‘Shocking’, ‘distressing’, ‘criminal’, ‘angry’, ‘disgusting’, ‘bullies’ – words and emotions that we’re sure will have crossed your minds and been experienced as you watched Panorama Undercover, broadcast last night (22nd May 2019).
8 years on from the Winterbourne View scandal, regretfully, concerningly and alarmingly, we again see the most vulnerable individuals in our society being abused by those who are there to provide support and care. As the programme suggested – questions must be asked of the Government – has it breached its promise to reform care for the most vulnerable?
It is our view that one of the fundamental lessons following Winterbourne, was to understand and by implication address the processes which lead to the development of corrupted cultures and abusive practices in care settings. Last nights programme would suggest that this lesson has not been learned.
Following Winterbourne View, the government set out policy documents advocating for approaches based on Positive Behaviour Support (PBS). Whilst there is a substantive body of research which suggests approaches underpinned by PBS can work, there is also a significant body of evidence of attempts at implementing PBS failing across sectors.
PBS is often presented as an approach which can be implemented by staff who have attended short duration courses, where the training is delivered as a script by trainers who themselves undertook scripted training. Training is not informed by a detailed organisational Training Needs Analysis and there is a significant lack of post training course support/mentorship.
This ‘reductionist’ approach to difficult behaviours fails to take into account the powerful external influences on service user and staff behaviour e.g. a lack of awareness of trauma, attachment and the impact of service cultures.
Services to individuals with complex issues continue to be provided by staff who are not valued, poorly trained, poorly supported, inadequately managed and led, and often overworked due to staff shortages and the casualisation of the workforce. Little attention is paid to how staff think and feel and how this is often a significant determinant of how they will respond to the behaviour of the individuals they support. Concentration in training is on staff skills and not the influence of the culture and practices of the service in which they work.
The Serious Case Review (SCR) following Winterbourne View identified serious management failings which:
‘allowed a closed and punitive culture to develop on the top floor of the hospital.’ (DH 2012).
It is likely that should a SCR be undertaken following last nights programme – this issue will again form one of the outcomes.
What we need to prevent future events such as those presented by Panorama Undercover are intelligent compassionate integrated approaches that help staff understand and deal with their own emotional challenges and to see the behaviours presented by the individuals they support as a presentation of the persons distress.
This is not just about training staff, its about providing ongoing supervision and support, accountability, management oversight and an effective inspection regime. Unless and until such approaches are embedded in services, then the risk of poor practice becomes a tragic reality for the many vulnerable people supported in services across the UK.