In recent times we have seen sickening revelations about physical abuse in care homes, neglect of hospital patients and sexual exploitation in children’s homes and elsewhere.
For me, the most worrying aspects of these tragic events is how often the abuse was allowed to continue, even after victims, families and professionals had tried to raise the alarm. It is chilling to think of how many individuals could have been spared their ordeals, but were let down for reasons ranging from a failure to implement shelf loads of policies and recommendations to the stigmatising of victims, the silencing of whistle-blowers and, at worst, wilful cover- ups.
The Independent Inquiry into Child Sexual Exploitation in Rotherham is scathing about the lack of effective scrutiny, the repeated failure over 15 years to deal with serious criticisms and the fact that members of the Rotherham Safeguarding Children Board rarely checked whether policies and procedures were being implemented.
Shadow home secretary Yvette Cooper MP has already identified the ‘Independent’ Police Complaints Commission as unfit for purpose, but theirs is by no means the only channel for complaints in which the public have lost faith, frequently frustrated by months of waiting for meaningless replies and convinced, often with good reason, that institutions and professionals are simply closing ranks against them.
If we are to avert future scandals, we must tackle the culture where abuse thrives, where recommendations are not implemented, where there is confusion over accountability and fear of recrimination for speaking out. One way is to sharpen up the response to early warnings from users and their families, from staff and from those to whom they are accountable. Here ‘s how we could make a start.
Develop consistency across all sectors
Instead of a myriad of recommendations, let’s pool the lessons and work on improving a consistency of approach across all sectors.
Strengthen complaints procedures
The public need transparent, easily accessible complaints procedures, clearly displayed at the point of service provision and online. In most instances this will begin with an internal inquiry, but too often bland and dismissive answers from public bodies leave people feeling internal procedures are a waste of time. Therefore any internal procedure should be time-limited, and organisations expected to record the wider lessons learned from any complaint and to implement change. The next stage, such as an Ombudsman, must be genuinely independent, and must have the powers to insist that any recommendations are implemented.
Improve scrutiny procedures
For all the fine words you on public body websites about scrutiny procedures, it can be hard to locate any information about what scrutiny has been undertaken and what recommendations accepted, never mind a critical appraisal of progress in implementing them. Rotherham is not the only council where you will find pitifully ineffective scrutiny. We must match the drive for greater devolution and local decision making with the upskilling and support needed for more robust scrutiny, which not only identifies areas of potential weakness but drives improvement. We also need much stronger requirements such as mandatory reporting of progress on action plans arising from any scrutiny or inspection activity.
Facilitate whistle blowing procedures
Hand in hand with improving scrutiny and complaints procedures, must go a drive to foster a culture of greater openness and willingness to listen to criticism from within, from staff who may be the first to spot the signs of things going wrong.
Eliminate inconsistency between public, private and third sector services
We need greater consistency in dealing with public, private and third sector providers of services, particularly as many services commissioned by the public sector are now provided by the private or third sector.
The Care Bill, when implemented, will make any care provision that has been arranged through a local authority, including by private and third sector providers, subject to the authority complaints’ procedure and the Ombudsman. However, the same will not apply to care arranged directly with a private provider. Likewise we find that private providers are not subject to the Freedom of Information Act and the Human Rights Act, both useful tools in exposing and challenging poor practice.
When it comes to private health care, whilst in theory consumer protection law could be used by trading standards against a private health provider, in practice this is not happening. It is certainly not an obvious route for a patient or their family, particularly if the patient’s care has been partly in the NHS and partly in private provision: the current situation in which private healthcare providers decide themselves whether a client’s complaint merits investigation is anything but independent: hence calls, including from Sir Bruce Keogh, to extend the health service ombudsman’s remit to include such private provision.
These and other anomalies need to be reformed in order to provide greater transparency, simpler redress procedures and help prevent abuse in future.