AUTISM AWARENESS An autistic child holding a ribbon symbol of colourful pieces of jigsaw together for day of raising awareness about people with Autism Spectrum Disorder throughout the world. Western Care provide support for 750 service users in Mayo with intellectual disabilities and/or autism.
One of the key issues in the ongoing controversy at Western Care centres around the Individualised Services (IS) section of the organisation.
IS provides support for service users who live in their own owned or rented accommodation.
According to internal Western Care figures seen by The Mayo News, there are 33 individualised services which operate under the management of the Head of Individualised Services. The 33 services are each a home setting with one service user in each.
It is this section that is central to the recent upheaval.
There are a further 71 individualised service settings in Western Care, but these are run outside the IS department, often by geographically based regional service managers.
Of the 33 services in the actual IS department, the internal documentation seen by The Mayo News confirms that five of these must be registered with health and social care service watchdog HIQA, while the remaining 28 are subject to ongoing reviews.
They were previously unregulated, that is to say they were not subject to outside scrutiny by HIQA.
In response to questions from The Mayo News in December, HIQA confirmed they had ‘received information of concern relating to individualised services being operated by Western Care Association and are currently engaging with the provider in this regard’.
We have spoken to over 30 former and current staff in Western Care in recent months since this story first broke. We’ve spoken to staff at all levels from senior management to service co-ordinators, social care workers and social care assistants.
Most of those we have spoken to contacted us to express concerns about two related issues – concerns about the Indiviudalised Services (IS) section and what they feel is the lack of sufficient oversight and governance by many at the top of Western Care to address these issues over a prolonged period.
Many of the issues raised to this newspaper about IS were raised in an independent report in 2020, the Wolfe Report.
Commissioned by Western Care, the findings were never made public but a copy of its findings have been seen by The Mayo News.
The executive summary gave a damning assessment: “In our view, Individualised Services, as an entity, is very much in a significant crisis situation at present, despite the best intentions of all involved.
“There is a high risk of burnout for some staff and management and there is also a high risk of staff injury.”
The Wolfe Report also raised concerns about IS’s workforce consisting of ‘mainly unqualified staff’; the service becoming ‘somewhat isolated from the broader organisation’; and that the ‘inadequate’ IS structure ‘poses a risk’ that Western Care is ‘not fully discharging its duty of care, to staff in particular’.
The report made a series of 14 recommendations which it said Western Care needed to act on ‘as a matter of priority’.
They included detailed needs and risk assessments of service users; ensuring that multi-disciplinary supports are provided to service users in IS; and for Western Care to decide if it can ‘sustain safely’ IS into the future.
Many current and former Western Care staff whom we spoke to in recent weeks expressed concerns that little had changed since the Wolfe Report.
While every account was in many respects unique to the person involved, there were many commonalities.
They included staff being afraid of raising matters of concern for fear of consequences; concerns that some service users in non-HIQA regulated IS settings were not getting the levels of multi-disciplinary and staffing supports needed; that the behaviour of many service users with profound challenges was worsening as a consequence; that staff were encouraged to underscore incident reports to avoid scrutiny in IS; that staff injury and stress were considerable factors and concerns, which in turn led to considerable staff turnover and a flux for service users who depend on settled staffing.
Also, many staff we spoke to highlighted considerable concerns about the suitability of some service users for settings not subject to HIQA oversight, an issue that has come to the fore in recent weeks with HIQA taking oversight of five IS services previously unregulated.
Protected Disclosures and IS investigation
Following the arrival of Protected Disclosures which raised concerns about some services in Individualised Services, an investigation into IS was ordered by then CEO Donal McCarthy in October and three senior staff were placed on leave.
However, Mr McCarthy had his employment terminated by the Board of Western Care in mid-November and he was subsequently replaced by an interim CEO, Dr Aoife O’Donohue.
In response to questions from this newspaper about Individualised Services earlier this month Western Care said ‘Individualised Services within Western Care are currently being examined as part of an independent, external review’.
This week, we run the stories of some current and former IS staff at all grades whom we have spoken to since this story broke.
These testimonies are in addition to protected disclosures made by former IS workers.
We have withheld many details which, though damning of the service provided, may help to identify the service user. Some of the details we withheld are harrowing.
