Winterbourne View – Where were the Deprivation of Liberty Safeguards?

One of the many things that have been concerning me since the Panorama programme about abuse within the Winterbourne View hospital for adults with learning disabilities was aired was the way that the safeguards implemented under the Mental Capacity Act were, or weren’t used.

Bearing in mind that a number of the patients/residents would have been formally detained under the Mental Health Act, that still leaves some that surely should/would/might have been subject to the Deprivation of Liberty Safeguards.

Law books 2

Eric E Johnson @ Flickr

On The Small Places, Lucy, in a fantastic post that breaks down a lot of the issues, writes on this matter stating

Undoubtedly everyone on that ward was deprived of their liberty, but were they detained under the provisions of the Mental Health Act, the Mental Capacity Act Deprivation of Liberty Safeguards, or just unlawfully detained?  It’s not a question that’s taken up, but from a legal perspective it’s very important.  If they were unlawfully detained, police should look at charges of false imprisonment on top of other charges relating to assaults and neglect.  If they were detained under the DoLS, who wrote the assessment that detention was in their best interests?  Did they place conditions upon the detention, and ensure they were upheld?  Was this assessment lawful, or should families be looking at issuing proceedings for unlawful detention against those who commissioned the care?

We don’t have answers to this question and I’m going to wander into the realms of supposition and guesswork with little apology, after all, I am no journalist.

I am going to presume that there was a poor use of the Deprivation of Liberty Safeguards – and I make this assumption based on the following grounds.

Firstly, there is a very poor understanding and implementation of Deprivation of Liberty Safeguards (DoLs).  I am a  practising Best Interests Assessor and a a social worker in a team that is primarily responsible for older adult. I go to a lot of residential and nursing homes. I go to a lot of hospitals. I observe and sometimes I assess. I have seen poor implementation and understanding in my own experience and can’t even begin to count the errors in the knowledge of the basic  tenets of the DoLs procedure that managing authorities (residential homes, nursing homes and hospitals) have. It’s a job to explain to colleagues as well.

This isn’t necessarily through lack of training, although sometimes it is merely about the speed of turnover – the staff that were trained are no longer in situ,  but it is also about a way that the safeguards are perceived. It’s also because all the training was done prior to the safeguards ‘going live’ to ensure the procedures were in place  but there have been changes through case law and through practice so professionals are lagging behind on the legal procedural knowledge and with training budgets cut, it can led to dangerous and unlawful practice.

Managing authorities are generally  (not exclusively) reluctant to trigger them because somehow they see it as bringing more attention to the ways the organisation operates or they see it as some kind of criticism for the way that they manage care. It may be or it may not be. If there is a deprivation of liberty there needs to be a legal framework in which it operates.

I’d venture to say that everyone at every level in every residential care facility needs to have an understanding and knowledge of the law and the way it relates to people who lack capacity to make certain decisions. I wonder what understanding those who assaulted patients in Winterbourne had of the law.

Any number of times  I have been told that a managing authority will request an authorisation after a review or when the social worker tells them to which, in itself, shows a misunderstanding of the legislation which requires immediate action and requests for assessments as soon as (or actually prior to) a deprivation of liberty takes place.

With the issue of the Deprivation of Liberty Safeguards and the Mental Capacity Act more generally come the role of advocates. Independent Mental Capacity Advocates have a statutory role within the Mental Capacity Act just as Independent Mental Health Advocates have a role under the Mental Health Act. Were there any advocates involved with the patients at Winterbourne? If so were they given the access which is allowed legally?

I genuinely believe that alongside criticism of the CQC which I will probably save for another post, it’s worth looking at the role of advocates and the potential that they could have to prevent abuse and to protect people who are vulnerable to abuse. I wonder if there should be a more robust system of advocacy in place (hint – yes, I think there should) to monitor placements from the basis of each resident. Cost? Why, yes, it would. And therein lies the rub but in any discussion of improvement, I think the role of an independent advocate looms large.

So why didn’t the Deprivation of Liberty Safeguards, safeguard the patients at Winterbourne View?

My own supposition is because they were completely ignored and not used.

What might a Best Interests Assessor have discovered that a CQC inspector couldn’t? Well, each resident affected would have had to be interviewed, as would staff members and family members. Deceptive staff members and frightened residents would still have been respectively deceptive and frightened but additional questioning and listening could have potentially led to a breakthrough. There would have been an examination of care plans and methods (although as we discussed in the office last week – any home can present a beautifully person centred care plan on paper – it’s a matter of implementation) and there would have potentially been a route in for more ‘relevant persons’ representatives’ to visit and ensure the well-being of the person being ‘deprived of their liberty’.

In a sense, I do wonder how many other ‘Winterbourne Views’ there are out there. I think while the culture of the organisations and the role of power needs to be examined, there also has to be an understanding of the law as it stands and whether safeguards were used  – if they were, why didn’t they safeguard? and if they weren’t (which is my suspicion) why weren’t they? Surely that is for the management (and the government agencies which monitor the legislation) to answer.

Databases

I am currently out of the office on ‘training’. I am learning all about a new wonderful database system which will supersede those we are currently using.

