What have Mid Staffordshire Foundation Trust, a residential care home for older people and a psychiatric ward got in common? Scandals about care practices, budget/funding problems and services run for the convenience of staff, not the needs of patients. In other words, the return of institutionalised care.

‘It was characterised by running the ward to suit the convenience of staff, not the needs of patients’

Institutionalisation was a big deal in the 1970s and 1980s. Patients on long stay wards were observed to gradually become over dependant on staff, to become compliant at the expense of their independence, to stop thinking for themselves.

Set in their ways

In response, long stay institutions were to be replaced by smaller, more homely units. Care values such as choice, independence dignity and respect were to be the principles informing how staff provided care.

Workforce

An unofficial staff culture existed

But of course it wasn’t just the patient who became institutionalised. Staff were often just as set in their ways, an unofficial staff room cultures existed within many institutions which was counter to the official culture. In extreme cases this included unsanctioned methods for dealing with patients who were considered uncooperative, demanding or difficult. In general, it was characterised by running the ward to suit the convenience of staff, not the needs of patients.

‘Budget cuts have seen staffing levels reduced, supervision less frequent, training opportunities reduced and a light touch inspection which was less effective in getting beneath the surface’

This staff culture has proved resistant to training and inspections but appeared to be overcome where staffing levels and supervision backed up the good practice covered in the training provided. Budget cuts have seen staffing levels reduced, supervision less frequent, training opportunities reduced and a light touch inspection which was less effective in getting beneath the surface.

Senior management’s preoccupation with budgets has been at the expense of promoting good care practices and the return of institutional care.

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