Topic: How to profit from NHS-funded torture and neglect

[Zetetic]

There's one bit of private-provided healthcare in the UK that rarely seems to be questioned in the way that, for example, Virgin bidding to run baby massage services in Coastal Wessex is. Easiest to show by example:

Cygnet Health Care runs over 100 'specialist' mental heath and learning disability services across Britain. A lot of these will be locked inpatient units (not necessarily 'secure' or 'forensic' but you won't be able to leave without having some actually open the door for you). Patients are placed in these services by their NHS or local authority.

Cygnet had a revenue of roughly a third-of-a-billion pounds in 2017. This follows a period of acquisition of other services in the UK, and their own buyout by Universal Health Services (an American hospital management company).

Every NHS places patients in these services, and other privately-run 'specialist' services - not just England, but also Wales and Scotland where the 'internal' market has mostly been undone.


Two male staff members single out a female patient for particular abuse.

Aware that she is scared of men, they tell her, in an effort to keep her quiet, that her room will be inundated with men.

They call this "pressing the man button", something which causes her great distress.

...

On one occasion, a male care worker threatens to "deck" a patient, while another patient is told they will be "put through the floor".

Whorlton Hall, County Durham


The inquest jury found:

    Long-term segregation and seclusion contributed to a decline in Claire's mental state

    Staffing levels "probably caused or contributed" to her death

    There was a failure to increase observations despite Claire making numerous self-harm attempts in the days prior to her death

    Had there been "sufficient staff" then Claire's care plan could have been followed and the risk period of 17:00 to 18:00 "would have been covered"

    There was a failure in allowing Claire to be alone in her room prior to her death, contrary to her care plan.

Cygnet Hospital, Coventry

[Zetetic]

I believe that these places have been with us every since 1948 (although please correct me if I'm wrong), but they flourished after the closure of the asylums.

Where we didn't provide communities or the services to support people to live in them, but where the distaste for visible state-operated hospitals for these people was too great, we farmed them out to less visible places under the aegis of private capital.

No longer was the NHS providing long-term care - a paternalistic institutionalising sin - rather it was just commissioning specialist places.

The popular political position is still that the only way forward is to obliterate the concept of long-term inpatient care. We apparently cannot conceive of long-term care with some sort of dignity, we must just learn to abandon these people more fully.

[Quote]

My local council had care homes, independent living arrangements, day centres, swimming pools, multi sensory buses and fuck knows what else for people with learning disabilities. It was genuinely fucking great. I worked for them, you took them out & had a good time, helped them do their shopping, went on holidays, day trips, they had a strong supportive social group, activities every night of the week. I took one bloke to Lord’s to watch the test match, it was his dream since he was little and his dad listened to the cricket on the radio. Just applied for the money, “oh, you’re taking so and so to the cricket? Great idea, I’ll get the check signed.” We had a strong union, good pay and safeguards in place, for us and them - no working twelve hours and coming in at six the next morning too knackered and bleary eyed to function. It seems mental looking back. New Labour get loads of shit, quite rightly in many regards but they did invest in things like that. Or did where I am.

Then the Tories/coalition got in, sold it all off, made me redundant (not that I’m in any way a victim here) got cheap nasty care companies in to do the job at half the price, with half the staff. Closed all the services, so those people had no where to go, no way to visit the friends they’d made, no escape really. Just useless mouths, eh? Can’t stack a shelf for minimum wage? Fuck you, you don’t count.

I did briefly work for one of those companies. Horrible nasty uniform, lowest wage possible, ridiculous turnover of staff, always short staffed (profits innit?), just get in anyone who’s willing to do the job regardless of suitability, the barest hint of care, after all you can’t provide much when you’re so focused on turning a profit and avoiding the legal issues from the veritable mountain of complaints, injuries, poor practice and general shoddiness   ... just horrible nasty spivs.

It seems like another example of us attempting to mould people and their needs to suit capital rather than having a regulated form of capitalism that serves the needs of the people within society. I’m never surprised at these stories sadly, shit like this is inevitable under the current system. If you want to make a profit, open a shop, don’t attempt to profit off the backs of the most vulnerable.

[Twed]

Thank you for the passionate, focused outrage here Zetetic. Sorry if that sounds sarcastic. It isn't.

[Johnny Yesno]

we must just learn to abandon these people more fully.

