I was extremely saddened but not surprised to read in the news this week of the physical and emotional abuse of vulnerable patients at the Cygnet Health Care Yew Trees hospital in Kirby le Soken, Essex.
The details emerged in a Care Quality Commission (CQC) report after the unit was inspected by the regulator in July and August.
The inspectors reviewed 21 episodes of CCTV footage, concluding that over 40 per cent showed "examples of inappropriate staff behaviour". The details of what exactly this consisted of are absolutely sickening:
- Inspectors witnessed staff drag, slap and kick a patient.
- Inspectors witnessed staff shove a patient.
- They witnessed staff using verbal and non verbal communication with patients, the content of which the hospital assessed as a trigger for patients' anxiety.
- They saw extremely negative interactions where staff "visibly became angry with patients, threw items in the vicinity of patients and stood very close to patients with intimidating body language (arms crossed, standing over them)".
- Some staff did not use restraint as a last resort. They did not attempt de-escalation first. Inspectors witnessed two examples where staff dragged patients across the floor, one example where staff used elbows in a patient's abdomen to alter their position, whilst the patient was restrained on the floor, and four examples where staff did not support the head of a patient who required this during restraint.
- In six examples of CCTV where restraint took place, it showed all male staff teams restraining female patients. There were no examples where female staff were swapped into the restraint team, despite being available on shift and, in some cases, being in the room during the restraint.
- ·Staff did not use seclusion appropriately, follow best practice or recognise when seclusion took place. Staff prevented a patient leaving their bedroom area.
At the time Cygnet Yew Trees, which is a 10-bedded hospital, is reported to have held eight female patients with autism or learning difficulties. It can only be imagined what life must have been like for those women, confined in an environment where they experienced such abusive, disrespectful and discriminatory behaviour directed towards themselves and others. Poignantly, in two examples of CCTV footage the CQC inspectors witnessed other patients trying to involve themselves in the restraint of another patient.
Staff have been suspended and referred to the police and the hospital has closed and may not reopen.
The first concern has to be what has happened to the women who were living there? Are they now safe? What have they been told about the reason why they have been moved at short notice? Will they get the support they must surely require now, in the aftermath of what has happened?
In my experience, the answers to these questions cannot be taken for granted. I have represented survivors of abuse at other so-called health and care placements, where there has been systemic abuse of residents, including Winterbourne View and Veilstone.
In at least one case, the place my client was moved to was at least as abusive as the placement they had been removed from.
The findings of the CQC are depressingly familiar to those previous scandals. The abuse did not take place in a vacuum.
The CQC were also critical of other staff and managers at Yew Trees: in 45 per cent of the episodes of CCTV multiple staff witnessed abusive and inappropriate behaviour and did not report a safeguarding concern. The CQC found that reasons for staff not raising concerns when they should have done included a belief that managers did not take concerns seriously and did not act due to favouritism. Some staff feared repercussion.
The CQC's report indicates these concerns were with foundation: when staff did raise concerns, managers did not act on them and take steps to safeguard patients.
In one example, where staff raised concerns about practice there was a delay of over 500 days before a safeguarding notification was sent to CQC and action was taken to investigate the concerns.
There were deficiencies in recruitment, supervision, assessment, monitoring and management of risks. Managers did not discover further incidents of abuse and poor staff practice through audits of CCTV – though the evidence was clearly there to be seen and it appears to have been Cygnet's expectation that incidents involving restraint of patients would be reviewed.
Not surprisingly, the CQC concluded that a poor organisational culture increased the risk of harm to patients, including abuse and human rights breaches.
The provider, Cygnet, also ran Whorlton Hall, where undercover filming aired by Panorama in May 2019 exposed staff intimidating, mocking and restraining patients with learning disabilities and autism.
The statement released by Cygnet this week stating it has "zero tolerance" approach to any kind of abuse (very similar to the statement they released last year) does ring somewhat hollow in the circumstances.
It is unlikely though that this is a scandal confined to one particular organisation. Whorlton Hall had recently been acquired from another organisation, the Danshell Group. Winterbourne View was run by the now defunct Castlebeck. There have been reports of abuse at services run by other major mental health providers including St Andrew's Healthcare.
As a lawyer specialising in abuse claims I have heard stories of many more, which have not come into the public domain.
An issue can be that there is a lack of evidence to corroborate residents' disclosures and families' suspicions.
The Yew Trees CQC report notes that inspectors reviewed all incident records relating to the episodes of CCTV they requested: 45 per cent of the reports did not align with the CCTV footage. Staff did not accurately record the descriptions of the incidents and none of the incident forms recorded inappropriate staff behaviour. In my experience, it is uncommon for them to do so. Systemic abuse of this sort takes place behind closed doors; it is hidden from outsiders, including funding organisations and the regulator. An earlier inspection report in April 2020 had described staff at Yew Trees as discreet, respectful and responsive when caring for patients.
CCTV recording of staff interaction with patients is therefore, sadly, essential and it must be mandatory for health and care placements looking after vulnerable people both to have this and to review it, where there is any incident involving a patient.
To ensure this is properly done, I would also call for the introduction of a duty of mandatory reporting of suspected abuse in regulated activities. In other words, it would be a criminal offence to see or hear of inappropriate staff behaviour like this and not make an immediate safeguarding notification.
Training alone cannot be the answer – and the effectiveness of training on restrictive physical interventions and safeguarding should be reviewed. I have been concerned for some time that training on physical handling strategies may create a risk that these are used more extensively than they would be otherwise. The failures at Yew Trees occurred despite records showing 96 per cent of staff had received safeguarding training.
However, my overall view is that measures like this to try to make inpatient placements for people with learning disabilities safer are just not tackling the underlying problem: which is that we must end the detention of people who are autistic and / or have learning disabilities.
We do not need more reports and inquiries to tell us this. Time and time again the evidence has shown that individual human rights simply are not protected by an institutional model of care. We must support people with learning disabilities to stay in their communities and live an ordinary life.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.