The Whorlton Hall Blog by @salsa442 and @dmarsden49

Following the Panorama uncovering yet more systematic institutional abuse for people with learning disabilities Team @WeLDNurses decided we had to chat about it. We had to offer people chance to reflect as well as process our own feelings about this atrocity.

As unpalatable as this is, Whorlton Hall is not the first of these events and will not be the last. Scandals have been happening since investigative journalism uncovered the goings on in the institutions and hospitals across the UK in the 1960's, as such Registered Learning Disability Nurses have grown up – and old - with the spectre of abuse hanging like a Dementor ready to suck the life out of each and every one of us. 

Abhorrent as it might be to acknowledge, abuses like those that darkened our TV screens recently, have been with us long before there were reporters and cameras to record it. At the same time we are much more ready to accept that some services and teams that will be exemplary, that are enabling people to live healthy, safe and fulfilled lives. Between these two possible points of quality is where the most of us live, aspiring to the exemplary. But do we spend much time guarding against becoming dysfunctional in our teams? Do you think those staff including the Registered Nurse set out on their career path thinking one day they'd be on TV, well possibly, but I expect they hoped the context would be significantly different.

69 people contributed to this chat, and with a total reach of over 2 million people, there was some clear interest in discussion, reflection, recognition of the awfulness of the situation, and making plans to minimise the risk of this happening again.

There was a unanimous outcry that the abuse witnessed within the programme was unacceptable, inhumane, degrading and a disgusting abuse of a position of trust.There was also a lot of discussion about the culture within the unit, failure to report and challenge poor care, collusion amongst the staff, poor leadership from the two nurses managing the unit to name a few. There was a culture of oppression with no person centred care and no therapeutic interventions for the people there.

More concerning was the apparent premeditation that was considered prior to the abuse of certain patients within the unit – the deliberate use of male staff for a patient who was frightened of men, the acknowledgment that once CCTV was installed in the corridors they would have to find other areas of the building to abuse people, or be more covert how they hurt people when in corridor areas. There was also regular planning as to how they could trigger a response from certain patients within the unit, deliberately baiting them in order to restrain them was very difficult watching and again shows an appalling abuse of a position of trust.

Was the skill mix right? Would more qualified nurses have supported the leadership team? Was there really a need for 27 staff per shift? Who was supporting the leadership team? Would regular Nhs learning disability nurse support have prevented some of this horror?

One thing that struck me, is that I have seen this before, this was Winterbourne all over again, and if as professionals, we want to make a change, then we must do thing differently, we must start to consider what changes need to be made to protect people with learning disabilities who are in crisis.

I see Assessment and Treatment Units (ATUs) as crisis beds, a mental health/behavioural support emergency department for people with learning disabilities. Of all the crisis/emergency beds, ATUs are the only ones that are routinely commissioned by Nhs, but care is delivered by private providers. Most emergency services are commissioned and provided by the Nhs – why do emergency services for people with learning disabilities have to be different?

I have worked within the Nhs for over 20years, and the current Nhs culture of honesty, open, transparency and person centred care is exactly what is needed in ATUs across the country. And while I’m not saying that all ATUs are like Winterbourne and Whorlton Hall, there is additional governance, scrutiny and support which can be gained from the Nhs systems in addition to training frameworks.

If I am honest, I believe there will always be a need for ATUs – there will always be people in crisis. It is the size, structure and management of these units that needs to be addressed to minimise the risk of further abuse for the people who need them.

Beyond the platitudes hashtags and mottos and memes, we could all do with considering and reflecting, what would the public discover if someone followed me with a secret camera? What implicit messages do I give out through my communication and behaviour and my omissions to challenge, in my day to day work? Are we comfortable with what we are achieving in our lives? Are the team's we work within functioning effectively? Are we satisfied that our team and individuals within it are achieving all they can and are capable of? If not are we and our teams heading toward the exemplar or the other place? 

It’s reasonable at this time to take a step back, to assess and acknowledge our performance, that of our teams and how we put our aspirations into practice and enable our teams to work together to achieve shared outcomes. Within this space of reflection we have a host of topics and subjects to consider, leadership, work place culture, identity, competence, staffing levels and skill mix, organisational learning and what I propose is that WeLDNurses explores one of these topics on a routine basis acknowledging that this is a cast iron action that our community can make a sustained commitment that will keep our distaste of those pictures alive and will have our commitment to improving practice and abuse minimisation made as concrete as we can.