The term ‘learned helplessness’ was new to me a few weeks ago. I still don’t know what it means. Other than a random excuse for the paucity of good care on offer at Slade House site (now known as chunkypoundland until the intricacies of potential land sales, profit taking and the like are laid bare).
The story of LB’s death and the subsequent damning CQC inspection (which Rich, barely containing his ire at the pre-Crimean levels of care identified regularly mutters ‘They found faeces on a chair?’) is documented in this blog. I recently acquired the quality review report that took place in November/December 2012. Four months before LB went into the unit. An internal inspection organised by the local authority/clinical commissioning group to make sure they were buying services fit for purpose.
It ain’t a pretty read.
What is astonishing is that the reviewer mentions clear concerns but didn’t mark them as actionable. And reader/s of the report obviously did nothing. The bar of what is acceptable is set so low I can’t help coming back to the ‘if this had been a dog home’ type thoughts. And they don’t see it. This isn’t learned helplessness, it’s ignorance. There’s no thought to what it must be like to experience living in the place. No reflection on the absolute powerlessness of the patients. Their ability to communicate hammered by medication dished out liberally, or crushed by brutality experienced at the hands of heavies in the name of ‘restraint’. And the possible/probable distancing of families.
I know this blog is used in teaching health/social care students, but for those of you who have been working in this area for a long old time now, particularly if your job involves reading and responding to quality reviews (in a clean, warm, comfortable and safe environment, sitting cosily on a shedload of power/influence), here’s a quicky quiz to help you reflect on the level of your bar.
Based on a hypothetical quality review report. Just to mix it up at bit, let’s imagine that the provision is known to have problems and was recently acquired by an out of county Trust (one of those too big to fail jobbies).
- The design, decor and under utilisation of areas are identified as ‘specific problems’ and ‘too cold and clinical’. Do you a) do nothing b) act?
- Patients report that noise and other behaviours disturb them, make them uncomfortable and at times scare them. Do you a) do nothing b) act?
- Feedback suggests that discharge from the service has been variable. Do you a) do nothing b) act?
- It isn’t clear that patients are receiving therapies from their records, but the reviewer was ‘informed’ they do. Do you a) do nothing b) act?
- Feedback from patients and observations on the ward suggest that activities are minimal within the unit. Do you a) do nothing b) act?
- Observations show that staffing levels cause delays in allowing patients to be able to leave the unit for agreed periods of time. Do you a) do nothing b) act?
Quick totting up of scores: a = 0 points b = 1
If you scored between:
0-1: back out of health or social care now. Do not pass Go.
2-3: you should take a long hard look at yourself and give your working practice some full on critical reflection. Perhaps spend time in the provision you commission. Hang out with the patients and learn that they are actually, er, human, just like you. Oh and dust off your copy of the Mental Capacity Act and reacquaint yourself with basic human rights principles while you’re at it.
4-5: Ok. Follow above advice, keep following up on actions and make sure this focus doesn’t fall by the wayside.
6: Good on yer.
One final point. Almost funny but isn’t. Because none of this is. In the minutes/reports available online for this period, everyone (Sloves, CCG, LA) dutifully report their Winterbourne JIP related actions. In detail. The same people, I assume who read and ignored the content of a report that provided clear indications (albeit couched in a flimflam language of ‘we were informed that stuff was happening’ even though it clearly wasn’t) that there were serious issues around what was being described as ‘care’ in ChunkyPoundland. Er, how does that work?
The level of blinkered stupidity is astounding. And we really should stop with the obsessive focus on Winterbourne View. It really ain’t helpful and I suspect may have created more harm than good at ground level in some places.