ORCHARD HILL - COMMUNITY
CARE PRACTICE SPECIAL 
© Reed Business Information Limited 2005 . All Rights Reserved. Written by Grant Wetherall (link to article)
The Orchard Hill abuse scandal, as did previous inquiries in Ely Hospital (1969) and Longcare (1998) and last year's Cornwall revelations, suggests that better advocacy, and pictorial and sign language communication systems may well have raised the alarm sooner.
The Healthcare Commission report says: "The overall model of care promoted dependency, and the views of people with learning difficulties were seldom heard and few staff had any specialist training in ways of communicating with people with learning difficulties."
If we had learned the lessons of Ely, Longcare and Cornwall, we would know that the lack of advocacy and communication systems were pivotal reasons why abuse was allowed to take root and flourish for so long.
Sutton and Merton PCT should take into account the important preventive role played by advocacy and representation services. Advocacy can create self-confidence and self-esteem in people with learning difficulties, thereby reducing the incidence of abuse as well as supporting individuals when a complaint has been made or abuse disclosed. The training and support roles of advocacy should be acknowledged and its involvement should be routine if a complaint or allegation of abuse has been made.
The Independent Longcare Inquiry Report warned that, "people with learning difficulties are particularly vulnerable if they have communication difficulties or if they have no active relatives or friends in the local community". Advocacy services can ensure that information is made available in an accessible form and that service users can therefore make contact with an advocacy service if they need support. However, advocates must ensure they have appropriate communication skills.
If no advocacy service is available locally, then the PCT should set up user groups in its services for disabled people. The make-up of such groups should include parents, service users, carers, local Mencap representatives and other disability groups. Such groups can be very influential in improving the day-to-day services and everyday lives of people with learning disabilities. As Tom Burgner, chair of the Longcare Inquiry, noted: "The potential of advocacy services to consult with local service users about the future shape of provision should be acknowledged and they should be appropriately resourced in order to maximise users' involvement in planning, monitoring and review."
Such a reduction of dependency on staff and the empowerment of service users can be achieved by teaching communication systems such as Makaton, TEEACH (Treatment and Education of Autistic and Related Communication Handicapped Children) and Picture Exchange Communication Systems (PECS) to service users, staff and carers.
Setting up such "augmentative communication systems" will not work unless the PCT creates a signing and symbol environment where the staff are ultimately responsible for promoting this daily. The PCT does not have to re-invent the wheel here as Makaton has already produced resources that would support this work: such as individual personal plans for reviews and an excellent adult protection communication system. Complaints leaflets in symbol format have also been developed by some local authorities.
Finally., appointing a designated staff member with the appropriate communication skills would also go a long way in implementing these programmes and would thus signal strongly the Trust's intent to ensure that abuse is not only stamped out but is prevented from ever returning to its services.
Grant Wetherall is team manager, Homefirst Community & Social Services Trust, Cookstown family and child care team, Northern Ireland. As a social work student on placement with Ealing Mencap he went undercover to help expose abuse at the Longcare homes.