We are also conscious of not identifying staff who spoke on the condition of anonymity. Therefore the names attached to each story are fictional and some staff details are withheld such as their role and length of service.
‘You were basically just keeping the service user alive’
I worked in Individualised Services from when I started with Western Care until I left last year. I took everything for granted and didn’t know any different.
I was with a service user in an unregulated service and in my time with that service user, they were in two different houses. The first house was an absolute dive and the second was not much better.
The first house was such a cold house. In weather like we’ve had here for the past two weeks when I would be sleeping over, I would have to go to bed fully clothed and have a big winter jacket, a wooly hat and gloves on me and a duvet over me.
The service user had to pay for virtually everything. Oil, electricity, food. Western Care gave so little to them financially in this regard and anytime we looked for anything for them, it was shot down by a senior manager.
Eventually the service user got a fuel card but only because the service co-ordinator went behind the back of a senior manager. I was told to make sure I did not let this senior manager know about the fuel card.
Staff often had to buy food for the service user and then get it back when their disability allowance came through.
Despite all this, for the first few years I was with this service user, they were brilliant to deal with.
You could bring them to your house. They knew all my family. You could bring them out for a meal, on different trips. You’d need to get them out of the house because the conditions were so bad but they loved going in the car and visiting people.
It was more luck than planning that had the service user in such a good place in that time. It was more to do with the staff on the ground because the service was neglected by Western Care.
One employee had a great record of working with this service user and knowing the best approaches with them. But they were not allowed near the service on the say so of a senior manager in Western Care.
Then, the service user had an illness and medication was prescribed which did not agree with them and the service user gradually got more and more challenging. The supports needed were often turned down by a senior manager.
There were no more trips and so restricted did the service user’s life become that you were basically just keeping the service user alive.
The behaviour got out of control and there were so many alarming incidents. Sometimes members of the public were attacked by the service user and staff being assaulted was very frequent.
Staff turnover has been a huge issue since. There was very little turnover before then.
One member of staff raised concerns but got nowhere.
I recall writing an incident report after the service user could have been killed and I graded it a critical incident, which would require an investigation. I then saw a manager downgrade the report so it would be below the critical incident threshold.
Often some service managers would be frightened when an incident was graded critical because a senior manager would not be happy with this grading.
In conversation with Edwin McGreal
‘Individualised Services was an investigation waiting to happen’
I worked in a number of Individualised services during my time in Western Care.
It was very apparent that if you were liked by senior management, you got on fine but if you had a problem with any questionable practices, you were blacklisted.
Then it was also apparent that senior management had favourites among the service users which was frightening, worrying and utterly wrong.
I worked on a number of services. My main one was testing but fulfilling. This service user was an outstanding individual but he was not treated near as well as other service users I worked with.
One in particular was considered by staff to be the the ‘golden child’ and could get whatever they wanted from a senior manager. Staff working there was regularly overruled by a senior manager. It was staggering what was done for this service user compared to others.
Staff were afraid to report incidents with this service user as they felt they would be blamed.
The service user attacked me on two occasions – the second in public where the guards had to be called.
When a senior manager spoke to me about it, they made it seem as if the incident was my fault, when in fact the service user tried to put my life in danger and the guards asked me to make a complaint so that they could record it and follow it up. I’m sorry now, I didn’t.
Individualised Services was an investigation waiting to happen.
In conversation with Edwin McGreal
‘So many amazing staff went in there and left, defeated and broken hearted’
I’m working in Western Care for several years now and helped to manage a lot of areas in Individualised Services (IS) in that time.
The reality is that in IS, we ran these services with very little help or support from senior management in Western Care.
I know from talking to a lot of staff in IS that staff are on their knees and struggle to keep going into work every day, their health and personal lives are suffering as a result of the mistreatment from senior management.
I love my job and it breaks my heart to see staff so disheartened, staff are dedicated to the individuals in our care and we have been left by senior management to man a sinking ship.
So many amazing staff went in there and left, defeated and broken hearted as they did their best for the organisation and the individuals in their care, they worked tirelessly to make sure that the lives of the people they were responsible for were reaching their full potential and beyond, but they were mistreated by senior management and were left feeling abandoned.
You are treated like a number. If I am not supported, then it is very difficult for me to support my staff in the way I would like. Staff on the ground is the bones of any organisation and without them we have no organisation.