Again. Oh, but this one is better, this one will reduce the amount of hours spent on it. This one will finally be a means to share information more wholly, effectively and will finally do away with paper filing. Except it won’t. Because we still need to print out and file everything on paper anyway. And, as I commented to the person sitting next to me, we’ll be back in a couple of years, learning about the next system.

I am a little cynical perhaps, but we are inundated with new systems and have been consistently. I am not afraid of these computer systems like some of my colleagues, I can even see the benefits but they change at such a rate that some people try to ignore their existence and for as long as the central and local government doesn’t consider the importance of the health and social care systems actually linking up then any work done will of course, have to be produced in triplicate on a health system, a social care system and a paper file system.

image izzymunchted at Flickr

This system is an NHS system. It seems pretty straightforward and intuitive and although not wanting to be cocky, I can’t understand wholly why I needed two days out of the office to learn about it. I can see the benefits of having a nice new sparkly system that talks to other systems and this time… in colour!

My grumpiness wasn’t eased  yesterday went the trainer told me (!) I was the first social worker she had trained that hadn’t ‘given her problems’?!

I told her half-jokingly that I could give her problems if she wanted me to but she didn’t get the joke and snarled me down until I reverted to gazing out of the window while others were being taken through the relatively basic instructions on how to open and close new windows again and again. And explanations that if you press the big red button that says ‘delete’ then it will be more difficult to get your work back on the screen…

No doubt I have another exhilarating day ahead of me..

Fast-track Social Work

Ed Balls

Image via Wikipedia

Yesterday, Ed Balls announced a plan to fast-track other ‘professionals’ like lawyers, teachers and police officers into social work on a one year ‘scheme’.

He says that this scheme – which will attract a £15,000 payment to those who take up the offer – would appeal to those who might be put off by a three year degree.

I wonder how much he knows about social work itself though outside his departmental bubble. Ten years ago, I took a two year postgraduate Masters course – the kind of which exist currently – and alongside me on my course were former teachers, police officers and even (believe it or not!) a clinical psychologist. Sure, we didn’t get £15,000 but we did two placements alongside the academic training.

I wonder how it will be compressed into one year. My understanding is that it will be ‘on the job’ type training. Perhaps he hasn’t learnt from the difficulties universities are having at the moment in finding placements.

Maybe I’m just too cynical but I have to wonder if Balls is even aware of the post-graduate route to train as a social worker. He seems completely oblivious to its existence – from his comments that social workers should be trained to post-graduate level (a good proportion already are, Balls!) to his comments that some professionals wouldn’t want to leave work to take a three year unpaid degree (the Masters attracts more funding and it’s only two years so no lawyer/teacher etc would be taking the three year route anyway!).

For all that, I don’t want to be too cynical. It isn’t Ed’s fault he is so ignorant but the idea behind it – namely to encourage people to seek a second career in social work – isn’t a bad one. I am just confused as to how the necessary skills can be compressed into one year – after all, as practitioners, they will still need the same knowledge and experience.

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A Course

Last week I went on a training course. As an AMHP I am obliged to complete 3 (I think!) training days every year which specifically relate to my role as an Approved Mental Health Professional in order to maintain my warrant.

So it was that last week there was a legal update course. I can’t say I was thrilled by the prospect. Generally, I don’t mind training. It’s a day out of the office and a chance to exercise different parts of the brain. I knew the course wouldn’t be oversubscribed as the levels of emails reminding us to sign up increased as the week progressed! So it was a nice, cosy group!

As it was, and in fact, if I’m brutally honest, as it usually is – it was more engaging than I was expecting. It was a pure and simple (if it ever is!) legal update with no more specific narrow focus so we applied more recent case law and some points of confusion between the old legislation and the new legislation (as the Mental Health Act was amended last autumn) to some practical case studies and examples of our own practice.

image limaoscarjuliet @ flickr

Two points of interest really from the training. Firstly, it was the first time I have ever, I think, in about ten years, attended a training course for social workers (yes, I know AMHPs don’t HAVE to be social workers but we all were on this occasion!) where there were more men than women present!

It was rather novel actually and although it made absolutely no different whatsoever to the course, the training or the dynamics – it was just a point of interest – for me anyway – because these are the kinds of things that occupy my mind when I should be thinking of recent case law!

The other part was that with the exception of one person, all the other attendees were from Emergency Duty Teams. So it was actually lovely to meet the ‘names on the report sheets’ finally. We don’t have much opportunity to meet those who work between 5pm and 9am and at weekends and holidays so it was great not only to put faces to names but also to engage in a wider discussion about the role of the generic social worker – as all the EDT workers have to have substantial experience both of Children and Families work and specifically of Mental Health work (as they are involved in those difficult through-the-night emergency decisions that all too often involve Mental Health Act Assessments and Emergency Child Protection work).

Apart from that the training was very well delivered and I shouldn’t really underestimate it! It reminded me how important it is to germinate ideas and case studies between us as otherwise it is very easy to grow a ‘team’ mentality and a way of working that isn’t always helpful all round.

