In a personal post, Alison Millar, who represented survivors of abuse at both Winterbourne View and Veilstone care home, gives her opinion on the future of residential care for adults with a learning disability.
It’s around five years since I first heard of the appalling abuse at Veilstone care home in Buckland Brewer, near Bideford – one of six private care homes in Devon for adults with a learning disability run by the now defunct Atlas Project Team Limited.
Although in my work as an abuse claims lawyer I regularly hear stories of mistreatment and neglect, I remain as shocked and angry now as I was at first about the treatment meted out to my clients and the other residents who were said to demonstrate ‘challenging behaviour’.
This was treatment that I believe amounted to torture, pure and simple, of vulnerable adults, who during the duration of their placements must consequently often have been in a condition of fear, confusion and distress.
As has now been exposed, at Veilstone and at Gatooma, its sister home in Holsworthy, seclusion rooms were in regular use. Tucked away behind the washing machines or a laundry these were bare, effectively empty of furniture – perhaps a punctured mattress on the floor – without heat, a television or radio or any toilet facilities.
Residents would be taken there forcibly and left for hours, even overnight. Sometimes the residents would wet or soil themselves. They would not be let out until they had been deemed sufficiently to demonstrate their compliance by performing a care task; this could include being forced to clean up their own excrement.
The reason for inflicting this most inhuman and degrading treatment could be that the resident had exhibited violence, distress or non-compliance with their care plan.
Veilstone and Gatooma were run along a strict behaviourist model of care. Care staff were told to look out for antecedents of challenging behaviour or ‘precursors’.
This included behaviour such as asking a question repeatedly, bodily functions such as enlarged pupils, or non-compliance such as not wanting to have a shower or do the ‘domestic incentives’ (such as cleaning the toilets, hoovering, gardening etc) which seemed to have taken up a large part of the residents’ days.
Effectively, the residents, who had neurological conditions such as autism, learning difficulties and / or mental disorder, were being punished for exhibiting features of their own individuality and humanity. Punishment and reward was used at Veilstone and Gatooma to train vulnerable people, as you might an animal, to do what their carers said.
In the circumstances, I welcome the convictions of some of the former staff and managers of Atlas Projects following the long-running Operation Baddeck (not all of the staff were convicted and some staff, indeed, gave evidence for the prosecution).
Devon and Cornwall Police must be commended for the hard work they put into what was demonstrably an enormously complex and challenging investigation.
It is significant that the convictions included the person who was effectively the managing director of Atlas and managerial staff – showing that employers who operate an institutionally abusive regime of care can be prosecuted and punished for their failure to discharge their duties.
As we now focus on securing civil accountability and redress for the former residents, however, some wider and unsettling questions remain to be answered. Firstly, how did so many members of the staff at Atlas become complicit in what was, as the prosecution in the criminal proceedings submitted, a regime of cruelty?
Junior staff members gave evidence in the criminal proceedings that they were largely following the training that they had been provided with.
The Trial Judge found as a matter of fact that the way things developed and deteriorated was not due to bad faith or malign intent but it was the result of a failure to take reasonable care of the residents: decent people were beguiled into the regime, thinking that it was not only justified but beneficial.
When this is compared to the degradation and intimidation of the residents that went on, what does this say about how we value and view people with learning disability, or indeed other people in society who are vulnerable and unable effectively to speak for themselves – this state of affairs is spookily reminiscent of the mistreatment of elderly patients at Mid Staffordshire Hospital.
One wonders whether staff who had misgivings were pressured into keeping quiet.
I agree with the calls for a mandatory reporting duty to be introduced into our child and adult protection system. That would introduce responsibility and accountability to help transform our culture of safeguarding and protect whistle-blowers from repercussions by making it mandatory to report concerns.
Further, my clients did not choose to live at the Atlas homes – these placements were chosen and commissioned for them by health and / or social services authorities.
Why did the commissioners – and The Care Quality Commission, the regulator of care services - not pick up the gross deficiencies of the Atlas model? To the contrary, Atlas was seemingly regarded as an organisation that had a track record of good outcomes for individuals who challenged other services or would otherwise be in inpatient settings.
The family of one of my clients started to express concerns at a relatively early stage about restrictive aspects of the Veilstone regime, such as the placement imposing their own value judgments as to what was “appropriate” or “not appropriate” behaviour without reference to family members or external professionals who knew the client.
Staff listened in to the family’s calls and criticised them afterwards for not talking to the client in an “age appropriate” way; treasured clothes and possessions were confiscated. The care home even challenged the client’s diagnosis of learning disability and prevented him from using the sign language he used to help him communicate.
Family contacts were cancelled when they did not fit in with the regime’s use of incentives to reward behaviour deemed positive.
These practices were clearly deeply worrying for a placement that was supposed to be supporting the client and making decisions in his best interests where he lacked capacity – a process which must by law take account of the views of family and carers.
Yet the family’s concerns were primarily seen in the context of relationships with Veilstone rather than ‘red flags’ of a regime that was oppressive and disregarded the service users’ human rights.
In my experience of working on claims for abuse and ill-treatment of adults at risk of harm, family members – with their unique insight into the personality, behaviour and needs of the person being cared for – are often the first to spot where something is ‘off’ or wrong.
However, their concerns are not always investigated with the seriousness they should be: too often they are seen as an unwanted interference. And many service users, of course, do not have family members who are able to visit or advocate for them.
Fundamentally, this is yet again another scandal arising out of the institutional abuse of people with learning difficulties. It is now 6 years since the Winterbourne View abuse scandal was exposed.
It is almost 20 years since the Longcare Inquiry (1998), which was established following the exposure of widespread abuse at two large residential homes for adults with learning disabilities in Buckinghamshire.
A positive culture with strong leadership rooted in human rights and staff empowered to challenge any practices inconsistent with these values is clearly vital to ensuring that services are decent and humane.
However, whilst there will undoubtedly be residential homes around the country providing an excellent standard of care, the list of scandals in learning disability residential services is already far too long.
I have no confidence, given the history, that the Atlas scandal will be the last one. Surely it is well overdue that we question whether this is a safe or effective model of care.
Clearly, it may not be easy to support someone in the community who is exhibiting aggressive and destructive behaviours – behaviours which may indeed be a reaction to traumas experienced or witnessed in other residential settings. But Atlas Project Team claimed to provide specialist care for people with a learning disability at a cost of up to £4,000 per person per week.
The starting point should be that people with a learning disability should be supported to live in the setting of their own choice. Often this will be their own home in their local community, unless they should express some other preference.
Residential care should be absolutely the last option and there should be proper contingency planning in community support packages and better preparation for important transitions such as when someone finishes school or college to avoid admission to inpatient settings or units as a crisis response.
I would support proposals for statutory change – such as the proposed LB Bill (named after Connor Sparrowhawk, ‘Laughing Boy’, who died an entirely preventable death in an inpatient unit) – to bring an enforceable right to community inclusion into effect.
Residential care and segregation for people with learning disabilities should finally be consigned to the past.