Mental health leaders must take an “it could happen here” approach to rooting out “toxic and closed” work cultures, in the wake of abuse exposed last week by Panorama.
That was the message from NHS England national mental health director Claire Murdoch in a letter to mental health, learning disability and autism provider leaders last week, after an undercover reporter revealed abuse of patients at the Edenfield Centre hospital, Greater Manchester.
Panorama filmed staff assaulting, inappropriately restraining and secluding and verbally abusing and humiliating patients at the medium-secure hospital run by Greater Manchester Mental Health NHS Foundation Trust.
Greater Manchester Police and nurses’ regulator the Nursing and Midwifery Council have begun investigations into the abuse, and the trust has suspended staff and commissioned an independent review of the service.
‘Hearbreaking and shameful’ footage
Murdoch described the programme’s footage as “heartbreaking and shameful”, but said that leaders needed to proceed on the basis that such abuse could be happening elsewhere, and take immediate actions to review their safeguarding systems.
Panorama was tipped off about the Edenfield Centre by a member of staff, prompting whistleblowing charity Protect to say that this illustrated failings in the health service’s “speak up” policy to empower staff to raise concerns.
Murdoch said mental health providers should review speak up arrangements, adding that abuse was prevented by, among other things, leaders and senior clinicians who had an open door and created “a safe environment for people to speak up about poor care”.
She urged leaders to ask themselves whether they were sufficiently visible, and heard enough from all staff on their wards, including healthcare assistants, cleaners and porters.
Paramount importance of patient voice
Murdoch also stressed the paramount importance of hearing from patients and their families, highlighting that those at Edenfield had reported the abuse they had experienced.
She said organisations needed to consider introducing peer-led support to enable patients to have their voices heard.
“In your own organisations you must ask how you are not only hearing the patient voice, but how you are acting on it,” she told leaders.
When people and families tell us things are not right as leaders, we must take action.”
In the light of the “role inappropriate use of restrictive interventions played in the unsafe treatment of patients” at Edenfield, she said leaders would need to “double down” on efforts to reduce levels of restraint.
This should include reviewing the use of segregation and seclusion on their wards and plans to remove patients from these settings.
They should also review arrangements for advocacy, complaints and patient care and treatment reviews, she added.
Murdoch said NHS England would bring forward the rollout of a programme to improve the quality of inpatient mental healthcare, which she hoped would tackle the root causes of unsafe care.
She urged leaders to feed back on how the programme should be developed by emailing its head, Liz Durrant.
‘Act now to tackle toxic and closed cultures’
Murdoch added: “Clearly, there is positive work already in train across many parts of the country, but
we must act now to ramp up that action to prevent the formation or perpetuation of toxic and closed cultures, and tackle unacceptable practices; the mindset that ‘it could happen here’ must be front and centre of each organisation’s response to what we collectively witnessed.
“We must prioritise listening to the people we serve and their families and taking effective action when they tell us something isn’t right.”
In response to the letter, the NHS Confederation’s mental health network, which represents sector providers, said it welcomed NHS England’s response to the Panorama programme.
Leaders ‘doing everything in their power’ to prevent abuse
“Such abuse, lack of care and basic respect for patients must never be tolerated anywhere,” said network chief executive Sean Duggan.
“Leaders will be taking a forensic look at the policies and processes they have in place across the services they manage to ensure that patients, family members and staff are listened to and truly heard when they raise concerns about care provision.
“They will also be doing everything in their power to ensure that this kind of practice never happens again, patients and their families have the right to expect safe care delivered to the highest of standards.”
Source: Community Care, 4th October 2022