When private care group Castlebeck was sold for £255m in 2006, it was seen as the UK’s leading provider of specialist health and rehabilitation services for adults with learning disabilities and complex needs. On 31 May last year a television exposé demolished the company’s reputation and shredded its value.
The BBC’s Panorama uncovered a shockingly abusive regime at Winterbourne View, a Castlebeck “assessment and treatment” hospital near Bristol. The company was charging an average £3,500 a week for each of up to 24 patients but providing an environment that, in the words of a subsequent serious case review, “raised the continuous possibility of harm and degradation”.
Eleven former members of staff of Winterbourne View have beenconvicted of criminal offences of abuse and are being sentenced this week. The unit has been closed, as have two others run by Castlebeck, but Panorama is preparing to broadcast another programme containing further revelations about the scandal, the company and the system that enabled it to boast, as it did in 2006, of its “five-fold value growth” in just four years.
Restoring Castlebeck’s good name may seem like mission impossible, but Sean Sullivan has been giving it his best shot. He is a “business turnaround” specialist, brought in last November at the instigation of what he calls the company’s stakeholders – taken to mean not only its owner,Lydian Capital Partners, an investment club for entrepreneurs including Irish tycoons John Magnier and JP McManus, but also the banks that largely funded the purchase of Castlebeck six years ago.
Sullivan, 51, is a no-nonsense character with an earlier career in utility management, whose past assignments have included sorting out the wholesale electricity market in Tbilisi, Georgia, and the water corporation in South Australia. But his family runs care homes and he was responsible for turning Care Principles, another leading UK provider, around, as well as large efficiency projects in the NHS. So he reckons he knows poor care practice when he sees it – when others may not.
So what did he find at Castlebeck when he was initially appointed as the company’s chief restructuring officer?
“A lot of half-blind people,” Sullivan says, referring to managers who weren’t seeing what was wrong.
In March, having drawn up a detailed action plan, he was made executive chairman and told to go ahead and implement the 51-point plan. Since then, he has swept through the organisation, spending £8m, instituting new practices and clearing out most of the management. He thinks his task is almost complete.
“Since March we have had a full-on, A-to-Z turnaround of all and everything that Castlebeck involves to get it into some sort of shape that is attractive for [care] commissioners, right for patients and has some commercial reality to it,” he says. “It’s not 100% yet – you can’t change every unit immediately – but we have turned around now in over 80%, perhaps 90%, of the units. I think we reached that point about three or four weeks ago. It is a repaired business.”
Many will be sceptical of his claims. It is an open secret that Lydian and/or the banks are seeking a buyer for the company and there will be suspicions that the makeover is only skin-deep. But the company is being unusually transparent about the transformation it says it is undertaking, and some influential voices in the care sector are impressed.
Support and endorsements
“Can we put our hand on our heart and say they are changing? Yes, we can,” says Ann Chivers, chief executive of the British Institute of Learning Disabilities (Bild). Her organisation is working with Castlebeck to offer support on advocacy and last-resort use of physical restraint, but it remains opposed in principle to the assessment-and-treatment model of care by which people with challenging behaviour are taken out of the community for indeterminate periods. This is still practised at some of the company’s remaining 20 units. “We have a reputation to protect and we had to really think about whether we should get involved,” Chivers stresses. “But they are definitely in turnaround mode. There is some very solid and robust stuff going on there.”
Another endorsement comes from Sukhvinder Kaur-Stubbs, a trustee of the Social Care Institute for Excellence, who has joined Castlebeck as a paid independent non-executive director. “I’ve been impressed with the approach that has been taken and the speed with which change has been made,” she says. “I think there is some learning from it for the care sector as a whole around what good governance should look like.”
Kaur-Stubbs sits on a Castlebeck board that has been revamped radically: Sullivan says that half its members now have a medical or nursing background. These include Debra Moore, brought in as director of nursing and patient safety, who was a learning disability nurse adviser to the Department of Health and joint lead of Valuing People, a programme for learning disability. Lee Reed, who had recently been appointed as the company’s chief executive at the time of the Winterbourne View scandal, and who declared himself “personally ashamed”, remains on the board as group director responsible for the separate mental health business.
Moore has taken the main responsibility for quality, audit, clinical risk and compliance across the organisation. But Sullivan sees the unit managers as the key to the success of his action plan – built on the findings of consultants PwC, called in after the scandal broke – and he has felt it necessary to take drastic measures. “Probably 70% [of managers] have exited the business,” he says euphemistically.
“You have got to have people who used to be a commissioner, or a senior nurse, and who are able to engage with commissioners in that same field. Suddenly they click and they get it.” He found some familiar faces among the managers he inherited. “There were individuals that I had let go at other organisations I turned around,” he says. “They have moved on again.”
Sullivan is poor management was at the root of Castlebeck’s malaise. “Winterbourne View was a photograph in time,” he says. He describes the abuse as “appalling” but says that culture “had been allowed to build up over a long period”. He says he has found some “stars” among the 1,100 staff, who have been rewarded with promotion, but he has relied heavily on bringing in experienced interim managers (“I have a little black book”), about half of whom he expects to stay on permanently.
All 20 remaining units in England and Scotland operating under the Castlebeck brand, and with a total capacity of about 350 people, have been refurbished and re-equipped from top to bottom at a cost of £3m. More importantly, though, all users of services are now reassessed regularly, with the involvement of their families and care commissioners, to try to make sure they do not languish in the system. Some, Sullivan admits, ought to be receiving different care elsewhere. Various outside organisations, including Bild, have been contracted to offer support on a range of issues.
Occupancy of the units, which dropped sharply after the revelations, has been rising again and, Sullivan says, is exceeding his target of 80% at 12 of the sites. For the first time in 16 months, care professionals are said to be calling unprompted to inquire about job openings, while internal satisfaction ratings by commissioners and families, shared with Society Guardian, show a positive score – though complaints about standards persist.
The unanswered question is whether Castlebeck will wholly abandon the assessment-and-treatment model, as critics demand. Sullivan, who expects to remain at the company for only a few more months, says part of the turnaround involves placing the units on care pathways so that they play a clear, time-limited role in an individual’s progress. He cites Thornfield Grange, formerly what he calls a “generic learning disability” facility in Bishop Auckland, County Durham, which has been converted into a rehabilitation unit for people with autism moving on from the company’s service near Darlington.
However, he believes there is a continuing need for long-stay units for some people who have been in hospital-type settings for most of their lives. “It’s a very difficult area, but we do have people in the UK, perhaps aged 60, who have a 40- year background in these services and may have been heavily medicated for much of that time,” Sullivan says. “What is the future for them if we do not provide a safe and supportive home for life?”