Date published: 9 November 2022

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Among the many political changes and focus on the cost of living in the media in recent months, there have been two television documentaries that will have alarmed anyone who works within the NHS or has loved ones within mental healthcare. BBC Panorama had an undercover journalist at a medium secure unit which revealed worrying practices and standards of care while Channel 4’s Despatches also filmed secretly and exposed equally shocking culture on two mental health wards.

Anyone who watched them couldn’t fail to be affected by what you saw and it’s natural to reflect on the issues highlighted by those two documentaries. As Chief Executive of one of the largest mental health and community health Trusts in the country, it would be remiss of me, and our organisation. if we didn’t examine our own practices.

We asked ourselves some very searching questions in the aftermath of both documentaries. Here at Mersey Care we strive to deliver what we call ‘Perfect Care’, which means we must aim for the highest possible standards in everything we do. I see it as about us all having a permanent continuous improvement mindset.

Our commitment to Perfect Care should be key to the way we care for our patients, service users and carers, the environment we provide to allow recovery and a healthy working environment for our staff where they feel supported and able to raise any concerns in psychologically safety. We strive for excellence in everything we do but that doesn’t mean everything always works as planned – the key is to be self aware enough to look at what caused any errors and learn from them so they aren’t repeated.

Below is a slide put together by our team preparing for this week’s inspection by the Care Quality Commission (CQC) of our high secure services. You will see from the list of actions and recommendations below that this will be an ongoing process where we will continually challenge our thinking and our practices.

The two documentaries are an important reminder that abuse can happen and we must remain vigilant and responsive in everything we do. What do we do to ensure closed cultures don’t become the dominant culture within healthcare and how do we best serve some of the most vulnerable member of society within our inpatient and other services?

The CQC definition of a closed culture is “one that can lead to harm, which can include human rights breaches such as abuse.” Some of the main features include:

  • Staff and/or management no longer seeing people using the service as people
  • Very few people being able to speak up for themselves. This could be because of a lack of communication skills, a lack of support to speak up, or fear of abuse
  • This may mean that people who use the service are more likely to be at risk of harm
  • This harm can be deliberate or unintentional. It can include abuse, human rights breaches or clinical harm.

What we’ve learned at Mersey Care is that it's important any organisation remains connected. For example, in 2012/3 we treated high, medium and low secure mental health services as separate business units who had their own way of doing things. What we’ve done since then is create the Secure Care Division which allows both patients and staff to move between different sections and gives a sense of continuity as well as opening eyes to improvements and alternative cultural practice.

We’ve also established the HOPE(s) model, a human rights based approach to working with individuals in segregation developed from research and clinical practice and introduced Restorative Just and Learning Culture to the organisation, which aims to provide a safe space for our workforce to report issues without fear of personal consequences. We have also supported a robust Freedom to Speak Up process, which is illustrated by the below animation.

The immediate instinct following the documentaries is to be concerned about undercover journalists and what they might reveal, which is the wrong thing to focus on.

The real question is that if people get around your processes, then there should be nothing we shouldn’t be prepared to talk about and explain so the outside world has a better understanding of our care for some of the most vulnerable patients in society.

We should not be scared to challenge our thoughts and the way we do things. One of the many changes we’ve made since these documentaries is each ward holding an extraordinary community meeting to encourage patients and service users to talk about the programme and any issues it may have raised for them.

Many patients have responded by saying how happy they are to be cared for by Mersey Care, which is good to hear but does not mean we have achieved our goal of ‘Perfect Care.’ It’s only by striving to be better and pushing the boundaries, supporting our patients and workforce, that we should prevent a repeat of those shocking scenes from the two documentaries.

I’m very happy that you’re proud of what you do, but we must always believe in better. We must remain curious about our problems and determined for change. Complacency isn’t just undesirable, it’s the start of a dangerously slippery slope.

Thank you all for everything you do

Prof Joe Rafferty CBE

Chief Executive