On Wednesday 22nd of May 2019, the BBC aired a Panorama undercover investigation into the abuse at a learning disability secure hospital, Whorlton Hall.
Reporter Olivia Davies went undercover as a healthcare worker following unresolved reports of abusive care. What she uncovered was some of the worst psychological torture and physical abuse recorded since the Winterbourne View scandal 8 years ago.
Olivia witnessed the total and systemic abuse of vulnerable adults including intentional bullying and acts of physical violence.
The staff at Whorlton Hall found ways to distress their patients and actively used them to gain emotional responses they could use to further cause physical and psychological harm.
Examples of this appalling behaviour included using a balloon to antagonise a female patient by ‘snapping’ it in front of her, knowing she had a fear of balloons. It was also known that the patient has a long fear of men. When she became upset, the team would send male staff to her room, often inside her room, or observing from outside, directing the female staff away, purely to cause her emotional distress.
They also developed this abusive practice by implementing a threat mechanism. Dubbed the ‘Man Button’ staff would say they are pressing the man button to call for male reinforcements to manage her. The outcome of this only served to cause the patient more distress, leading to more challenging behaviour, ultimately resulting in more males attending, leaving her in an unbreakable cycle of torment the staff team had set up for her.
This illustrates how poor the staff’s ethos and approach to care and recovery was, and how little embedded any training on behaviour management was.
The staff team at Whorlton Hall appeared to lack any real, substantial training in understanding behaviour and the principals of management and reducing restrictive practice. Indeed if they did have the training, it was not of a suitable standard or quality to embed the core values of any behavioural approaches used within the service.
A few other examples I want to highlight in this post include how a healthcare worker was filmed trying to forcibly bully a patient into taking PRN medication, then refusing it when she didn’t agree with what the patient was saying. One of the most of disconcerting elements about this particular event (outside the abusive way the staff member was behaving) was the lack of Nurse oversight and supervision. After all, medications and it’s administration does, and must sit with the qualified staff, including the clinical judgement over when and how it should be offered.
This to me indicates how little understanding the staff had in terms of professional accountability, the role of registered nurses, and the importance of multi-disciplinary working, as well as little knowledge around medication itself and the laws surrounding its use.
Throughout the report, multiple staff are overheard discussing how they want to physically assault patients including ‘decking’ them. On camera, one staff member actually recounts an occasion where he ‘clotheslined’ a patient to knock them down. Another staff member recounts how he hit a patient several times. Off-camera, Olivia details how 6 staff member told her they had “Deliberately hurt’ patients.
Any training system in place at Whorlton Hall should have embedded a strong moral sense of accountability and understanding in the belief that physical violence and force should never be used to threaten, punish or intimidate service users.
One thing that really haunted me from this report was how, when faced with the installation of CCTV cameras on the ward, the staff actively talked about ways to beat the system to allow them to continue to abuse the patients.
This cold, callousness and vindictive nature of a staff team are both shocking to the core and heartbreaking. It reflects on not just the staff at Whorlton Hall, but on staff services throughout the country- of which many services carry out fantastic work, in difficult situations every day, and they do so in positive and supportive ways, helping their service users to recover and re-integrate back into the community.
During one restraint the staff are seen to tackle the patient to ground. The actions the staff took at this time, not only were completely unnecessary but also not trained taught techniques. In fact, in a meeting with the deputy manager, Olivia is told the taught techniques are no good, and to use whatever works when restraining, and then lie in official reports.
This attitude is wholly disturbing and illustrates a complete failure to manage challenging behaviour at every level. Advising staff to use non-taught techniques is extremely dangerous and puts everybody at risk, not just the service user being held, but also the staff involved. What’s more from a management level, we can see how the service did not recognise the importance of completing a regular training needs analysis. As we know, sometimes challenging behaviour can be more extreme than what the training caters for, and if this is the case, it is the responsibility of the service to adapt and change and improve the training, not advise improvising on the spot.
Outside of the obvious issues raised in the report, I would also like to take your attention to the wards general approach to restrictive practice and the ideologies that (I hope) had been put to bed years ago.
During one restraint of a male patient (which itself was an unnecessary restraint to start with), a healthcare worker implemented a plan to remove the patient’s belongings from his room. The nurse on the scene agreed and they decided to remove everything the patient owned.
I understand there are occasions when patients personal belongings may need to be removed from the patient for security and risk-related reasons. There is, however, never a reason to remove all of a person’s belongings, and in fact, to do so would be very anti-therapeutic; and may even be seen as a punishment. If we have to remove items from a patient only items that are actual risks relevant to that person should be removed at a time when they actually pose a risk of harm. In this case, the patient was not in his room, therefore nothing posed a risk, and the staff failed to identify what items and belongings would be a risk had he had access to them.
The number of occasions documented in the report where services users experienced abuse is too many to list here, and we urge everyone vested in safeguarding the care industry to watch the broadcast to see first hand what was witnessed to gain an understanding the total and complete failure of the staff, service provider and the CQC regulators.
I have, myself worked within a range of secure learning disability services, and worked with service users who have been subjected to acts of abuse from caregivers.
Having worked in such environments and now training them in the safer and therapeutic management of violence and aggression, I know that what was happening at Whorlton Hall is far from what we would expect from a service such as this.
I am unfamiliar with Maybo as a restraint model itself, preferring to teach under The GSA model which is the same model I was taught 14 years ago on my initial induction. The GSA model was used at the service after my leaving the organisation three and a half years ago.
Our training under the GSA model is based on a person-centric approach, looking at the root cause of the behaviour. By understanding the principals of primary preventative strategies and secondary reactive strategies to prevent challenging behaviour before it becomes necessary to restrain.
We extensively teach staff the importance of accurate reporting and recording of restraints and behaviour in general to promote the safer practice.
We teach the law and the rights of a person to defend themselves and use restrictive practice but we ensure staff use this knowledge responsibly and discuss the outcome of using force inappropriately.
When teaching restraint it is imperative the person being held is kept safe at all times. So we educate staff on the risks of restraint, both physically but also psychologically. This means staff carrying out restraint know how they may cause harm to those they restrain.
The airing of the latest hospital abuse scandal by BBC Panorama, as shocking as the content is, was important to end the abuse at Whorlton Hall. However, how do we safeguard against this happening again?
Better managers? Better staff selection? Better CQC inspection and auditing?
Yes to all of these questions, but that is clearly not going to be enough. I firmly believe that it all starts with better training. That’s why we deliver our training the way we do. Skills that work as safe as possible based on solid theory training around behaviour and a least restrictive approach backed by the industry leader in the prevention and management of violence and aggression, The GSA.
We know our training programmes will provide services with a better way to keep both staff and service users safe, and that’s we are extremely pleased to be working towards BILD Accreditation with the new training standards.
We are also extremely proud to be named the latest Endorsed Learning Provider by Norfolk and Suffolk Care Support.
Call 01508 218017 for more information.