Monday, 11 March 2013

If Castlebeck was Starbucks.......



If Castlebeck was Starbucks……

...would public outrage and pressure have forced them to close more than 18 months ago? If poor care was horsemeat, would it still be being passed off as something it isn't to those that pay for it? We are talking about the lives of some of the most hidden and vulnerable members of our society, and not crap overpriced coffee and corporation tax avoidance, or beef being replaced with horse. Yet Castlebeck have miraculously been able to keep trading despite being exposed on national television as an abusive, neglectful , morally and ethically bankrupt organisation who are paid vast sums of taxpayers money to ‘care’ for hundreds of vulnerable people. The organisation has slowly withered and now died because their reputation has suffered irreparable damage. Not because of a public outcry that they were still operating. What does that say about our society? What does that say about us as a sector?

When I was involved with making early personal budgets happen back in 2003, I remember imagining then that if people with disabilities and their families made real choices about who supports them and how they are supported, there would be no need for most of the quality assurance tools and regulations we have, if supporters, PA’s and organisations weren’t up to scratch, then they could just be gotten rid of and better ones found. None of this waiting for commissioners to make things better, or torturous processes of complaints and negotiations with providers to improve. If you don’t do the job you are supposed to do then that’s it…that would surely be all the quality assurance procedures that are needed….

Ten years later this maybe the case for the minority of older and disabled people who are really in charge of what happens in their lives, and for this we ought to celebrate, but for every person that is in charge, there will be many more that aren’t. So, do we need to wait for everyone to be given a personal budget or an individual service fund before things can get better in their lives? And is this the only answer? There are groups of people that ‘personalisation’ has completely passed by and this includes those labelled as challenging; those that end up in places like Winterbourne View.

The week before last, myself and colleagues went to five cities and talked to self advocates, families, providers and commissioners about what we could do to drive up good quality in services and drive out poor quality. This is part of the national response to Winterbourne View where provider organisations have come together to form a Driving Up Quality Alliance to address the problems of quality in the care of people with learning disabilities who challenge.

We challenged providers to think about what our role as a sector is in driving up quality, not just within our own organisations but across all services. To think about what our role is to drive out poor services and poor commissioning. And to think about how we can introduce aspiration into the lives of people who are often written off as ‘too difficult’.

It is easy to focus only on Winterbourne View where we saw the worst of what an organisation is capable of, but there were another 150 services for people with behaviour that is challenging that were inspected and more than half of them did not even meet minimum standards. Some of these organisations are good organisations that want to do the right thing, and have some good values but still are not up to scratch. It is also easy to just focus on healthcare and assessment and treatment units when we know that it is not all hunky dory out there in residential care, supported housing and supported living. We get hundreds of calls from people with learning disabilities and families to our advice service asking us for help in dealing with poor services. Some of what we hear is shocking but not surprising. We need to start being a lot more honest and challenging as a sector about how we really are doing.

What we heard from those that we spoke to was a real desire to find a way to come together and make radical changes in our sector. Honesty, openness and transparency about what providers and commissioners are doing and why they are doing what they do has to be at the forefront of these changes. Addressing the culture and leadership in our organisations is also important – how those in charge take responsibility and be accountable for what they do or don’t do. How the people supported, families and staff are treated and valued tells us a lot about an organisation and we need to understand more about what this looks like in a good organisation.

We also heard that achieving good housing and support for people with learning disabilities is not that difficult, no matter how complicated our sector chooses to make it. Supporting people who challenge requires highly skilled support and commissioners and providers that are committed – not always easy- but there are some providers and commissioners who are doing this successfully and helping people to lead ordinary lives.

As providers, we shouldn't need to wait to be told what to do to make services better, or wait for personalisation to come to us. Personalisation is not just about personal budgets, individual service funds or having person centred plans. It is about how we operate as organisations and individuals to give the people we support what they are asking for. We can’t change poor commissioning but we can take responsibility as a sector to make what people with learning disabilities want a reality and ensure that our organisations are the best they can be.