The NDTi team reflect on why, after a myriad of public inquiries, we are still seeing reports of mistreatment to people who live in care and support settings.
Last Night’s report from the BBC’s File on 4 about Supported Living will undoubtably be followed by collective outrage. But, outrage alone does not drive change – the missing ingredient is morality.
The first critical report into conditions in care services was on St Mary of Bethlam. What might be more surprising is that this happened in 1403, some 615 years ago. Even though society has significantly changed since then, it’s a stark reflection that we are still talking about similar problems. In more recent times we’ve had Winterbourne View and Veilstone and as an organisation, at NDTi, we have made it a clear priority to continue to tackle such injustices. So why are we still seeing programmes and reports that highlight the same problems?
Let’s stop pretending this is about a lack of money. Whilst contracts and fees are being cut, some providers continue to report the same level of profit, using this as evidence of a strong business and a badge of sustainability to attract new investment and commissions – but sustainability of what? Profit usually comes from having a great product or service that people want, not by cutting quality to the bare bone. In a market of little or no choice for the individual, it’s easy to generate profit through making efficiencies, but doing so means reducing the quality of care in their practices somewhere. In this type of market there are few incentives for organisations to change. Of course, a lot depends on their interpretation of what support actually means for the individual.
Morally, support cannot be a strangle hold on liberties, a locked door or a deprivation of a person’s rights. It’s about recognising and celebrating the contributions and gifts that each person has to offer and helping them to remain connected to their families and communities to continue that contribution. It’s not about providing the bare minimum. Supported living only works if it has good person-centred practices with experienced and informed staff.
As highlighted in the programme, there is an unhealthy relationship developing between some of the housing placement landlords and the care providers - this is eroding the true choice and control for people about where they live and how they spend their time. Commissioning should be about people, not places. Commissioners have a responsibility to look at the long-term effectiveness for people’s lives as well as balancing budgets. Without this oversight, supported living risks becoming a wellbeing lottery based on how agile organisations are to respond to individual needs and the quality of what they are willing to offer. We know that the worst abuse happens when people are isolated, away from their community and families. A connected life is a safer one. The common factors in abuse cases are isolation, institutionalisation, a lack of voice and a feeling of being “different” to others in society. We have the strongest laws around inclusion and human rights, but laws alone will not drive change, our collective moral compass amongst commissioners, landlords, care providers and individuals has an important role to play.
Most health and social care staff are navigating interconnected barriers of organisational culture, management, policy, budgets, attitudes, skills and even national culture – it all seems to conspire against progress. And yet, as illustrated by our recent evidence studies from Time to Connect and Community Led Support, there are many individuals and organisations whose work is still able to make a real difference to people’s lives. Evidence shows that the common ingredients for success are courage in leadership, downright tenacity, reduced bureaucracy, and being supported by colleagues and partner organisations to listen to people, before deciding actions that impact on lives.
Organisations often talk about a shared vision, a beacon of hope that they are working towards. Visions can be shaken by changes in government, society, budgets, leadership and priorities. A commitment to a shared morality gives an organisation a set of principles and values that define who they are now and how they’ll continue to behave regardless of difficulties. It’s not about hope for the future, it’s about committing to change now.
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