The Culture of Culture Blame

            Many of the failings of Mid Staffordshire NHS trust were blamed on the culture within the service, similarly the abuse at Winterbourne View saw the culture word used to describe how and why abuse was allowed to happen. Blame on ‘culture’ is not limited to health and social care. The rail franchise fiasco last year was blamed on a culture of fear, and the banking crisis which sparked the current financial crisis is often blamed on the culture within those institutions.

            Yet does blaming the culture in an organisation really solve the issue and what does it really mean?

            The culture within an organisation is the result of the leadership, or lack of, and the way those in the organisation react to that leadership. What ensues is a group mentality that becomes self-perpetuating and, if it goes unchecked, something that descends to the lowest possible denominator and is often directed by dominance rather than leadership. Once embroiled within the group mentality it is far easier for members to dismiss personal responsibility and place all responsibility on the culture within the organisation.

            It also makes it harder to challenge the group mentality. People fear being ostracised by colleagues, fear they may lose their job or, in extreme circumstances, fear particularly dominant individuals. Those who believe that something is wrong but fear to speak up eventually feel they have become complicate in the wrong doing, “I will be blamed because I did not speak up earlier”. Others will just ignore what they believe is wrong and reconcile it in their own minds by saying to themselves “that is just the way it is done here”.

            The real blame is not on the culture of the organisation but on the leadership of the organisation and the lack of responsibility and accountability throughout the organisation. People in such cultures prefer to pass the buck about failings, blaming others or the policy framework they have to work in or, indeed, the culture of the organisation rather than being prepared to stand up and say I got this wrong. Those who set the tone for the organisational culture, including those in Westminster, must start to take responsibility for the organisations under their control, they must encourage accountability and they must ensure the culture of responsibility and accountability reaches right down through the organisation.

            In social care we must be aware of and ward against the possibility of a lack of responsibility and accountability and promote effective leadership.

            For example, multi-disciplinary working is common place now but we often hear of ineffectiveness because of people working ‘in silos’ (a jargon term I don’t really like) and the danger is everyone trying to work together defers leadership and responsibility to other agencies with the result nothing gets achieved and the only person to lose out is the person who needs joined up services.

            Effective leadership, responsibility and accountability are the best ways to promote good practice and if we are to provide the best possible care services they are the things that need to be at the top of the Health & Social Care agenda.

Winterbourne View Report: Smoke & Mirrors?

Any action to improve the lives of those with learning disabilities has to be welcome and many of the proposals in the Governments Winterbourne View Final Report are good yet that does not mean the report should go unchallenged especially as there are some inconsistencies where it appears the Government may be trying to deflect responsibility introducing ideas that, actually, really already exist.

Norman Lamb and others have focused a lot on corporate responsibility. Norman Lamb said “This case has revealed weaknesses in the system’s ability to hold the leaders of care organisations to account. This is a gap in the care regulatory framework, and we intend to close it”.

In fact the Health and Social Act 2008 made care organisations accountable and open to prosecution if they fail to meet the regulations, and Castlebeck certainly failed on a number of them. The Care Quality Commission also has the power to cancel a providers registration. In addition there are also the legal requirements under the Health & Safety Act 1974, the HSE’s guidance states:

“Recent case law has confirmed that directors cannot avoid a charge of neglect under section 37 by arranging their organisation’s business so as to leave them ignorant of circumstances which would trigger their obligation to address health and safety breaches.
Those found guilty are liable for fines and, in some cases, imprisonment.”

As the abuse at Winterbourne View clearly breaches the Health & Safety requirement to keep everyone in the place of business safe, surely Castlebeck should have been prosecuted.

Rather than taking time to draft new legislation surely it would make more sense to ensure existing legislation is being used effectively.

We also need to take care over how the Government frames the action which it proposes to take, for example in its timetable for action we have:

From June 2012 – CQC will take enforcement action against providers who do not operate effective processes to ensure they have sufficient numbers of properly trained staff, &;

From April 2013 – CQC will assess whether providers are delivering care consistent with the statement of purpose made at the time of registration
Although welcome moves the real question, unanswered by the report, is why were these not already happening? Both are required by the Health & Social Care Act regulations and, as such, form part of the requirements of registration. Yes there has been a change of leadership at the CQC and things have improved but it does not mean that such things should be omitted from the report nor does it excuse the absence of any action to ensure such things do not happen again.

The report also fails to answer the question of Government inaction on social care, particularly in terms of those with Learning Disabilities where the principles of Valuing People seemed to have faded in to dim memory. Much of what is being proposed should already have been in place and it is the Governments neglect of social care that means they are now only acting because they are forced to.

There is also a serious omission from the report that is equally important to the Winterbourne View case and that is Whistleblowing. Action could have been taken much sooner if the reports to Castlebeck and CQC were acted upon and some of the abuse witnessed in the Panorama film would not have happened. Yet nowhere in the list of action to be taken is a review of existing Public Interest Disclosure law, the responsibilities of statutory bodies to act or even report when abuse is alleged.

For all the effort to prevent abuse it is still down to people reporting it before it can be truly uncovered, I doubt very much if regulatory bodies have uncovered abuse through annual inspections, and therefore there has to be much more done in the way of encouraging people to disclose abuse along with a much more robust response when such reports are made that reports all allegations not just those that make it to safeguarding referral stage.

It would be wrong throw out the baby with the bath water and there are some very positive proposals in the report. It is right to end the existence of these pseudo-hospitals and it is right to move all people with learning disabilities toward person centred support.

We need more action on learning disability services and not just for those who find themselves confined in so called hospitals. Abuse happens in other places to and we need equal action to eradicate hate crime in the community where life is not regulated by the CQC.

This report should just be a start, let's have a new white paper on how the Government and society will support those with Learning Disabilities to lead fuller and safer lives.

We shouldn't gag the BBC

Newsnight had two stories of child abuse, one they suppressed and one they failed to verify the facts. The result has been a total breakdown in the BBC news department with resignations aplenty and the entire news agenda dominated by the BBC.

Yet we must be careful.

Firstly the fallout at the BBC has obscured the very important issue of systematic and institutional abuse of young people in care, as well as the abuse by celebrities who held a position of trust. And, while the horrendous events reported by Newsnight are described as ‘historic’, the fact remains that abuse can scar people for life, impacting on their lifelong mental health, ability to form relationships etc.

There are still unanswered questions about the events at the homes in North Wales but these questions have been eclipsed by the frenzied call for heads at the BBC. The real story revolves around the original investigation in the early 1990’s yet, it seems, the truth will be buried beneath the bodies of those falling on their swords at the BBC.

In the second instance we need to be careful about this fevered attack on BBC News. After all, what percentage of news output at the BBC do these two Newsnight programmes amount to? Probably very little and we must not frighten BBC News into ‘playing safe’ with such stories in the future.

Without BBC reporting the Winterbourne View abuse could still be going on, elderly people could still be abused in certain care homes etc. Although these were Panorama investigations they still come under the BBC News banner.

We have more to commend BBC News for than we have to dismiss it with the fervour shown by many in high places and we need it to continue to investigate the wrong doings in society and expose abuse wherever it happens. The danger is BBC News producers will become too afraid of the ramifications of being too controversial and facing the wrath of those who disagree.

Newsnight cocked-up yet, if you read the circumstances, they were GIVEN the high profile name, further reading tells us that the victim in question was told that name twenty odd years ago. Reporters should have gone further in verifying the name and that is the only failure causing the BBC frenzy while the real story goes unreported and, possibly, uninvestigated.

The majority of the BBC News output is good, their exposure of injustices must continue and we must not allow this current mistake to stop this.