Gwenda Thomas, Deputy Minister for Children and Social Services
In 2011 we were all shocked to learn of the appalling abuse suffered by adults with a learning disability at Winterbourne View Hospital, near Bristol which was identified through a BBC Panorama Programme. We determined then to do all we can to ensure that such abuse never happens in Wales.
In December 2012 the Department of Health published its final report into Winterbourne View Hospital ‘Transforming care: A National Response to Winterbourne View Hospital’ http://www.dh.gov.uk/health/2012/12/final-winterbourne/ This followed on from the Winterbourne View Hospital Serious Case Review commissioned by South Gloucestershire Safeguarding Adults Board which was published in August of last year http://www.southglos.gov.uk/Pages/Article Pages/Community Care - Housing/Older and disabled people/Winterbourne-View-11204.aspx
I would like to take this opportunity to update you on the actions taken in Wales since the airing of the BBC Panorama programme and my Written Statement in June 2011.
Healthcare Inspectorate Wales (HIW)
HIW is responsible for reviewing the quality and safety of patient care commissioned and provided by healthcare organisations in Wales. Whilst there was no individual from Wales being cared for in Winterbourne View Hospital at the time, following the Panorama programme HIW revised and strengthened its methodology and approach to its unannounced inspections of learning disability services. These now take place over two days and have a much stronger focus on the experiences of service users including more observational activity as well as; for example, reviewing care plans/Mental Health Act documentation (where relevant) and talking to staff, relatives and carers.
All independent sector providers of learning disability services have been inspected using this new approach and any issues identified dealt with either at the time of the inspection or by way of a follow up letter and action plan where required. HIW will continue with these unannounced inspections of each provider on at least an annual basis but will carry out more frequent inspections if it becomes aware of concerns that need immediate action or investigation.
HIW has recently extended this inspection programme to NHS providers of learning disability services. The HIW has also met with Welsh NHS commissioners and commissioners from the South West of England to clarify respective roles and responsibilities with regard to learning disability services and placements and to strengthen arrangements for sharing intelligence and any concerns about providers.
Care and Social Service Inspectorate Wales (CSSIW)
CSSIW’s role is to inspect and review local authority social services, and regulate and inspect care settings and agencies. Although Winterbourne View was registered as a private hospital, it is important that safeguarding the rights of people with learning disabilities living in care homes is also given priority.
At the time the concerns arose, the approach to regulation and inspection adopted by Care Quality Commission (CQC) was quite different to that adopted by CSSIW. Unlike CQC, CSSIW has always maintained annual inspection visits to care homes with increased frequency for services where there are concerns. CSSIW consider that regulation in Wales would have been responsive and identified the concerns highlighted by the Serious Case Review as:
- Inspections focus on quality of life and rights and control;
- It uses observational methods which identify institutional abuse; and
- It has introduced a proactive response to incoming concerns.
From 1 October 2012, CSSIW has embedded new registration and enforcement processes including taking action where a home fails to put in place registered managers in a timely manner. It also plans to use people with a learning disability and carers as independent visitors to care home settings and this is now being piloted in South West Wales.
Learning Disability Advisory Group
Last year the Learning Disability Advisory Group was established to provide me with advice on the development of learning disability policy within the context of our reform programme ‘Sustainable Social Services’ and other relevant issues. At its first meeting in September 2012 the Group agreed that one of its priorities will be to provide me with advice on the lessons to be learnt from Winterbourne View and actions needed to be taken in Wales to improve the safeguarding and care of our people with a learning disability. They will be assisted in this work by the Challenging Behaviour Community of Practice whose meetings are funded by the Welsh Government.
I will also be writing to Directors of Social Services and Chief Executives of Local Health Boards reminding them about the ‘Self Assessment Checklist for People with a Learning Disability and Challenging Behaviour’ which was drawn up a sub group of the previous learning disability advisory group.
Social Services and Well-being (Wales) Bill
As set out in my Written Statement of 18 October 2012 the Social Services and Well-being (Wales) Bill, which will be presented to the Assembly Government for consideration early this year, includes provisions to strengthen safeguarding for all people at risk in Wales. It will introduce a coherent legal framework for adult protection in Wales which will ensure that the multi-agency response to adult abuse will be as consistent, co-ordinated and robust as the response to child abuse.
The framework will contain a definition of an 'adult at risk' and place some form of duties to report, cooperate, investigate and share information on a range of agencies, including the health service.
A National Independent Safeguarding Board will be established which will advise Ministers on the adequacy and effectiveness of safeguarding arrangements and on action to help strengthen policy and improve practice. The Board will have an expert membership and provide support and advice to Safeguarding Boards to ensure their effectiveness.
The Social Services Regulation and Inspection White Paper and Bill
The Social Services Regulation and Inspection White Paper will deal with the fundamental issues of Social Services and social care regulation: the regulation and inspection of social care services for children and adults, the regulation of the workforce and of training and the regulation and inspection of local authority Social Services. I have committed to the publication of a White Paper for consultation this year. The current timetable is for a Regulation and Inspection Bill to be introduced for Scrutiny in early 2015.
The Social Care Workforce
In Wales we want to boost the esteem in which social work and social care is held in the public eye. This will not only offer fairer recognition for the good work done by social care workers, including those working in care homes, but it will also help us to recruit and retain the brightest and the best to the sector.
In order to further professionalise the workforce we are taking forward a number of pieces of work, in tandem with our partners, these include the development of a Workforce Strategy for the whole of the Social Care Workforce in Wales, that will set out the way forward for this workforce over the next 10 years to enable the commitment in Sustainable Social Services to be fulfilled. We are also intending to develop career pathways for social care workers and we are considering extending the existing powers of the Care Council so that they can regulate the training of social care workers, so that social care workers can enjoy a consistently high standard of training and qualifications. Finally, we are extending the regulation of social care managers to include domiciliary care managers, because of the significant influence of these roles on day to day practice.
Overall, the strengthened approach to inspections and the workforce, increased engagement with providers, better use of information and intelligence and improvements to be brought about by the Social Services and Well-Being (Wales) Bill should, as far as it is possible, reduce the risk of the abuse carried out at Winterbourne View Hospital, from happening in Wales.