caught mistreating and assaulting patients with learning disabilities and autism. These acts triggered public revulsion at the cruelties perpetrated at this hospital, and exposed the hospital’s poor management and external oversight structures.

Knowledge that the average weekly fee for care at Winterbourne View was £3500 prompted questions over the stewardship of public money. In 2010, the 24 bed hospital had an annual turnover of £3.7 million. Considering the lack of financial transparency and co-operation that we experienced when compiling the Adult Serious Case Review (ASCR) established in the wake of the scandal, it is still hard to determine how much of this revenue was actually used for the running of the hospital and how much was consumed by the hospital’s parent company Castlebeck Ltd.

So, why couldn’t an Adult Serious Case Review (ASCR) access this kind of information? The answer is threefold:

1) An ASCR is a non-statutory instrument commissioned by a local Safeguarding Adults Board and whilst there are advantages to its current model as, unlike children’s SCRs where template reviews have not resulted in the promised learning envisaged, and therefore they can maintain their 37 independence and ingenuity, co-operation with ASCR is a voluntary process, so neither individuals nor agencies can be compelled to contribute or to accept the recommendations.

2) Because of the non-statutory nature of ASCRs, where there is no compulsion to co-operate or provide evidence, Castlebeck’s circumscribed their more significant contributions under the guises of “commercial sensitivity and confidentiality”. This therefore limited the scope of our investigation.

3) It requires forensic accountancy skills of the variety summarised by Private Eye (1327, 16 November 2012) to make sense of Castlebeck’s operations, “The company that owns Winterbourne View…is itself part of a group called CB Care Ltd, which itself is owned, via Jersey, by Swiss-based private equity group Lydian, backed by a group of Irish billionaires.”

Winterbourne View’s ASCR expressed concern that Castlebeck appeared to have made decisions about profitability, over and above decisions about the effective and humane delivery of a service. Whilst former staff were tried and convicted, Castlebeck’s opaque organisational hierarchy has been spared the attentions of the criminal justice system. We argue, therefore, that perhaps there is a case for developing a “hierarchy of liability” to buttress the concept of “corporate neglect”. Had there been such a hierarchy, ex-patients’ families might have challenged the commissioning PCTs for failing to ensure patients’ health and wellbeing, and the commissioning PCTs might have challenged Castlebeck for such a bracing indictment of “assessment and treatment.”

Many commissioners placing adults in Winterbourne View Hospital used Castlebeck’s own contract. In the future this inattentive place-hunting has to be replaced by intelligence-led 38 commissioning which does not fund a service that declines to share information about how monies are spent on the basis of “commercial sensitivity.” Contracts with providers should specify, inter alia, that co-operation with any investigation concerning the safety and wellbeing of patients is a prerequisite.

One of the main recommendations from our review, which Castlebeck failed to ever respond to, is that corporations should be liable for the costs associated with the ASCR, which in this case were wholly borne by South Gloucestershire Council. Surely it is wrong that a local council paid for an ASCR into abuse in a private hospital owned by a corporate body making phenomenal operating profits largely funded by the tax payer?

The report, in full, is available to download here.

Monday, 18 February 2013

Black Minority Ethnic (BME) issues in social care

The organisation I am founder director of, CPEA, has partnered with Savera, a specialist service which aims to offer consultancy and training on Black Minority Ethnic (BME) issues. Our assignments over the last dozen years have impressed on us time and again the importance of integrating black perspectives into all aspects of social care. It is only like this we can improve choices to the people, families, children, young people and communities we serve. Self evidently cultural awareness is integral to our offer on leadership and workforce development and in the nature of how we design, deliver and review services. We are pleased to be working to support Savera build their customer base and thought you might want to hear more...

This service has been set up by two BME workers, Imtiaz Khan and Kishwar Haque, who have extensive experience of working as social work practitioners (over 46 years between them). These specialists, if required, will work alongside other professionals to integrate black perspectives in the field of training and consultancy in relation to issues relating to BME children and families. The service will focus on Adoption and Fostering but can also offer consultancy on any BME issues that are required by statutory, voluntary or independent agencies.

Find out more here.