When you approached senior management for advice or support around staff or improving the lives of the individuals in your care it was always met with another hurdle to overcome and nearly always ended with a ‘no, no, no’ …
Donal McCarthy inherited a toxic environment, it was and still is a burning platform, but yet he was willing and able to take it on.
Donal McCarthy was trying his best to make changes and make them fast. The board chastised him for doing what he was instructed to do, the foundations were not solid to begin with but it is crumbling now, it doesn’t make sense that they would remove someone that was there to improve the organisation.
There is a toxic culture there and it was there long before I arrived.
There were problems every day. It never stopped. You were always firefighting.
Some services in IS received a lot of support from senior management and others were ignored.
‘It broke me’
The inequality in there is shocking and only those who shouted the loudest would get heard, the vast majority of people with disabilities are non-verbal … hence some never get heard.
The people we support have disabilities but that doesn’t make them any different to you and me, if anything it makes them more unique, they are so smart and clued in to what’s going on around them. They can read the vibe in a room and they will know if something isn’t right, they have amazing awareness and if a staff member goes into their home on edge they will pick up on it straightaway and this can often lead to challenging behaviour.
The communication and respect of senior management to staff is vitally important and it can make or break team.
I’m an experienced and qualified social care professional. I’ve worked in many organisations and I have worked with many challenging situations in my career. I work in this profession to make a difference in people’s lives, I think I can speak for many people in this profession, we are not just social care professionals, we are friends, we are counsellors, we are a shoulder to lean on and we are here because we care.
Western Care has and had the most amazing people work for them but because they are not supported and looked after, they left. It’s just so sad to watch it when all you want to do is make things better for everyone but you have nothing left in the tank.
You are defeated!
We don’t do this job for the money. It is a vocation but people are being run over.
I have seen people go out half the person they were when they went in. People are railroaded, destroyed and disrespected. No one is being supported by the people that they were told would support them.
I tried my best but it broke me.
Nothing has changed since this all began and nothing will change as long as the powers that be are still holding the reins.
In conversation with Edwin McGreal
‘Management in Western Care don’t like to be questioned’
I had previously worked in a HIQA service with another provider before moving to Western Care and working in an unregulated service in Individualised Services (IS) and it became apparent early on that there were a lot of issues in this service.
We were often told that a senior manager would not be happy if they found out about particular interventions made on behalf of the service user, be they medication or referrals to behavioural support or psychology.
There was an arrogance in Individualised Services. You would often be told ‘we don’t do that in IS’ but this was, for me, not a positive.
It was like a Godsend when Donal McCarthy stepped in and started making changes to IS.
The accommodation was absolutely chronic and getting worse by the day.
The dampness in the house was a huge issue and there was a failure on behalf of the landlord too.
It is awful for the service user and staff are working in horrendous conditions.
There are other services in IS where staff are assaulted and abused on a daily basis with no internal support and multi-disciplinary support actively fought against by some senior managers. We were frequently asked to underscore incidents so as to stop a critical incident review taking place, which might expose the service to more scrutiny.
So trying to change anything is not easy.
Managers in Western Care get hot and bothered very easily. They don’t like to be questioned and they don’t like alternative views. There are definitely organisational cultural issues across the board in Western Care.
In conversation with Edwin McGreal
‘I really believe this is way worse than Áras Attracta’
To be honest it is hard to know where to start with Western Care.
I worked with them for over ten years up to recently. I had been appointed to take over the running of a service in Individualised Services (IS) and I was shocked and horrified by what I saw.
Donal McCarthy, the former CEO, came out to the service and spent three and a half hours meeting myself, staff and the service user. He was proactive and listened. The service was unsafe.
The making of Donal was he had no past in healthcare. Those of us in here become blinkered over time. He was coming with a fresh set of eyes.
Then he was fired.
I really believe this is way worse than Áras Attracta. The organisation is toxic from the top down.
Staff are frequently attacked on duty, incidents are frequently not reported or downgraded so no allied disciplines are getting involved because if they were, they would unearth the abuse of both service users and staff.
For instance in the service I went into, in the previous six months one or two reports went in. In my three weeks there were 15 incidents reported.
Senior management in IS did not want any spotlights. Reports would trigger allied supports, behavioural support, occupational therapy, psychology, mental health etc.
But because reports were not going in or being downgraded, staff and users were not getting the supports from allied supports which can address the problem.