For the benefit of shareholders.

[Zetetic]

I'm not sure that's true, insofar as really abandoning these people wouldn't be profitable. It'd be cheap for the state, but not profitable for others.

I think it's probably very earnestly meant by some, for one thing. I think in reality it's an endpoint that we aren't really working towards - other than using it as a lever to shut NHS-provided services.


One of the thing that gnaws at me the most these days is that I increasingly worry that attempting to highlight and resolve issues NHS mental health and learning disability inpatient services - particularly where they relate to having enough - is counter-productive. Either you just make a risk more visible (and it's better to palm that off into the private sector) or you make a service more expensive (and more attractive to form out to commissioning).


I know that this isn't a great forum topic. There's not much to say in response. (Although I appreciate those who already have, particularly Quote's contribution of context.) It's horrible but no one really cares much. Panoramas can garner some brief interest, but even then it's mostly specialists worrying at their profession and carers who already know.

The patients are the ideal people to traffic in for this sort of thing. Variously - individuals prone violence and worse, those nasty manipulative drama-enjoying women, and creatures who make such awful noises betraying that they're not really human (and we'll be rid of them in a few a decades anyway if we just screen a bit harder). Painful to think about at best.

[Zetetic]

Remember how Winterbourne went nowhere, not really.

Compare to Mid Staffs - which I'm not going to pretend has really solved anything but built some momentum towards trying to - where the volume of outrage and framing were very different.

See how some stories are about how there are bad systems - excessive financial pressures, lack of staffing governance - and some are about how there are bad people.

[Fambo Number Mive]

What can we do at a personal level to try and put pressure on the government to change things? I could write to my MP but I don't know how much they can do and it does seem like Labour is doing quite a bit to hold the government to account anyway (my MP is Labour).

What I saw in this documentary makes me so angry. Even if these people are badly paid (£16k as a starting salary doesn't help encourage decent staff to stay), there is no excuse for the way they are treating the patients. There seemed to be so many of them doing it on both the Whorlton Hall documentary and the Winterbourne View documentary.

I just feel like there needs to be a movement for change.

[Buelligan]

I care hugely about this but I cannot read it, it literally makes me want to kill people and I know that's wrong.  Fambo made a thread on a similar subject and I couldn't go in it either.  Fucking hell, humans are the fucking pits, some of them.

[madhair60]

I care hugely about this but I cannot read it, it literally makes me want to kill people and I know that's wrong.  Fambo made a thread on a similar subject and I couldn't go in it either.  Fucking hell, humans are the fucking pits, some of them.

Same with me unfortunately. Very violent thoughts. And it would be utterly justified, it really would.

[Zetetic]

I appreciate each of you might not be talking about the nurses and support workers, but I say again -

See how some stories are about how there are bad systems … and some are about how there are bad people.

The latter are compelling stories but they sap the possibility of the scandal having any real power for change. At worst they make us hate the people, and at best they make us talk about professional registers and individual duties.

These people are bad. But a broken system placed them in a position power, and a broken system then cultivated the worst aspects of their nature and helped them repeat the process with others.

[Zetetic]

I just feel like there needs to be a movement for change.

And, bluntly, such a movement needs to know how to determine the meaning of tragedies - and not let them just become about how every nurse has to work harder at being better.

[shiftwork2]

Shitty behaviour in care settings is down to recruitment of bad eggs, and having enough of them in a team that the decent majority go along with it.  I have seen some terrible stuff in my time.  Staff members mocking patients with learning difficulties (in private) and taking turns to go out and have a look and a laugh.  A distressed elderly gentleman pissing his pyjamas because he couldn't comply with a mask breathing instruction given by a short-tempered harridan intent on intimidating him.  Neither match what's been filmed by Panorama but I firmly believe tolerance for these episodes lies behind the headline-hitting care disasters, such as the one unfolding.

[Fambo Number Mive]

It seems that the oversight and regulation of care still isn't working. The CQC are once again tweeting away with apologies but will anything change? Why not make all inspections unannounced?

This is quite an interesting Twitter thread where someone who works for a similar organisation to the CQC gives some signs that things may not be right at a care facility: https://twitter.com/AnnMemmott/status/1131438469782409216

There were 100 visits to Whorlton Hall in the year before the documentary was shown.

