Why the Western Care story matters

Comment
Edwin McGreal

THE current strife at Western Care has been raised in the DΡil and prompted answers from the Taoiseach. It has featured at length on RTÉ Radio One’s Drivetime programme.
It has been covered extensively in these pages since we first broke news of the turmoil in our issue of November 22 and has caused great concern throughout the county.
The concern is not just limited to its 850 plus service users, 1,000 staff and all their families. It extends to the general populace of Mayo who have a huge grΡ for a vital organisation set up by volunteers in 1966 to provide care and support for people with intellectual disabilities.  
That grΡ has led to two polarising reactions, in our experience of recent weeks.
Firstly, are those who value the important role Western Care play in the county and want answers to questions that have arisen and want the organisation to provide top quality care and support for its service users and for its staff to feel listened to, respected and enjoy working for the organisation.
There are others who also value the role Western Care play, but feel that the organisation is coming under unfair scrutiny and that those raising issues must have ‘grudges’ or ‘gripes’.
In deciding how to cover such a story in The Mayo News, we have a responsibility to evaluate such matters deeply. There are always going to be people with gripes and there are always going to be issues in any organisation the size of Western Care.
But over the years in local journalism, and living in this county all your life, you build up contacts and get to know people whose judgement and opinions you can trust and others for whom you may be more circumspect about.
The level of communication this newspaper has received from current and former staff at Western Care, and families of service users, has been far beyond anything that this journalist has experienced for any other story in over 20 years working for this newspaper.
Not alone that, so much of the information has come from very reliable people whose bona fides we trust in this matter.
You cannot ignore such a story when you hear about substandard care for service users, many of whom have no voice; staff who feel they were in very unsafe working environments and were marginalised if they raised concerns.
Be in no doubt, the issues being raised are not minor.
In our coverage of this story so far, we have not named any current or former staff we have quoted because of their fears of being victimised as a consequence, even if they are former workers. They still have to get employment in the general social care sector and not every organisation welcomes people with open arms who are willing to speak truth to power.
That fear is perhaps why this issue has remained under the radar for so long, because it is not a recent development internally. One of the four protected disclosures in front of the organisation is over four years old. Several staff spoke of consequences for them after they raised concerns, including the impact on job security.
Some of those who reached out to us did not even wanted to be quoted anonymously. They simply wanted to give us a sense of their perspective. Many former staff we’ve spoken to said they have been scarred by their experiences in Western Care. Many family members of service users say they feel the provision of services for their loved one could be under threat if they raise any concerns.

Independent validation
ALL that being said, when you are trying to stand up a story such as this, independent validation of the concerns help immeasurably.
Seeing the Wolfe Report stood up many of the concerns which had been expressed to us by current and former staff.
Not all concerns, indeed, but plenty of them.
Concerns about the Individualised Services (IS) section of Western Care have been common to every single conversation we’ve had with current and former staff in recent weeks.
The Wolfe Report, prepared in 2020, underscores many of those concerns.
The independent report was commissioned by Western Care.
Though its findings were never made public by Western Care, a copy of the report has been seen by The Mayo News.
The executive summary of the Wolfe Report in October 2020 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 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 and while each account was 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 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 and 51 more unregulated services now subject to review.

Grave concerns
Many people we spoke to expressed grave concerns about some service users in non-HIQA services who were not receiving appropriate levels of care and argued that the reason was cost.
“When a service is regulated it costs substantially more than an unregulated service due to the requirement to meet stringent health and safety standards. Furthermore, the quality of accommodation is usually significantly better in HIQA designated centres,” one former employee very familiar with IS and HIQA regulations told us.
“Where does Western Care obtain its funding? Almost entirely from the HSE. The HSE knows the profile of the vulnerable service users in IS and yet seems to apply no meaningful governance or oversight to what they have ‘sub-contracted’ to Western Care. Unfortunately, the same may be said about the Western Care board.
“The consequence of multiple service users languishing in undesignated centres for years is a legacy of apparent neglect and deprivation compared to their compatriots in designated centres,” they added.
These are, clearly, very serious concerns.
Staff point out that some service users have strong family networks, but others do not. Many service users are vulnerable and have profound issues. They have no voice.
HIQA provide oversight for some services but even there, there are concerns.
When that HIQA oversight is absent in non-designated settings, what oversight is there?
Staff can write up incident reports and can also recommend multi-disciplinary supports for service users such as behavioural supports, psychology etc.
But it is a common theme from our conversations that in IS, the underscoring of risk from serious incidents was common and encouraged; that multi-disciplinary supports are discouraged, even though these professionals are within the organisation.
Several staff have told us they have been knocked back when they’ve raised concerns about services in IS. So what does that say about internal oversight?

Independent investigation
Mayo Sinn Féin TD Rose Conway-Walsh has received significant correspondence on this matter also, particularly since she made calls for an independent investigation into issues at Western Care in late November.
“When something arrives on my desk, never mind when 10, 20, 30, 40 pieces of correspondence arrive at my desk, I have an absolute duty of care to make sure they are followed up on and investigated,” she told Tommy Marren on Midwest Radio recently.
“What’s permeating through all the correspondence is that there’s a culture of people not being listened to within the organisation … In any large organisation you will get personality clashes … [But] the consistency of what I’m getting and the depth of it and the breadth of it really has to be looked at to give assurances.
“People feel in the organisation that when they report things and put their head above the parapet that somehow then not only are they not listened to but are earmarked as troublemakers … There seems to be a deep culture there and there is an opportunity to change that culture now, to really change it because we desperately need the services of Western Care,” she added.
With an Interim CEO in place since the end of November, she was asked the fair question if Western Care should be given the space to get on what addressing issues.
Deputy Conway-Walsh referred to a Western Care statement which said the recommendations in the Wolfe Report were ‘considered’ by Western Care.
“If that (report) had been there for two years and the recommendations were considered rather than acted upon and the Wolfe Report was only a minutiae of what appeared on my desk, that would just leave me to think … It (an independent report) is absolutely essential,” she said.
Her experience of what current and former staff have told her broadly chime with what has come into The Mayo News also.

Unanswered questions
THIS is an evolving story and it is clear that certain efforts are being made to address some of the issues relating to IS and, indeed, the broader organisation.
But some questions remain unanswered.
Why were so many IS services non-designated when they should have been subject to HIQA scrutiny?
Why were some staff marginalised for raising concerns about behaviour and the level of care and support service users in such areas were receiving? We say that having spoken to many of them.
What knowledge had the board of Western Care of ongoing issues in IS?
Who was provided with a copy of the Wolfe Report after it was sent to Western Care in October 2020? Were the board, staff, senior management, service users and their families appraised of an independent assessment of IS which said it was in ‘a significant crisis situation’?
Were senior management in the organisation aware of many staff in IS being afraid to talk and the practice of underscoring risk? If so, what actions were taken?
Why was Donal McCarthy, after just six months in the role, relieved of his duties as CEO in midNovember by the board of Western Care?
We have asked many of these questions of Western Care but have received non-specific statements in response.
The Minister for Disabilities, Anne Rabbitte, has said there is no need for an independent investigation, but it is hard to disagree with Rose Conway-Walsh on this.
There are so many causes for concern that were left unchecked by both Western Care and the HSE that it is hard to have confidence in any internal investigation.
This story has a way to run yet before some very vulnerable service users, and staff who have had to endure far too much in the line of their work, get the answers they deserve.