In conversation with Edwin McGreal
‘I was hit four or five times on the back of my head with a galvanised metal mop bucket’
When I started with Western Care as a social care assistant I was with a fantastic manager but when I left that service, that was the end of the fantastic management.
Some of the managers I worked under since were just terrible.
I ended up in an individualised service with a service user with very challenging needs but the service was not helping the service user at all.
This service was so disorganised. The service was never getting enough funding either. The frontline manager would often say there is no money full stop and suggest we fundraise ourselves to get money into the service.
We were in a very small house and it was not at all suitable for the service user in question. You couldn’t swing a cat in it.
But there was a big fear among staff working in the service about raising concerns about the suitability of the house.
Managers in Western Care do not like to be challenged. I was often told by one superior that my job is to think below your shoulders. Some days there would be fight in you and other days there wouldn’t. You’d gradually get worn down, weak and keep the head down.
As part of a scheduled review, the service was reviewed and the person who came from Western Care headquarters said the service user needed to be moved immediately. That didn’t happen and they are still in the same house today.
Issues at the service got worse. The service user could often get physical.
Western Care came and divided the house because the service user had got so challenging and the staff were not qualified and so Western Care were incapable of meeting the needs of the service user. So they put in a dividing door and closed down half of an already small house from the service user.
Considering the service user’s health issues, it must have been like being in a torture chamber for them.
Like I say, the service user could often get physical. One time they hit me four or five times on the back of my head with a galvanised metal mop bucket. Someone dragged me outside to safety and I had to take some time off work.
Before I did so, I suggested it be marked a critical incident but it turned out it was put in as a lower incident.
I bore no anger towards the service user. They were acting out because they just were not getting the level of support needed and new staff coming into the service did not know how to deal with them because they had not been properly trained. I loved [the service user] like they were my own child.
We had asked several times for the service to become a HIQA service but there was no urgency from management on this.
Staffing was an issue. New staff needed to be inducted and then had to shadow but a senior manager did away with that, thought it wasn’t necessary. So staff with no knowledge or experience of the service user were being thrown straight in.
Staff were taken for granted too.
We were working 10-25 hours over the contracted hours because they couldn’t get staff. We were often told to come in for shifts we were not down for and were often told if we don’t come in, the service will have to close so we were made to feel responsible for that. Not everyone was capable of pushing back. There was a fear there among staff. Management would often have people on panels in some services so there would be zero contracts. They did what they could to control you.
In conversation with Edwin McGreal
‘Bullying of staff was widespread’
I worked with Western Care for just four months before I was told I was being let go from my probation.
I have over 20 years of social care experience. I qualified from Sligo in 2003 and I have eleven years of management experience.
I was working in Individualised Services (IS) and a couple of weeks in I told a senior manager about my previous job and how the service in question had not went well and that I had to make a protected disclosure.
From then on, everything changed. I was bullied from that day on and they wanted me gone.
I’m under no doubt senior management in IS thought I would act on what I might see in IS and so they wanted me out.
I was told I was not being kept on because of my communication skills and because I couldn’t manage staff. Many of those staff are working with me now in my new job and we get on great.
It definitely impacted me and took me about 18 months to recover from.
I have worked for ten different providers in the west and east of the country. Western Care are out on their own in terms of what I saw.
I just don’t know how they’ve got away with it in IS. Were the organisation not wondering why so many people are leaving from IS? They are like a law unto themselves in IS.
Bullying of staff was widespread. Add in inexperienced staff and it is a volatile situation.
A senior manager used to say about rostering staff – ‘always leave them crying for more hours’. That was one of their ways of controlling staff.
There was a feeling in IS that they were better than everyone else and knew better than everyone else. They dished the rest of the organisation continuously.
They rule by bullying and they seem to actively seek inexperienced, unqualified staff who are less likely to call foul on things. They felt threatened by anyone with experience who might talk. They actively went after people straight out of college who know nothing but Western Care and had no experience with other organisations and therefore knew no different.
They would often play people off against each other. For instance another colleague who left, I was afraid of my life of her. When I would come into a room, a manager would give out about this colleague. We’ve spoken since and the same thing was happening to her – when she walked into a room, the manager would give out about me to her.
How are they getting away with it?
In conversation with Edwin McGreal