The conviction to care

Dr Margaret Flynn is a force to be reckoned with in community care regulation – with her remit having included chairing the National Independent Safeguarding Board of Wales, chairing Lancashire’s Safeguarding Adults Board, acting as director of All Wales People First, trustee of Anheddau [a Wales charity for people living with learning disabilities], and joint editor of the Journal of Adult Protection.

Path to protection

Flynn has worked as an academic and policy researcher since the 1980s, before moving into undertaking official reviews and reports in serious cases of care failings, and chairing a number of serious case reviews. Her reviews include the Steven Hoskin serious case review, the Winterbourne View hospital serious case review, and, more recently, the safeguarding adults review of Cawston Park hospital.

She was also commissioned by the First Minister of Wales to undertake the 2013 Welsh government review ‘In search of accountability’ on the neglect of older people living in care homes, and Operation Jasmine, the subsequent multi-million pound police investigation.

On her current work, Flynn expands: “I’m the director of a very small company that does all sorts of interesting things. I’m currently doing some work with a barrister colleague… about upholding professional standards in Wales. It’s about standards of doctors and dentists… reviewing that and reflecting on how and where it might be improved.

“I’m also really interested in the circumstances of people with compromised communication skills – most particularly when families have struggled to secure better services for their relatives. I’m very willing to work with those families, but also with, and on behalf of, people who’ve had these continually displaced relationships. I do all sorts of things. I actually have a very, very interesting working life.”

Contemplating how she began this path, Flynn reflects: “Initially, and a long time ago, I was an academic. I moved into service development roles, and then became the director of my own company. And throughout that period, I’ve learnt a lot from the expertise and skills of people with first-hand experiences of health services, as well as social care services. And that includes professionals – but most particularly from the families of people who want to seek better lives for their relatives with different kinds of support needs. So it’s from academia – where I really thought I would linger all those years ago.”

When asked why specifically community care, Flynn muses: “I suppose I go back to my personal origins. I have a brother with a learning disability, and his life and circumstances have shaped a lot of my interests in not merely the circumstances of people with learning disabilities, but also in the ways in which families are supported…

“We [Flynn and Hodgetts] also have a shared colleague, Dr Aled Griffiths, and I think it was 30 years ago that I asked Aled to write a document on community care, called ‘What Can We Do?’. He wrote that with Gwyneth Roberts, and it was a sort of ‘how to’ navigate your way around community care legislation – because that was very typically a question that was asked when we picked the phone up to family members. It’s a landscape that’s remarkably sparse given the complexity of it and the obstacles that families have to navigate.”

Leading change

The principal focus of Flynn’s work is adult protection – as she notes: “I think almost without exception, the work I’ve been involved in, whether it’s around service development activities or requests to undertake very specific reviews, [means] I’ve encountered people who have been harmed and sometimes the indifference that the families have met in seeking to challenge services or individuals responsible for the harm.

“I chaired Lancashire’s Safeguarding Board for many years, and I when I moved to Wales, I was told about a post coming up chairing the National Independent Safeguarding Board in Wales. It was the inaugural Board, the terms of which were set out in the Social Services and Well-being (Wales) Act 2014. I was fortunate to become the chair and even more fortunate to work with five fantastic people who were leaders in their own right – extraordinarily competent people – and we were able to have oversight of safeguarding activities concerning children and adults in Wales.”

Thinking back on one of the most publicly prominent reviews, her review of Operation Jasmine, Flynn comments: “I was delighted to be asked by the First Minister to undertake the scrutiny of homes that were owned by a husband and wife, GPs in southeast Wales, back in 2013, and that work introduced me to lots of people who were working in all sorts of ways to improve the circumstances of older people.

“For me, it was an opportunity to work with the families of older people who had received egregious treatment in these homes, and to meet the inspectors who had worked their socks off to effect change – and yet were stymied, effectively, by the legislation at the time. I wanted to involve people’s families in fashioning something of a different reality.

“I think I was as animated as they were to be able to see that actually, they all went through an identical process of incredible sadness as they realised that they could no longer support their mums or dads, or even their husbands and wives, due to dementia. And so, with enormous reluctance and sadness, they had sought to secure a home for them.

“Then came the process of noticing that something wasn’t quite right. Then, from just seeing the beginning, came the gradual process of challenge and seeking change – and then the disheartening distress of realising that change wasn’t going to happen – or that the responses were sometimes even punitive.

“So it was it was quite an exercise working with those families and making sure that I was accompanied by them when, for example… we met with the regulators to learn about what had happened and how we do things different and better now.

