The Drowned & The Saved

Last night, I put down my book (Primo Levi’s The Drowned and the Saved) to watch the Panorama programme about the gross failure of care in a UK residential care home.   I went from reading about  inhuman behaviour to watching it on TV.

Whilst I’m not saying that the care home at the centre of Panorama’s programme last night was like a concentration camp, there are certain common themes: the abuse of power, the cruelty that humans are capable of, and the despair of the victims.

A few years ago my gut told me that there was “something not right” about a clinical service I was working with.  There were small things that I saw, read, heard about that when pieced together made me feel uncomfortable.   There was nothing substantial, no evidence of wrong-doing, just this gut feeling.    Then one day a Senior Manager came to me to tell me that they had the same gut feeling.

We spent some time developing a plan and we enlisted the support of  an Occupational Psychologist.  I spoke to my boss, who in turn supported me when I met with our Chief Executive.  My CEO listened and I was given resources for six months and the go-ahead to implement our plan.

But what had caused this service to deteriorate?   My Occ Psych called it “Institutionalism”:   a group of individuals who had worked with each other over a significant period of years with few (if any) newcomers to the group; a group that worked in isolation – often caused due to geographical reasons (but this is not always the case).  As a result, bad behaviour and poor standards creep into the service.

Certainly there was a power-base.  It wasn’t necessarily the senior members of the management team.  There were alliances within the group and the struggle for power was continuous.  However, the greatest threat was the newcomer – the person who challenged “the way we do things round here”.    At first, the group would try to seek an understanding with the newbie, convert them.    But in essence, there were two choices

a) To go “native” – to join the rest of the group with poor behaviour.  Or at least stand at the side and allow it to happen.  They are probably told that even if they do report it – nobody would believe them.  To be honest, for many this option is taken in order to survive.  For a Healthcare Assistant who has been unemployed for six months it is undoubtedly easier to conform, as the other option might lose them their job.

b) To challenge the behaviour.  However, the group would close ranks and there would be signs of bullying and intimidation towards the newcomer.   After a short period of time the newbie will simply move on to their next job.

So the role of a Whistleblower is incredibly important in these situations.  They need to be taken seriously and protected. It’s also important that there is strong HR leadership – patient in executing their strategy, and compelling  in their vision to ensure that the right people are engaged along the journey.

But it’s not easy.  In my case I still distinctly remember a Saturday afternoon when I was at home working. I burst into tears:  not because anything had happened, but because I feared the potential of something happening;  because I was frustrated – if there had been evidence  of misconduct I could have advised on a swifter and more definitive approach (although paradoxically, there had been evidence it would meant that a patient had already been abused).

Was I successful?  In six months – no.  But we had made some fundamental changes, both in terms of personnel and organisational culture.  A robust development plan was being implemented, and I felt assured that the service was increasing its level of clinical care.  But there was still so much more work to be done.

In the aftermath of yesterday’s programme, there have been suggestions that it’s the CEO of the residential care home who’s at fault;  and that the CEO of the CQC has failed in his duty to ensure such care homes are regulated.

I disagree: it’s all our responsibilities to follow our “gut” when we believe that the standards of care aren’t quite as high as we expect them to be.  Senior managers need to listen, and then have the confidence to take appropriate positive action.  If we don’t, we will forever have to carry the burden of our own guilt.


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