CQC to overhaul learning disabilities regulation after scandal

The announcement from the Care Quality Commission comes after an undercover BBC Panorama investigation earlier this month showed patients at Whorlton Hall being mocked and intimidated at the hands of staff.

After the programme aired, the CQC issued an apology for missing “what was really going on” at the 17-bed unit in County Durham during its last inspection regime. 

The scandal came eight years after Panorama revealed similar atrocities at Winterbourne View, a private hospital for people with learning disabilities in South Gloucestershire.

In wake of the revelations, the CQC has commissioned a review of its regulation of Whorlton Hall between 2015 and 2019.

“These hospitals are completely inappropriate environments for people with learning disabilities”

Dan Scorer

In a statement today, the regulator said this would “include recommendations for how its regulation of similar services can be improved, in the context of a raised level of risk of abuse and harm”.

Dan Scorer, head of policy and public affairs at the learning disability charity Mencap, said he hoped the review would lead to a “much-needed inspection regime change”.

“These hospitals are completely inappropriate environments for people with learning disabilities and/or autism and leave them at increased risk of abuse and neglect,” he told Nursing Times.

“It is clear that the regulation of these hospitals is inadequate and is failing people with learning disabilities and/or autism who are trapped in these ‘modern day asylums’,” Mr Scorer said.

“While the CQC has taken the positive step by commissioning an independent review into its failures to regulate Whorlton Hall, we need a guarantee from both the CQC and government that this review will lead to a much-needed inspection regime change to ensure that they do not fail to uncover systematic abuse in hospitals ever again,” he added.

“It’s systemic abuse and it needs to get under what creates those cultures”

Jonathan Beebee

He called for “urgent action” from the government and NHS to follow through with their pledge to replace these hospitals with good quality support in the community.

Jim Blair, health advisor to the human rights disability charity BILD, and associate professor in learning disabilities at Kingston and St George’s universities in London, said a review of the CQC’s inspections of Whorlton Hall was “essential”.

“The findings must be acted on within a specific time regulated manner to ensure embedded systematic actions can be taken to ensure better inspections going forward,” he added. 

Jim Blair

Jim Blair

Jim Blair

Himself a clinical specialist adviser to the CQC, Mr Blair said he had “for a long time” called for a new key line of enquiry to be included as part of the regulator’s inspections looking at staff attitudes and values. 

He urged nurses to report mistreatment of people using these services when they saw it but said better systems also needed to be put in place to support them to do so.

“Nurses must always stand up and challenge poor care wherever it occurs but must necessarily be supported to do so within a genuine environment of support to do so,” Mr Blair told Nursing Times.

“This is something I feel needs to be addressed by the Nursing and Midwifery Council in partnership with providers as well as commissioners as a matter of urgency,” he noted.

Jonathan Beebee, a member of the Royal College of Nursing’s Learning Disability Nursing Forum, welcomed the announcement but said he believed the situation could warrant a public inquiry. 

“Nurses must always stand up and challenge poor care wherever it occurs”

Jim Blair

He said changes needed to be made to address what he labelled a culture of abuse in hospitals like Whorlton Hall, which has now been shut down. 

“They get these cultures developed where it’s us and them, we are the custodians and they are the bad guys, we have got to keep them in line, we’ve got to make sure they know their place,” Mr Beebee told Nursing Times. 

“The culture just develops and you can even put really good people into those cultures and they will get carried with what is expected of them, so it can make good people act bad,” he said. 

“It’s systemic abuse and it needs to get under what creates those cultures, what leads to creating cultures that breed abuse and how do we avoid that,” he added.

Mr Beebee called on nurses to speak up if they saw people with learning disabilites being treated poorly in care settings.

“There’s a saying, ‘the standards you walk past are the standards you accept’,” he said. 

“If you see something that you are not happy with, we have got to be the voice of the people we support…we have got to report it,” added Mr Beebee, whose “frustration” with the lack of good services for people with learning disabilities led him to start his own home care company called PBS4.

While the CQC had made good progress since Winterbourne View, “there’s clearly lots more to be done”, he said.

The CQC has also asked former senior civil servant David Noble to undertake a separate independent review into how it dealt with concerns raised by Barry Stanley-Wilkinson, a former CQC inspector who claims he wrote a report about Whorlton Hall in 2015 rating it “inadequate” but it was never published.