“A report by an United States
Inc. found that there were over
700,000 “patient safety events”
affecting 667,828 Medicare
beneﬁciaries from 2007 through
2009. These events resulted in
79,670 patient deaths and cost
the Medicare program nearly
$7.3 billion. [Patient Safety in
American Hospitals March
Not in residential care
[Source: Action on Elder Abuse Data - relative risk of abuse]
So why do we keep falling back
on the institutional response?
“It is not easy. What do we do when we don't
know what to do? I want that guy out of sight,
out sound, out of mind… The situation keeps
cropping up in our society, when no matter how
liked, esteemed or loved, some people become
insufferable to others. No one they know wants
to live with them. They are not breaking the law,
but they arouse in those around them such
urgent feelings of pity, worry, fear, disgust, ager,
exasperation, concern, that something has to
be done. A social worker or psychiatrist is
R D Laing
Institutions didn’t come into
existence because they were
safer than communities. Instead:
• The loss of jobs and family
structures in the countryside
• Industrialisation and the lack
of work and support
opportunities in the towns
• Eugenic panic and the fear of
difference and the fantasies of
We know only too well that
institutions are unsafe.
Connor Sparrowhawk drowned
in a bath in an assessment &
Torture at Winterbourne View, a
specialist residential care unit
“There was a lack of care,
compassion, humanity and leadership.
The most basic standards of care were
not observed, and fundamental rights to
dignity were not respected. Elderly
and vulnerable patients were left
unwashed, unfed and without ﬂuids.”
Even for people in ‘community care’ services
institutional practices continue and safety is
often imperilled in the name of safety.
1. Michael lived in residential care home.
2. He was threatened by the police, even placed in the
cells, after he got angry because he was not free to go
to the ice cream van in his street.
3. Yet he walked home everyday from the day centre - by
himself - because the day centre was ‘boring’.
4. And his mum tried to quietly teach him independence
skills - although worried that she’d be told off by social
Safety sometimes does demand control - but
only in the most extreme of circumstances and
after considering all the other possible options.
There is an everyday totalitarianism for
many people living in institutional care.
Freedom is replaced with order and control.
Love is replaced with management.
But it’s not just institutions that are unsafe…
Communities can be very unsafe too, especially
for people in real poverty.
These are 44 women working with WomenCentre in
Halifax. Each column represents one woman and the
combination of problems with which they have to battle
WomenCentre have a
remarkable success rate in:
• Reducing abuse and
• Keeping children safe
• Keeping women out of prison
• Helping women get their lives
back on track
• Increasing mental health
• and much more…
WomenCentre’s success is built on a
sophisticated and holistic model of support
They have also developed and led critical strategic developments to
prevent abuse and family breakdown across the whole community.
So does modern social work support the
kinds of relationships between
professionals and citizens which really
Care management systems do
not always seem as ﬂexible
enough to allow the right mix of
hands on work and
• The emphasis continues to be
in placing people or setting up
packages of support.
• People recognise that others
can - sometimes - take
leadership roles - but the
system doesn’t support it.
• Those who need the most
support often lose out as time
is spent working with others.
Patrick left the institution with the most
severe reputation for dangerous
behaviour. So what made Patrick safe?
• Independent living for people
with very complex needs
• Managed personal assistants
- recruited just for you
• Individual Service Funds -
managed ﬂexible budgets
• Totally bespoke support -
designed around you
Practical guidance to help people
develop their own support solutions
Does modern social work develop the right
kinds of skills to enable social workers to
create community-focused support
feared that self-
the risks people
face. But it seems
to leave people
control and well
correlated. It is
being in the
control of others
that is most risky.
1. Capacity - assume I can decide
2. Speciﬁcity - don’t generalise any
3. Selection - let me pick any
4. Suitability - ﬁnd a suitable person
5. Best interest - pay attention to
6. Involvement - I can still be involved
7. Review - things change
freedom is vital
Does modern social work
understand and know how to
support freedom effectively?
A failure to support effective advocacy by families seems
to have been a common pattern for the young people
who ended up in Winterbourne View and similar places.
On average each person had been in
10 different institutional settings,
Residential schools (n=3) Acute
hospitals (n=3) Residential colleges
(n=1) Low secure hospitals (n=6)
Specialist facilities (n=6) Residential
All six had been victims of abuse,
Neglect (n=2) Sexual abuse (n=6)
Physical abuse (n=5) Financial abuse
We seem to be
crime and abuse
O’Brien’s model of good support sees
safeguarding as a critical element of community
connecting. Isolation is the biggest danger.
The emergence of Local Area Coordination
reﬂects a desire to refocus energy on
preventing crisis and enabling citizenship.
of the people in
are and should
not be staff.
paid staff and
staff is not the
key to safety.
Does modern social work know
how to work with communities
to keep people safe?