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Prevention is better than cure

Lynne PhairWhat is the leader’s role in preventing organisational abuse? Lynne Phair, Independent Consultant Nurse and Expert Witness is delivering a keynote speech at the Restraint Reduction Conference next week. Here she talks through some of the key themes from her presentation, which is based on her book: Adult Safeguarding: A care leader’s guide, published by Hawke Publications, London.


A career of 37 years cannot be anything but littered with challenging stories about the changes in personal, professional and societal attitudes towards care.  These changes have resulted, over time, in some previously acceptable approaches to care now being considered, quite rightly, as abusive.  As care practices change the biggest lesson I believe we can learn is to honestly reflect on what we did as professionals in the past in the light of the wisdom and improved practices and understanding we have now, and learn.

Today health and social care practice is supported by international evidence based practice. The individual rights of all adults are recognised and enshrined in law and the abuse of adults at risk of harm is recognised; the need to prevent abuse is supported across society and the media.

A significant contribution to the research into abuse of vulnerable adults in the UK has been undertaken by a collaboration of universities and research organisations; brought together by funding provided by the Department of Health (England) and Comic Relief.  The research sets out to improve our understanding of the context, causes and consequences of mistreatment in Organisational settings.

The inquest into the deaths of 19 people at the Orchid View Care home in West Sussex in 2011 became national headlines.  The multi-agency investigation, and subsequent serious case review, brought into the public arena the catastrophic impact on residents of neglect, and incompetent management and leadership at all levels of an organisation.  Everyone can learn from the suffering of the residents at Orchid View and, in my view, all leaders have a duty to do so.

My years of experience in adult safeguarding together with evidence from the literature has given me the opportunity to identify what I believe are 10 fundamental aspects of leadership that need to be demonstrated to prevent organisational abuse developing.

I believe that, as leaders, we must continuously examine ourselves and how we lead staff and uphold standards which enable adults at risk of abuse and their families to live their lives in the manner they wish.  All leaders, all the time, must understand the potential in all of us to lead a neglectful service or condone abusive systems, if we don’t have courage and pride in the work we do.

Despite  public, political, and organisational claims that we must all stand up and be counted, and that whistleblowing and fighting for those who have no voice is the right thing to do; the impact these actions can have at personal and professional levels must never be underestimated.  Challenging organisational abuse and neglect is essential but it requires great courage; a courage that can be career limiting, personally painful and, sometimes, psychologically damaging.

My presentation, on the afternoon of Friday 13 November, is based on my book which is my contribution to supporting those care leaders in health and social care who, disregarding those who may try to influence them otherwise, have the courage to stand up for those who have no voice and who want to support everyone within their teams to do the same.


Georgiou N (2014) Orchid View Serious Case Review. West Sussex Adults Safeguarding Board.

Brooker D, La Fontaine J, De Vries K, Porter T (2011) ‘How can I tell you what’s going on here?’  The development of PIECE-dem: An observational framework to bring to light the perspective of residents with advanced dementia living in care homes.  University of Worcester – Association of Dementia Studies.

Killett A, Bowes A, Brooker D et al (2013) What makes a difference to resident experience?  Digging deep into care home culture: The CHOICE (Care Home Organizations Implementing Cultures of Excellence) research report. PANICOA.