How many other care facilities is similar abuse taking place in? The CQC need to change and not leave rooting about abuse in care faciltiies to Panorama.

[Fambo Number Mive]

And, bluntly, such a movement needs to know how to determine the meaning of tragedies - and not let them just become about how every nurse has to work harder at being better.

Yes, it seems to me that there is a total failing with regulation  and safeguarding of the care sector, who is in charge of the care sector (privatisation and treating care services like a financial asset for wealthy people to buy and sell) and what happens to people who are found guilty of abuse as well as the actions of individual staff members. I think it reflects a lack of respect for disabled people in British society as well. People seemed to forget about Winterbourne View after a year or so. I hope people won't do the same for Whorlton Hall (and I think people need to be reminded about Winterbourne View as well).

Private Eye's In The Back section (which covered the abuse at the Solar Centre in Doncaster) is good at reporting on it, but how many people read it? Aside from PE and Panorama, much of the media don't seem to care. How many journalists know people with disabilities or have a basic understanding of the care sector? We also have media who don't have the time or money to go out and investigate stories and just focus on what's going on with Twitter rows.

[EbbyVale]

A friend of mine does investigatory inquiries, usually related to child death, and she talks in terms of social systems and institutions having faultlines--that there are ways a particular construction will be weak.  Sso for instance if there are a lot of bad staff there's a reason for that, and it's usually requires a failing on more than one level.

She also finds huge variability from council to council when it comes to care, and it's not necessarily strictly about economics. 

[confettiinmyhair]

Working now in a tier three Mental Health service it shocks me how people end up over two hundred miles (or more) away from their home town or city. The physical health equivalent would be recovering from an illness, and being isolated from your support network whilst you try and heal.

[Fambo Number Mive]

Ten arrests made: https://www.bbc.co.uk/news/uk-england-48400861

[greenman]

My local council had care homes, independent living arrangements, day centres, swimming pools, multi sensory buses and fuck knows what else for people with learning disabilities. It was genuinely fucking great. I worked for them, you took them out & had a good time, helped them do their shopping, went on holidays, day trips, they had a strong supportive social group, activities every night of the week. I took one bloke to Lord’s to watch the test match, it was his dream since he was little and his dad listened to the cricket on the radio. Just applied for the money, “oh, you’re taking so and so to the cricket? Great idea, I’ll get the check signed.” We had a strong union, good pay and safeguards in place, for us and them - no working twelve hours and coming in at six the next morning too knackered and bleary eyed to function. It seems mental looking back. New Labour get loads of shit, quite rightly in many regards but they did invest in things like that. Or did where I am.

Then the Tories/coalition got in, sold it all off, made me redundant (not that I’m in any way a victim here) got cheap nasty care companies in to do the job at half the price, with half the staff. Closed all the services, so those people had no where to go, no way to visit the friends they’d made, no escape really. Just useless mouths, eh? Can’t stack a shelf for minimum wage? Fuck you, you don’t count.

I did briefly work for one of those companies. Horrible nasty uniform, lowest wage possible, ridiculous turnover of staff, always short staffed (profits innit?), just get in anyone who’s willing to do the job regardless of suitability, the barest hint of care, after all you can’t provide much when you’re so focused on turning a profit and avoiding the legal issues from the veritable mountain of complaints, injuries, poor practice and general shoddiness   ... just horrible nasty spivs.

It seems like another example of us attempting to mould people and their needs to suit capital rather than having a regulated form of capitalism that serves the needs of the people within society. I’m never surprised at these stories sadly, shit like this is inevitable under the current system. If you want to make a profit, open a shop, don’t attempt to profit off the backs of the most vulnerable.

There does seem to be a clear pattern of ignoring these underlying issues in the media, I mean we get isolated reports of poor care every so often but it typically seems to be painted as an aberration rather than part of a widespread culture. The again you could say much the same for coverage of public healthcare as whole, the BBC are rarely willing to point the finger at government cuts and the report typically ends with parroting some dodgy statement about spending levels unquestioningly.

[Zetetic]

I take the point, but fuck 'culture' as well. These places and their cultures are, in large part, the product of the systems they exist in and the incentives of those systems.

Yes, sufficiently upstanding and resilient people can still carve oases of dignity and so on. But we shouldn't be dependent on such individuals.