Golden Hello

The Local Government Association stated yesterday that the public castigation of social workers in the UK through a variety of media outlets has had an impact on the recruitment of staff. This isn’t any great surprise after all, I’ve had to justify my choice of profession to random people I meet in a social context more than ever over the past few months.

I won’t be embarrassed by it although it seems that’s pretty much the way the government is happy for it to go judging by their pandering to the tabloids.

image *Micky at Flickr

So it was interesting to note that the government also announced a plan to offer graduates places on a ‘National Management Trainee Scheme’ along with payments of £20 000 to trainees who enrol on the programme run by the ‘National Skills Academy’ (oh, that makes it really clear).

That, along with the lately announced CareFirst scheme to put 50,000 long term unemployed people into the social care workforce through training – which sounds at least potentially positive.

It’s a bit confusing though- for me anyway. Phil Hope, the Care Services Minister says he wants to

lure experienced graduates, managers and leaders from the private sector into the social care sector

and he thinks a £20 000 package from the ‘National Skills Academy’ will do this?

Is he looking at new graduates or at ‘luring people from the private sector’ because while I can see £20 000 being very tempting to new graduates, I’m not sure it would be so much to those who are already successful (because we don’t want the unsuccessful ones, right?) private sector leaders.

I had a nose around the National Skills Academy site. I didn’t know what it was and had never heard of it. Honestly though, the language and government-speak just made me run scared from it. It did however, mention a little about this graduate scheme saying it will establish

A new trainee scheme with equal status to local government, central government and health schemes. Intended to identify future leaders in any setting and give entrants a rounded experience of different types of employment. Entrants could be new to social care or existing staff, with an emphasis on increasing the diversity of people in leadership roles.

Maybe I’m over simplistic and over idealistic but I can’t help thinking the £20 000 would be better spent training up front line social workers and providing substantial and useful on-the-job training for newly qualified social workers (that the universities seem unable to offer as a matter of course)  rather than pumping the money into the management system which already suffers from too much detachment from the front line services.  Good management is necessary but I am of the mind that a manager should always be prepared to do for themselves what they ask others to do. That might be a little simplistic but it’s generally served me well for although I’ve never managed people directly, having worked for many years providing direct care has informed what I ask care homes and care agencies to do enormously.

I know I shouldn’t be so cynical – after all – maybe it is a genius idea that is the government’s way of solving all the problems.. the government created.

I just can’t help it though. Years of being micro-managed and de-skilled through frankly ineffectual management and being told at regular intervals how important re-organisations are again, and again and again at the expense of the actual relationship-building work and support and advocacy work which makes a real impact on the lives of those who we work with can become a teeny bit disheartening.

I’m not ready to give up yet though. My aim is to change from the inside but more and more I can see myself drifting into the voluntary sector eventually.

Training

It’s a fairly busy month in the Mental Health teams with the impeding (3rd November) changes in the Mental Health legislation in England and Wales.

Having attended my ASW (Approved Social Worker) to AMHP (Approved Mental Health Professional) conversion course, a mere 3 months after receiving my warrant, I have somehow (actually, I believe it’s related to the above!) become involved in the training of other members of our service in the changes that are coming in with the new legislation.

k.susuki at flickr

k.susuki at flickr

I ran (with a colleague) the first of the training sessions yesterday. It was a lot more positive than I had feared it would be. I was concerned that either there would be some ‘information overload’ or that I had pared too finely the ‘essential information’ needed. Too much reliance on PowerPoint too. That was a genuine worry

It was the first time I’d delivered training, as such. I have given presentations but they have tended to be much shorter – of up to an hour. I spent a couple of years teaching English as a Second Language, mostly overseas and to a wide variety of age groups and levels but again, those sessions were much shorter. At least it had given me a lot of experience with ‘interesting’ activities and the importance of some element of interaction and group work.

But this was training. This was different. This was new.

We had drummed together a few activities related to the subject matter including a quick quiz on current legislation (with one .. um..  deliberate mistake)  and a couple of case studies with lots of discussion points.

We have another couple of general sessions to run as well as some more specialised ones on request. I think there’s a little bit of fine-tuning to be done before the next session.. maybe the ‘deliberate’ error was a little too subtle!

We made significant use of the materials provided on the Care Services Improvement Partnership site, which comes highly recommended.

They even have a  very handy (and brief) summary of all the changes here.

As for the training, well, it isn’t over yet. I enjoyed it though. I definitely see it as an area that I would like to develop in my own work. My not-so-secret ambition has always been to move towards teaching when I do just get too tired to continue with the front line work. Management of a team doesn’t interest me and I’ve harboured the wish to move into a more pedagogical role for many years. All these experiences are good then in the long term planning.

Indulgence

A completely self-serving and indulgent post if I can be forgiven, so I’ll keep it brief!

It’s Sunday, it’s a holiday weekend and I’m fairly busy but I did get a letter yesterday from the university confirming that the portfolio for my Approved Social Worker (ASW) training course has, quite literally, ticked all the boxes – and is being recommended for a pass.

It wasn’t easy but it possibly isn’t worthy of too much reflection as there won’t be any more ASW training. Next time round, it moves out of the exclusive domain of social workers and into the realms of Approved Mental Health Professionals….