Let sleeping watchdogs lie

I wrote the following article for Private Eye (06/03/12).  You can view the full FOI disclosure of emails sent between Wintebourne View care and the CQC here (PDF, 3.53MB).

The correspondence also included a CQC-written report which chronologically summarises incidents at Winterbourne View prior to the Panorama documentary which exposed abuse in 2011. Here, it is published for the first time. You can read it here.  

 

Claims of ill-treatment and abuse, numerous police investigations and concerns over safeguarding at the Winterbourne View were reported to the failing Care Quality Commission (CQC) as far back as 2009 – it has emerged.

But the watchdog did nothing for nearly two years, until it was forced to act last May by a  BBC Panorama investigation showing patients with learning disabilities being verbally and physically being verbally and physically abused. The private hospital for adults with learning disabilities was then closed and 10 staff arrested.

The health and care regulator has consistently blamed the hospital for failing to notify it of serious incidents. But documents obtained by the Eye reveal that the CQC had been officially alerted to at least four separate allegations of staff abusing patients, which were also been reported to the police, dating back to October 2009. During the previous year the local authority had also informed CQC that there had been two unspecified safeguarding issues.

The first serious incident when police were called involved Ben Pullar, a patient who lost a tooth amid allegations that he was punched while he was being restrained. Although the local safeguarding board, run by South Gloucestershire Council, met with the patient’s family, no arrests were made.

The following year, police investigated at least three more allegations of abuse by staff. In February, a patient claimed she had been pushed and struck for not going to dinner with other patients. In July, a support worker reported witnessing a patient being slapped twice, once in the shower and once in her room. And in August 2010, another patient alleged her neck had been “squeezed” and she was having difficulty swallowing. That month CQC also received a notice from Castlebeck, which owns Winterbourne  View, that it had given a verbal warning to a support worker for “shouting and pulling a patient with some force”. Officers came to the home and took witness statements but made no arrests.

The number and frequency of reports and incidents should have alerted both the CQC and the local authority that something was wrong at Winterbourne. Tom Pullar, whose brother made allegations against staff at Winterbourne, told the Eye that the official account given by care workers of Ben’s injury was “unbelievable”. The report from the hospital sent to the CQC stated that while under restraint he “bit the alleged perpetrator on his hand. The alleged perpetrator pulled his hand out several times to free it and in the process a bottom incisor came out of the patient’s mouth.”

Mr Pullar says his brother was punched, and the investigation relied completely on the staff members’ evidence. He told us: “The CQC and the police were naïve to believe what people said without questioning it. It was one person’s word against a vulnerable person’s word.”

The documents, obtained by the Eye under the Freedom of Information Act, suggest there was at least one other attempt at whistleblowing which could not be revealed because the people involved expected them to remain confidential.

The CQC’s Director of Operations, Amanda Sherlock, said last year that the home “effectively misled us by not keeping us informed about incidents as required by the law. Had we been told about all these things, we could have taken action earlier.”

And even now, the organisation remains in denial, claiming that “the incident books weren’t available to us. We were not being given a full picture of what was going on. If a care home is not telling us what is going on, it’s very difficult for us to do our job.”

This neatly ignores the CQC’s responsibility to send in inspectors in and demanded the incidents books – as it did once the BBC investigation had done the job instead.


Exclusive: How CQC budget was slashed to make “savings”

After the Winterbourne View Care Home scandal, exposed by Panorama earlier this year, questions were raised about the resources and funding of the Care Quality Commission (CQC).

Now, a series of emails and documents obtained by this blog have revealed how the government forced the CQC to cut nearly £1 million.

Less than a week after George Osborne’s “emergency budget” in May 2010, the Department of Health made it clear to the CQC that they would not escape funding cuts. An email to the CQC explained: “Although as a protected department DH will not see a reduction in its 2010-11 budget, we are not and should not be exempt from the need to make savings”.

The CQC told the Department of Health they would need a capital budget of £17.5 million in 2010-11. But by July, they had been informed that they would be receiving nearly £1 million less – just £16.4 million. The CQC’s Director of Finance told staff: “This should be sufficient although there are some emerging issues”.

The previous year, the CQC had to write a desperate five-page letter to the Department of Health asking asking that they be considered for some additional funding. It boasts “we have delivered recurring savings of £44m”, but warned: “There are further ‘one off costs’ that will be necessary in 2010/11 in order for us to satisfy our obligations before CQC reaches ‘steady state’.

Savings in the CQC have been accompanied by a dramatic fall in the number of inspections that are undertaken. Figures released under the Freedom of Information Act show that there were only 5,331 inspections this year, compared to more than 48,000 inspections six years ago. In May, the CQC were criticised for failing to act on reports of abuse in Winterbourne View care home.

David Brindle had this to say in The Guardian:

On resources, critics have seized on the fact that the CQC’s annual budget of £164m is 30% less than the combined funding of the organisations it succeeded in 2009, even though it is being expected to do more. As well as NHS trusts, care homes, care agencies and dental practices, the body is due next year to start regulating GP practices. According to Williams [Dame Jo Williams, CQC chair], each of the full quota of 900 inspectors – and until recently there have been up to 130 frozen vacancies – handles a mixed portfolio of some 50 different provider units and makes judgment calls, based on evidence of relative risk, about when and how often to visit (almost always unannounced, contrary to widespread belief).

Earlier this year, Pat Healy of the National Pensioners’ Convention said: “The quality of inspection of care homes is unsatisfactory, mainly because the regulator, the Care Quality Commission, is expected to do more for less money and does not have enough inspectors to do the job properly.”

The CQC doesn’t seem to keep an online FOI disclosure log, so here is a selection of the more interesting documents…

Email from DH   Email from John Lappin    Email from Cynthia Bower    Email from DH 2     CQC Budget Notification (Doc 11 20101222 ) (Excel)    Revised Budget for 2010 and 11   Letter from DoH re CQC 2011 and 12 Indicative Budget      DoH ALB Planning Guidance   DoH ALB Planning Guidance – supporting docs     Letter from DoH re CQC 2010 and 11 Final Budget     Letter from DoH re CQC 2011 and 12 Initial Budget

NB: This article has been subsequently published on the Liberal Conspiracy website here.

Exclusive: Care home inspections hit record low as CQC funding slashed

The Care Quality Commission has been forced to admit that it inspects far fewer care homes than ever before.

Figures released under the Freedom of Information Act show that there were only 5,331 inspections this year, compared to more than 48,000 inspections six years ago.

CQC inspection numbers are shown in the graph below.

A small proportion of the decline is down to changes in responsibility, that meant Ofsted took over inspecting certain institutions. But this doesn’t account for much.

The CQC has been damaged by budget cuts and, as a result, has shifted it’s approach to inspections. Rather than visiting lots of homes, inspectors will now visit far fewer homes but almost always (98% of the time) do so unannounced.

Although unannounced inspections are obviously more likely to catch problems, there are now so few inspections it is inevitable that the CQC will miss scores of serious issues. This was highlighted recently by Panorama’s exposure of abuse taking place in Winterourne View Care Home. In that instance, the CQC failed to pick up on the abuse despite a senior nurse, Terry Bryan, reporting the issues to the regulator. When the CQC failed to step in, Bryan contacted the BBC.

View the documents here:

Table of adult social care inspection activity from 2002 v1 (Word doc)

ASC services at 090910 (3) (Excel)