"Cygnet, the firm that runs the 17-bed hospital unit for adults with learning difficulties and autism, said it was "shocked and deeply saddened" by the allegations."

Universal Health Services stock price was unaffected.

[Quote]

There does seem to be a clear pattern of ignoring these underlying issues in the media, I mean we get isolated reports of poor care every so often but it typically seems to be painted as an aberration rather than part of a widespread culture. The again you could say much the same for coverage of public healthcare as whole, the BBC are rarely willing to point the finger at government cuts and the report typically ends with parroting some dodgy statement about spending levels unquestioningly.

To be clear, I don’t want to say that slapping residents around and mentally torturing them is in any way part of the system. At least, I fucking hope it isn’t.

But hiring anyone who happens to walk through the door and agrees to start straight away and work twelve hour shifts, with minimal training and few colleagues to assist - yeah, daily. Under those circumstances, some shady characters might slip through. As long as you have no criminal convictions, you’re good to go. And staff are always needed.

A poor company happy to take the profits and blag the standards of care? Yep. Absolutely. A girl I worked with years ago got a job for a company charging £1,000-a week fees to look after elderly dementia patients, the daily food allowance for those residents was three pound something. I know there’s other costs to consider, but three quid for three main meals? I pay more for a sandwich. Rats in a residents room, again, someone I knew had that experience.  CQC inspection? Suddenly, we’re magically fully staffed, over staffed even compared to usual routine. Had they turned up a day earlier, incognito to visit their Nan or something, it’d be a different story. Which implies that that level of staffing is what you really need to run a service effectively and at a reasonable level of care...

Paying poorly and putting intolerable workload on people? Yes. It’s stressful, and if you’re getting paid the same wage as the average shelf stacker, but with a million times more pressure on your head, you can’t blame decent staff for thinking: “fuck this”.

Understaffed? Hahaha. That’s standard. I looked after an entire floor of 25+ residents on my own, not willingly, but frustratingly regularly. “Couldn’t get the staff to cover mate, but crack on. Good luck with that.”  If I needed help (and most of these people can barely move) then I have to leg it downstairs and try and find someone to lend a hand. Two meagre fifteen minute breaks? No chance, you barely have time to breathe.

Again, none of these are any excuse for the utter cuntitude displayed in some of the cases mentioned in the OP, that’s just people being horrible. But getting to the stage where those people are hired and in some cases a culture of bad care by small groups of those people develop, I can see that happening sadly.

This is not to denigrate the many, many fine and genuinely caring people who do work incredibly hard and try their very best. But y’know, the company makes the profit regardless of whether standards are high or mediocre and of course, business is business...

I mean no right thinking company states openly: ‘shoddy care a speciality, we honestly don’t give a fuck’ but managers get targets for staffing levels, for wages, for expenditure, and someone above them is saying “I know it’s tough at the moment but once x, y & z are sorted we’re turning on the money tap, it’ll pick up...” there’s good faith all down the line. The vast majority of people don’t want to give bad care or fail those they’re charged with looking after, sometimes they just need to prioritise someone else. Frankly you feel like a piece of shit having to say “not now, sorry. Bit busy, I’ll get to you when I can...”

I’ve never been in to a shareholders meeting or high level management pow-wow so have no idea if a shady business model of exploitation and maximising profits is openly discussed, so I really dunno. No one put out any literature at companies I worked for (some alright, some appalling) saying anything other than the standard feelgoodery and marketing spiel.

I have noticed elsewhere the large amounts of money donated to the Conservative party by certain care providers of course. Around the time Cameron & co took a sledgehammer to the welfare state and the various traditional safety nets began to be dismantled and replaced by the benevolent, wise guiding hand of the free market there was quite a flurry of companies willing to make donations...

In the interests of balance there are companies I’ve heard good things about and who have good reputations for their standards of care. I don’t want to be entirely negative. The systems of running care as reimagined under recent governments don’t particularly seem to be set up with wonderful care as their main and sole aim though.

Just my own opinions and experiences, mind - and baring in mind, I am quite cynical. Worked for the council first all over the shop within their various learning disabilities facilities (no real horror stories there, indeed it looks heavenly from today’s perspective), a care company who took over the care of those with learning disabilities, a general domiciliary care company and a company dealing with elderly dementia patients.

[Fambo Number Mive]

It feels like this story is slipping down the news agenda already. I do wonder if anything will change this time, given how little changed after Winterbourne View, the Solar Centre abuse in Doncaster or with the many other cases.

