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Terry Bryan: 'Why doesn’t person-centred care extend to vulnerable people?'


People with a learning disability or a mental health label are not treated in a respectful manner, says Terry Bryan

Does anyone ever look at the lofty principles organisations use to describe themselves? Do we think any of these actually make the transition to operational levels?

I have worked alongside vulnerable people, such as those with learning disabilities or mental health problems, for more than 30 years. There have been some changes in that time. Currently, we like to think we are “person centred”, where the fundamental idea is that the vulnerable person holds the power, not the nurse or carer. Many of our brightest minds have elaborated on this, and we now stand at a glorious crossroads where vulnerable people write their risk and support plans and live their lives as they wish. Actually, no.

In my current work, I lead teams that transfer vulnerable people between services in the UK and abroad, attend court hearings, funerals and so on.

We rely on the expertise, patience and experience of the teams who deal with the person at the centre of each transfer. We ensure that the person is given as much information as possible before the move, is involved in how it happens and is treated respectfully, to complete the transfer with a minimum of anxiety or distress. In a person-centred way, if you will.

That’s where things tend to change. For example, I have arrived at services having spent the entire journey gently talking and listening to an extremely angry person, using every skill I know to keep the peace, only to be met with a wall of silence or grunts from the staff. That’s if they even answer. The other day, an entire hospital wing just wasn’t answering. Our passenger shrugged as I pressed every door bell I could find. Eventually, we were discovered accidentally by staff going off shift. Sometimes staff do not even say hello to us. Sometimes we are ignored - left in the middle of a building, not knowing who to talk to. Staff mumble under their breath, whisper in corridors and ignore our passenger when they ask for a bathroom or a cigarette after the long journey.

So, once again: how many lofty principles actually make the transition to operational levels?

It happens abroad too. I was recently in the Far East to bring a man back to the UK. The service there blatantly ignored him when he asked a simple question, yet immediately answered me when I asked it on his behalf. The man shrugged and loudly whispered that it “happened all the time”. I was indignant on his behalf, but he persuaded me not to pursue it. He called it cultural.

We generally have a good idea of a person’s level of risk before we meet them, but I always ask for more information, such as favourite topics of conversation or trigger words to avoid. I would estimate that 90% of the staff I ask tell me nothing. Staff will point to individual care plans and risk assessments, all written by staff and kept in the office. Individualised yes, person centred, no.

Our passengers invariably accept this level of rudeness. As a professional nurse, responsible for the safe and least-problematic transfer I can provide for each person we ride with, this is unacceptable to me.

I’ve worked as a Care Quality Commission bank compliance inspector this year too. At 20 unannounced visits around the country, I was treated with utmost respect and offered all the courtesies expected. So why aren’t I greeted in the same way when I arrive with a passenger with a learning disability or mental health label? Why isn’t the person I’m with accorded the same courtesies I was offered as a CQC inspector?

In a former life, I worked at Winterbourne View. After what I saw there, I wanted change and I still do. I’m really not convinced things are changing fast enough.

Terry Bryan was the nurse whistleblower at Winterbourne View


Readers' comments (6)

  • michael stone

    Hi Terry,

    re your :

    'Does anyone ever look at the lofty principles organisations use to describe themselves? Do we think any of these actually make the transition to operational levels?'

    I don't - I'm bothered about behaviour in an entirely different area to you, but again there is lip service to the concept of patient-led behaviour, and what the organisations 'claim to do in their statements' isn't matched by behaviour as experienced on the ground.

    I'm also with you on:

    'I’m really not convinced things are changing fast enough.'

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  • First of all .......well done Terry for the whistle blowing.

    Good article and I agree with it 100%

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  • First of all .......well done Terry for the whistle blowing.

    Good article and I agree with it 100%

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  • tinkerbell

    Terry thank you for having the guts to stand out from the herd, for speaking up for the vulnerable, for doing the right thing regardless. Well done.

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  • David Dickinson

    I was employed by David as a Team Leader at the XXXX unit from early 2000 until the Autumn of the same year, a position I left in order to complete my DipSW and to widen my experience of learning disabled clients with mental health problems prior to the DipSW, and can honestly say that I would not have taken the role had it not been for the open and positive attitude that David exuded whilst talking about the work in the unit. In the year that I worked with/for him, I never saw his enthusiasm for working with these very difficult clients wane. He was proactive in his working and extremely supportive of the clients and his policies and methods were always extremely person-centred/focused and of the highest regards for the values that I work within now as a social worker. (Richard Hill, Care Manager for Older People, Gillingham 15.3.06)

    During 2010 I moved & took a reduced post as staff nurse up north and repeatedly complained about abuses including the repeated abuse of locked seclusions that precipitated two internal inquiry (cover-ups) within an LD forensic service located in the north-east although eventually I received written "thanks" from the trust CEO for bringing the matter to his personal attention. During the earlier months I was met with an extended spurious "disciplinary" witch hunt involving any miniscule infringement which eventually saw my dismissal for examining the record of one seclusion victim although such accessing was normal and expected practice within the closed service. Thus the allegation was changed on appeal to "looking for too long". The trust involved referred my case to the NMC whose returning solicitor seemed more hawkish than the rogue and embellishing original charges. The forensic service treated LD clients appallingly..easily the worst that Ive seen in 37 years and I insisted upon respect towards service users which earnt me derision and contempt..also the lying suggestion of my practice being "out of date" by both a senior manager and head of professional development although contradicted by the fact that the second inquiry commented about one example of modern practice , i.e. my work, found in the service i.e. to be emulated and repeated throughout (the "challenging behaviour pathway") given to me because the service users named nurse had never heard of it. The NMC continue with cobbling a fresh allegation of "using my home computer" to write my original complaint in 2010. The NMCs case presentation is flawed with documents cut and pasted making it incomprehensible. Consequently I have taken out a formal complaint against the NMC who have referred me to the Practice and Conduct committee. The CQC and Safeguarding appear mere apologists for the trust and accept their explanations which havnt been given to me despite my detailed accounts of abuses to them. I have some great support from within the trust one of which was a colleague social worker and still employed.
    Should I have just gone to Panorama?

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  • michael stone

    David Dickinson | 3-Aug-2013 4:16 pm

    I keep reading that sort of disturbing story - where is this 'openness and transparency' and 'patient-centred care' I am being told about 'from above' to actually be found ?

    I can easily beleive your comments about the way your 'complaint' was handled - pretty much fits in with my own experience of trying to raise something with a PCT, and then complaining to the PHSO about the PCT's behaviour.

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