The abuse revealed by Panorama at Edenfield Centre in Manchester is truly shocking. While the failings of Greater Manchester Mental Health Trust are a personal tragedy for the people they were supposed to care for, that is compounded by the fact the lessons to be learned are far from new. 

While the obvious comparison is with the scandals at Winterbourne View and Whorlton Hall, because they took place within similar settings, the need for boards and senior managers to address the risks associated with toxic cultures is well known. As we commented following the prosecutions of Greenfeeds Limited and Aster Healthcare, it is for boards to ensure that their organisations have a positive culture which promotes the safety and wellbeing of both employees and those they support. 

Both the sad events at Edenfield and the recent investigation into the toxic culture at the South East Ambulance Service demonstrate the need to listen to concerns raised by whistleblowers, as well as people provided with care and their family and friends. Too often organisations take a defensive approach to complaints, rather than seeking to identify whether the concerns may give an insight that something is going wrong. When organisations show that they respond positively to complaints and concerns, they can also create an atmosphere in which everyone feels empowered to highlight risks and errors without the fear that they will be ostracised and bullied. 

While whistleblowing can be an important safety net when things go badly wrong, in an organisation which actively promotes the raising of concerns, speaking out to ensure the best interests of those you support should be a matter that is accepted and welcomed by all.

The abuse revealed at Edenfield Centre also highlighted that it is essential that those supported are facilitated to raise complaints and concerns in a forum that is appropriate to their needs but also where those listening to the concerns have an element of independence from the practical day-to-day delivery of care. It was evident that those at Edenfield and their families were disillusioned, feeling that their concerns would be ignored or it would be portrayed as they were 'making it up'.

In principle, the CQC could fulfil the role of the independent listener described above. In fact, over the last two years, since introducing their new regulatory strategy, the CQC has promised to focus resources on the services posing the greatest risk and to put the voice of people being supported at the heart of their work. Yet, it does not feel this aspect of the CQC's strategy is operating effectively. So often in our work, we see the CQC give far greater weight to isolated concerns (which with only limited investigations could be found to be unjustified) than objective evidence of positive outcomes and overwhelming complimentary feedback. Yet, Greater Manchester Mental Health Trust’s Forensic and Secure services were rated 'good' until that rating was suspended as a result of the broadcast.

An ineffective regulatory strategy fails all those within the system. All those involved in the sector would welcome a regulatory approach which is effective, consistent and fair. Against that background, it appears all the more frustrating that in this case concerns raised by those being supported and their families were overlooked and that once again there was a failure to look for wider evidence to demonstrate whether their concerns were justified. 

The poor outcomes and care provided in this institutional setting also reinforce the need for the CQC to take positive action to encourage the development of a wider range of community placements (see our recent blog on the introduction of the Mental Health Act Reform Bill). There is a clear pattern that the worst scandals of this type have arisen in large institutional settings. There is an equally clear pattern that the number of people living with learning disabilities and autism in unsuitable placements has remained stubbornly high despite repeated government policies and initiatives. As outlined in our earlier commentary, the CQC must work with providers to adapt their approach to the registration of new services to encourage the development of appropriate placements for those with higher acuity needs.

Finally, what should not be lost as we all reflect on the Panorama documentary is the fantastic work that the vast majority of those in the health and social care sector do each day. It is the role of all of us (including the CQC) to ensure as well as detailing the impact of negative cultures, we highlight the immeasurable impact of positive cultures that breed safe and happy environments for those receiving and providing care.