- CQC should carry out more unannounced inspections, says report
- Inspectors rated Whorlton Hall “good” twice despite safeguarding concerns
- CQC says it welcomes recommendations to improve
The scandalous failings at Whorlton Hall exposed by undercover reporters could have been detected sooner by the Care Quality Commission if it had carried out more unannounced visits, a new independent review has concluded.
Clinical psychologist Glynis Murphy’s report, published today, was commissioned by the CQC shortly after secret filming by BBC Panorama showed staff abusing patients with severe learning difficulties at the privately run 17-bed unit in Durham.
Whorlton Hall was closed and 10 staff were arrested following the Panorama programme, which was aired in May 2019.
In the wake of the scandal, fundamental concerns were raised about the CQC’s involvement. The watchdog had twice given the unit a “good” rating, despite concerns being raised about the service, including on safeguarding and staffing, it emerged.
Professor Murphy’s investigation covered seven CQC inspections of the unit between 2015 — when whistleblowing concerns were first raised — and 2019.
The report said: “It is clear… that there are a number of improvements that are needed to the CQC process.
“However, given the inspection and regulatory process in place at the time, it may be that abuse could not have been recognised. None of the CQC inspectors saw punitive or abusive behaviour by staff (though three did say they felt uncomfortable and uneasy in the service).
“Where there is a small group of devious staff who deliberately mislead both those engaged in inspection and regulation processes… it is very difficult to detect their actions, especially when service users are very vulnerable and have limited communication skills.
“In hindsight, unannounced visits, especially at evenings and weekends, may have helped to detect failings in the service.”
It also recommended:
- Use of CCTV to detect potential staff abuse;
- The CQC should make available data on abuse allegations, complaints and concerns;
- Inspectors should prioritise in-depth service user interviews, in private; and
- The CQC should consider enhanced inspections at services at risk of failings, including more time interviewing service users, staff surveys and interviews with former staff who left after a short period.
The CQC said it had already started to develop methods to track abuse allegations and staffing issues at services. It was also considering evidence and ethical issues around using CCTV surveillance to track potential abuse, and it was drafting a new set of guidelines on the types of services it would give registration to in the future.
The report also recommended the regulator should stop registering services such as Whorlton Hall which are in “very isolated… unsuitable buildings” with “out of date models of care” for people with learning disabilities or mental health conditions.
The report defined “out of date” models of care as being “difficult for families to access, [as well as having] high numbers of unqualified staff, poor provision of activities, low numbers of qualified nurses, and insufficient MDT presence”.
“[The CQC] should not allow expansion of such services that already exist and should consider how best to alter those that they have already registered,” the report concluded.
During the period concerned, Whorlton Hall was mostly run by private provider the Danshell Group, although it was later taken over by another private provider, Cygnet.
When the CQC rated Whorlton Hall as “good” overall in a report published in December 2017, a total of 33 allegations of abuse from patients and staff at the hospital had been made in the previous 12 months, and there were 128 incidents of restraint in the preceding six months.
Staff turnover at the hospital stood at 54 per cent, and there were allegations by both patients and an ex-staff member about “serious assaults” on patients by staff — which were either retracted by patients or, in the case of the ex-staff member, dismissed as “malicious” by police.
An unpublished 2015 report, by then-inspector Barry Stanley-Wilkinson who later turned whistleblower, found 129 incidents of restraint at the hospitals in six months, four serious incidents and five allegations of abuse from patients against staff.
In June 2016, Whorlton Hall was rated as “good”, despite finding there had been 188 restraints in six months and seven serious incidents. A focused inspection a year later, which rated Whorlton Hall’s effectiveness as “requires improvement”, found there were 17 serious incidents in six months — and police had been called in to six of them.
CQC chief executive Ian Trenholm said: “We welcome Professor Murphy’s review which makes a number of recommendations for how we can improve our inspections and regulation of services similar to Whorlton Hall in the future.
“We will be incorporating the recommendations into our new strategy to ensure we improve how we regulate mental health, learning disability and/or autism services to get it right for people who use these services.”
The independent review did not interview Cygnet staff members after the provider raised concerns about the “terms of reference” and the ongoing criminal investigations.
HSJ has approached Cygnet for comment.