“We will learn the lessons – but it makes me think we [people] must be such slow learners. And yet we continue to talk about it. The Report went on to help shape legislation concerning regulation and inspection, in the Regulation and Inspection of Social Care (Wales) Act 2016 (RISCA 2016). The Minister for Health at the time also said he wanted workshops around Wales, in the community, to talk to very large numbers of professionals, and also to work with them in in discussing what it was they were doing to address some of the dreadful circumstances that hadn’t enabled, but it somehow made possible, the dreadful behaviour in those cases.

“Then there were inquests, for which I regret I wasn’t able to work with the families as closely I had previously. Not that I could have been instrumental in changing anything around the inquest, but I think it was hard for those whose relatives feature in the process to engage with it.

“And then the outcome? Well, it sort of disappeared, didn’t it? It was in the news and then… nothing. And that’s the nature of scandal. We promise change, and lessons, and all sorts – and then suddenly there’s another.”

Slow-motion neglect

“I also worked on one of the cases at Cawston Park hospital… this was Ben King’s inquest. He [was] a young man with Down’s Syndrome, and his was the third death at this private hospital in Norfolk. It was a fascinating experience, because very typically, as the author of a safeguarding adults review, you have to work with that which you’re given. And there are lots of reasons for organisations not to share information. There’s nothing to compel individuals to share information.

“So I was interested, and I think somewhat dismayed, to see that the information that was made available to me and to the panel looking at Cawston Park hospital for the purposes of the safeguarding adults review was somewhat limited, and the coroner was able to prise a great deal more information out of the hospital than I managed. Not that it did the hospital any particular favours. I think it just remains a very disheartening picture of slow-motion neglect, with a great many failures at so many levels.

“I was able to make the really uncomfortable ‘compare and contrast’ observations because I’d undertaken the review 10 years ago in Winterbourne View in South Gloucestershire. Often, services arose not because of any local needs assessment, but they were business opportunities. The common themes were families were struggling to manage, or services were struggling to manage. The cruelty of some individuals was a theme, and inattention to people’s physical healthcare and mental wellbeing was also a theme, as were inattention to physical welfare and around medication, seclusion, restraint and observation.

“I’m shocked by the inactivity of young men and women in services of this nature… people spending days in beds or sitting in peripheral seats, and bored. It’s a waste. It’s a waste of young people’s interests and lives – and, I find, a dreadful blind spot when we think about effective provision and also the stewardship of public money.

 “It’s right Panorama put a spotlight on the issue of fees in homes owned by the huge providers and looked at the backdrop and the make-up of these companies.”

What can we do?

When asked what solicitors can do when faced with families in such tragic circumstances, Flynn replies: “Actually, sometimes, as we’ve learnt, the honour is just helping someone along the way… [saying] ‘Here’s the pros, here’s the cons. Think about it.’ Not saying, ‘I think you’ve got to do this.’ Because that’s so tempting, isn’t it?

“So I think one bit of advice for solicitors is around just giving people space – space to set out their grievances. Space to listen to the pivotal events that have led to this place – and asking them about what it is they’ve done so far, and what it is they think is going to be really useful. Because it’s through that process that we arrive at a decision.”

Another area in which Flynn assists families finding support and legal representation is inquests. She and I recently supported the family in Re Foulkes (Mared Thomas), in which the coroner made a Regulation 28 Preventing Future Deaths Report against Cardiff University, which found, among other things, that “the sharing of examination results and how examinations are marked is complex, confusing and at times capable of appearing misleading”.

Flynn describes the current sparsity of legal aid provision as: “Heartbreaking. It’s heartbreaking. From my perspective, people need lawyers. People need good advice. They need it. They need you next to them.”

Asking questions

Another of Flynn’s passions is mental capacity, and the safeguards to ensure equity and appropriateness in the day-to-day lives of individuals lacking in capacity – from the fair provision of financial allowances for those under a financial power of attorney (on which she notes: “it’s actually not a bad question for solicitors to ask families of people who require support in their decision making”), to the issue of ‘predatory marriage’ and wills.

On that issue, she adds: “Why aren’t solicitors asking [more] questions? You know, it would take a couple of questions to appreciate that actually, someone’s mum did not even know this guy’s [her future husband’s] name. I think that is something so simple. And yet I suspect the business of your day-to-day work when you see people takes over. You’ve got to ask questions.”

“In fact, that’s one of the lovely things about starting life as a researcher – you can be legitimately nosy, and it’s great and mostly people will tell you, seeing you’re asking questions, not to catch people out but rather to understand – to understand and gather what their world is and what it looks like from their shoes.”

Dr Margaret Flynn, director of Flynn & Eley Associates, was interviewed by Chaynee Hodgetts, Solicitors Journal features and opinion editor and mature pupil barrister with Nexus Chambers. Enquiries for Dr Flynn can be sent c/o: chaynee.hodgetts@solicitorsjournal.com