[Zetetic]

It feels like this story is slipping down the news agenda already.

I have been wondering about looking at this (and Winterbourne View) properly - quantifying attention given and some brief analysis of the language used.

I suggest finding out about private units local to you - starting with Cygnet's - and writing to your local representatives (from councillors to MPs - they all have some remit here). I would ask when they last visited these places, if they're happy that they're safe and - if they're Labour or Plaid or SNP or Green etc. - asking if they think that essential NHS-funded services should be run by private companies.

If there aren't any local to you - pick somewhere else.

If you belong to a left-wing party or a relevant union, raise the questions there.

Any other suggestions would be welcome.

[Fambo Number Mive]

Some very good ideas Zetetic.

Perhaps what is also needed is a grassroots group to call for change? Writing to local papers etc. How do you keep a story in the news agenda?

Could other activist organisations get more involved?

Someone asking about abuse in the care sector and reforming care on Question Time would be good. Or Any Questions. I know QT is a bit rubbish and toxic but it does get the issue out there.

[Zetetic]

Could other activist organisations get more involved?

There's an issue here as well, with prominent mental health and learning disability charities (who aren't the only form of activist organisation, I emphasise) also being heavily involved in providing NHS-funded services, including some which are not a million-miles away from the sort of services that Cygnet provides.

Here's an example of a CQC 2015 report on a Mencap-run residential home, for example.

Even though they're not 'for-profit' private companies, this clearly compromises them when it comes these sorts of issues. (And others - like whether 'sleeping-in' care workers should be paid the minimum wage. (This is a little bit more complicated than my gloss suggests, but still.))

[Zetetic]

Meanwhile, we're seeing England's decision to discard nursing bursaries is contributing to further reductions in the training numbers. (Everywhere else in the UK retains them I believe - but that doesn't mean we get to retain the benefit, what with England's ridiculous London bonuses and the like.)

"It says the decline has affected all branches of nursing, although the 50% fall in applicants for learning-disability nursing since 2016 is particularly severe."

Well.

[mothman]

This is probably quite a simplistic question (compared to Zete's own fantastic posts), but isn't this kind of behaviour counterproductive for these companies to be taking? After all, it's not exactly selling the glorious sunlit uplands we all have to look forward to once shorn of the shackles of NHS tyranny, is it?

And the counter-argument, that this only happens because it's the NHS who choose providers (so, not like it'll be when we ALL get to choose) through a prism of lowest bidders, necessitating these heroic providers to cut standards in pursuit of their just rewards, the Holy Profit, feels a bit nuanced and complex to make a convincing political argument that'll appeal to a public who insist on continuing to support the NHS.

Though it does go a long way to explaining why (given our RW press) these incidents quickly fade from the spotlight, whilst failings at an actual NHS trust (Mid Staffs), however justified, continue to run and run...

[Zetetic]

but isn't this kind of behaviour counterproductive for these companies to be taking? After all, it's not exactly selling the glorious sunlit uplands we all have to look forward to once shorn of the shackles of NHS tyranny, is it?

I don't think it matters, because these people don't matter.

Neither you or I are the mentally subnormal half-humans, whom we hope to disappear entirely from our society almost entirely within our lifetimes. Why bother to think about in the short time that they have left?

We're not manipulative emotional abusing borderline whores, women who aren't even suffering from a real mental health problem. They've brought it on themselves with their awful personalities.

We're not anti-social violent thugs or predatory paedophiles.  Surely, if anything, these people deserve worse?

The victims are overwhelmingly variously inarticulate, scary, upsetting, and unpleasant-to-be-around, to at least some degree. Their conditions - or at least their expression or manifestation - are often, in part, related to deprived or traumatic backgrounds. Those closest to them share those backgrounds, and they too are rarely well-spoken or photogenic.

These events aren't taken as speaking to health or social care more widely. Not even really to mental health care.

[Zetetic]

https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2019/05/25/college-deplores-abuse-scenes

RCPsych have put out a statement saying that they aren't, in general, very pleased with abuse, which is nice.

Then the focus on the idea that all we need to do is fix specialist community services and…

[Fambo Number Mive]

Good point made about the Health Secretary: https://twitter.com/_danparton/status/1132583318233518082