It is now two weeks since Panorama’s findings at the Edenfield Centre in Manchester were published. Since then, Greater Manchester Mental Health NHS Foundation Trust (the Trust) has begun disciplinary action, by suspending staff, commissioning an independent clinical review and deploying additional senior clinical and operational management staff to ensure that appropriate working practices are being followed. Clinical reviews have been carried out in relation to affected patients and advocacy support has been put in place for patients, carers and families. The Edenfield Centre has also been closed to new patient admissions.
Other organisations are taking action too. Greater Manchester Police has begun an investigation into the allegations and the CQC has suspended the Trust’s current Good rating for Forensic Services whilst it finalises its findings from inspections that were carried out in response to the emerging concerns from Panorama. The CQC says it has already taken enforcement action and will take further action if necessary.
Panorama filmed scenes that should never take place in a health or social care setting. But as we have seen from Winterbourne View, Whorlton Hall – and now the Edenfield Centre – these scenes are not always isolated cases. The natural response after revelations like these is one of shock and horror at how things could have gone so badly wrong. In the initial aftermath, the immediate priority is to ensure the safety of those affected, followed by a robust investigation, with appropriate consequences for those responsible. Longer term, feelings of shock and horror need to translate into serious action across the sector: the responsibility of getting things right lies with all organisations involved in health and social care, from providers to regulators, and from local authorities to central government.
It is clear from Panorama’s findings that a toxic, abusive culture had been allowed to develop at the Edenfield Centre. Patients were bullied, taunted and inappropriately restrained; staff did not listen to them, and concerns were ignored and overlooked. Panorama was reportedly tipped off about the Edenfield Centre by a member of staff, which raises obvious questions about why that staff member did not raise concerns with management and regulators, and if they did, why those concerns appear not to have been addressed. High-profile abuses in health and care often bear the hallmarks of closed cultures: teams working in isolated settings with embedded management teams where abuse and human rights breaches go unreported. This has been a particular danger throughout the Covid-19 pandemic where services have been provided in a more isolated way, laying the foundations for closed cultures to develop within organisations.
Clearly, more needs to be done to tackle closed cultures and to stop them from developing in the first place. Listening to people and addressing concerns at the earliest opportunity are key, and this must be a priority, not only for providers, but for the regulator. Since their strategy launch, the CQC has been clear that it wants to ensure that people who are supported have a stronger voice. It promised to regulate with an approach that is driven by people’s experiences, to check whether there is a risk of poor culture going undetected and to act where improvements are not made quickly enough. The CQC’s draft inspection timetable suggests that there will be an ongoing assessment of services as information becomes available, with the idea that judgements will be updated more quickly. If effective in practice, these aspirations would clearly help to ensure that people are listened to and that concerns are raised earlier, with responses being better monitored. In turn, that would help to prevent closed cultures from forming.
Therein lies the problem. Whilst the intentions behind the CQC’s aims and ambitions sound promising, we are not seeing them being reflected in the CQC’s regulatory approach. As the BBC identified, the CQC noted that there was ‘strong’ leadership at the Trust and only suspended its Good rating for Forensic Services after the BBC shared information from its filming. Clearly, the CQC has some way to go in adjusting its proposed regulatory methods to make sure they work for providers and keep people safe. In particular, the CQC needs to make sure that its assessments are wide-ranging and thorough, rather than a simple analysis of issues in isolation. Not only does that help to ensure balance and fairness for providers, but it also means that concerns are less likely to slip through the net.
The CQC recently paused the implementation of its new strategy, and whether that is related to the findings at the Edenfield Centre or not, this should allow time for reflection on the failures at the Centre and how they could have been prevented. In line with the CQC’s core themes, that learning must then be shared across the sector so that organisations can work together to make sure scenes like those filmed at the Edenfield Centre never happen again.