The context is someone hearing comments that were "shocking", and that were so shocking they could only be delivered behind closed doors. This is a good, but not infallible, sign of a dysfunctional culture in health care. It might be fine in other industries, but in health care there are strong links between this culture and poor, harmful, practice.

It's interesting that making a complaint is seen as a negative thing to do: if there's no basis for the complaint no action is taken. Action is only taken - the compaint is only negative for the HCP - if the HCP has done something wrong.

> and seeing how the staff was venting, talking and joking about patients - once the doors were closed. I was very shocked,

The standard you walk past is the standard you accept.

Have a read of the reports I mentioned to see where this toxic culture leads.

Here's mid Staffs, but they all say the same:
Mid Staffordshire: https://www.gov.uk/government/publications/report-of-the-mid...

> During the course of both the first inquiry and the present there has been a constant refrain from those charged with managing, leading, overseeing or regulating the Trust’s provision of services that no cause for concern was drawn to their attention, or that no one spoke up about concerns

People need to speak up. And when they do speak up, they need to be listened to.

> Negative culture

> While it is clear that, in spite of the warning signs, the wider system did not react to the constant flow of information signalling cause for concern, those with the most clear and close responsibility for ensuring that a safe and good standard care was provided to patients in Stafford, namely the Board and other leaders within the Trust, failed to appreciate the enormity of what was happening, reacted too slowly, if at all, to some matters of concern of which they were aware, and downplayed the significance of others. In the first report, this was attributed in a large part to an engrained culture of tolerance of poor standards, a focus on finance and targets, denial of concerns, and an isolation from practice elsewhere. Nothing I have heard in this Inquiry suggests that this analysis was wrong. Indeed the evidence has only reinforced it.

The first point in the executive summary to the Winterbourne View report says this:

> The abuse revealed at Winterbourne View hospital was criminal. Staff whose job was to care for and help people instead routinely mistreated and abused them. Its management
allowed a culture of abuse to flourish. Warning signs were not picked up or acted on by health or local authorities, and concerns raised by a whistleblower went unheeded. The fact that it took a television documentary to raise the alarm was itself a mark of failings in the system.

Staff didn't go to Winterbourne View and immediately start punching people in the face. The abuse started with a culture of dehumanising these people, and closing off the wards to prevent criticism.

> The Serious Case Review also sets out very clearly that for a substantial portion of the time in which Winterbourne View operated, families and other visitors were not allowed access to the wards or individual patients’ bedrooms. This meant there was very little opportunity for outsiders to observe daily living in the hospital and enabled a closed and punitive culture to develop on the top floor of the hospital. Patients had limited access to advocacy and complaints were not dealt with.