Whorlton Hall: a predictable tragedy?BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4705 (Published 23 July 2019) Cite this as: BMJ 2019;366:l4705
All rapid responses
The editorial on Whorlton Hall by Professor Murphy continues to highlight institutional abuse of vulnerable patients that continues despite improved safeguarding training, care home environments and regulatory systems. The Social Care Institute for Excellence (SCIE) has identified many underlying factors associated with institutional abuse including management, staff recruitment, staffing levels, adherence to policy and procedure, staff training, record- keeping, choice of service levels and dehumanisation. Beadle – Brown et al (2017) argued just moving people out of institutions into community settings does not bring about automatic improvement in quality of life particularly for people with more severe intellectual disabilities as well as complex needs such as challenging behaviour. This requires community services to provide services close to vulnerable patients home and their families, particularly accessible positive behavioural support. There remains little substantial evidence in effective interventions in preventing abuse in people with learning disabilities and the elderly.
We support Professor G Murphy’s and the families’ call to action to invest substantially in community services. We call on the NIHR to fund research in safeguarding and preventing abuse in institutional care. The Transforming Care programme needs an ongoing replacement to work, including an enhanced emphasis on the care of children and young people and of managing transition to adulthood with CQC to evaluate measures such as quarterly corrective action preventives action plans CAPA.
This has been compounded by multiple delays in publication the long-awaited Government Green Paper on social care which appears to have intensified local councils' rationing of much-needed community care. In addition to central changes, all health care professionals visiting institutions need to be vigilant to detect signs of abuse and take responsibility to raise safeguarding concerns early. The RCGP adult safeguarding toolkit is useful guidance for primary care health professionals. Inevitably further abuses will come to light in future at other care institutions but we must continue to minimise the risks and work both at a system and individual level to shine a light and improve the quality of life of all vulnerable people.
Dr Matt Hoghton, FRCP FRCGP GP Clevedon Medical Centre, Old Street, Clevedon Bristol BS21 6DG and ex RCGP Learning disabilities champion 2009-2012
Dr Kirsten Lamb, MRCGP Retired GP, NHS Herts CCG clinical lead for learning disability and chair of RCGP special interest group for Learning Disability
1. Murphy Glynis. Whorlton Hall: a predictable tragedy? BMJ 2019; 366 :l4705
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Competing interests: No competing interests