Tuesday, 7 June 2011

Dickens Lives! Bullies Rule OK!

Back home from Germany to distressing telly — Paul Kenyon’s BBC Panorama Undercover Care: the Abuse Exposed. Joe Casey spent five weeks undercover as a care assistant at a private hospital for people with learning difficulties seemingly run along similar lines to Guantanamo Bay.

Watching it was not easy, but the film demonstrates exactly what public service investigative journalism is for, and deserves major recognition:
The project was planned after a professional nurse blew the whistle on bullying behaviour among some of the care assistants at Winterbourne View, near Bristol. Particular attention focused on a great bullying bear of a carer who had seemingly built a whole culture of harassing those weaker than himself for his own amusement. Let none be deceived. The assessment of oft very limited service users can be challenging work, involving occasional need for physical restraint. This, however, was simply torture.

What do we learn?
  1. About Bullies
    There is deep in some people a need to exploit others' weaknesses for their own gratification — to wind people up until they snap and then bring down the panoply of the rules upon them. There is a cruel, bullying streak in our culture at every level. An archbishop of the last century was told his broadcast on the subject of the abdication of Edward VIII had not gone down well with the public because it had appeared to be kicking a man when he was down. “But what’s the point of kicking him if he isn’t?” mused his Grace. Bullying behaviour, even in Church, happens on various levels, and should always be called out for what it is. Go along with the bully and you create the culture in which such behaviour thrives. Indulge them and you will have hell to pay. Remain silent and you collude.

  2. About Hospitals
    The hospital’s owners had a large chest of what turn out to be fatuous awards and service gongs. You cannot legislate compassion and humanity by guidelines and targets. Whilst it’s good to know Wayne and some of his cohorts are currently helping the police with their inquiries, and shooting the sergeant is a classic response to failure, the systemics of their own operation allowed the owners to ignore clear distress signals from their own whistleblowing employee, employ several wildly unsuitable care workers, remain ignorant about what happens on their own property, ignore several injuries amongst the service users — all of these are management and governance failures, in which Wayne played but a walk-on part.

  3. About Regulation and Safeguarding
    The same whistleblower approached the Care Quality Commission — the Government’s regulatory body — and they also ignored him. This raises profound concerns that, again, transcend one official’s judgment in this case, poor as it obviously was. CQC had inspected Winterbourne View three times in the past two years. How did they miss all evidence of wrongdoing, and how can we know that there is not widespread undetected abuse going on elsewhere?


Lesley said...

Excellent post Alan, thank-you. I watched 'The King's Speech' the other day and found the character of the ABC in that most disturbing. I wonder whether the only way forward is a mixture of unerring kindness as a model and courageous truth-telling... wondering whether this was the recipe that Jesus used...

UKViewer said...

I despair of this country. We have systems in place to prevent abuse, including 'whistle blower' legislation, but it's not much use if those wishing to highlight issues are ignored.

I spent time in care as a child in the 1950's (5 years exactly). The home we were in was RC and had, for the time, a robust discpline system, which escalated to Corporal Punishment as punishment. Normally, if we were punished in this way, we acknowledged our own guilt for some misdemeanour. But, I noted then and later in RC Schools in London, that the Cane was wielded lustily and often.

There is a theory that the cycle of abuse may be carried on through generations, those abused, likely to become abusers themselves. I believe that there is an element of truth in this. But, receiving the cane as a child, did not turn me into an abuser, so why does it affect some and not others?

I cannot conceive on how people come to become abusers, but we have a duty to report bullying, but those we report it to, have a responsibility to act on the report, whatever the consequences for their organisation or the abuser concerned.

I hope that the owners of the care home concerned are charged with neglect along with those in the CQC who ignored the reported abuse. Off course, being a government agency, it is unlikely that the head will go, someone further down will be disciplined or even sacked. Scapegoating is developed to a fine art in public services to avoid CEOs and governing bodies taking responsibility for their lapses.

Ann Memmott said...

Thank you, Bishop Alan, for raising this on your blog.

I've had to reassure so many worried families, and so many scared people with LD or who are on the autism spectrum. There are excellent care homes and excellent workers, of course. But there are also so many occasions where vulnerable people are treated as less than human, and not a soul cares or believes the person if they ask for help. People's brains do contortions trying to justify why so many sit and just watch it happen:

"It's not our job to get involved. It's nothing to do with me. Surely they must be imagining it. Surely they must be exaggerating as a way of seeking attention. Surely they deserved it. Surely they can sort it out themselves ", etc. If it was a young child being stamped on, would we act differently compared to our reaction if it's a 20 yr old who is frightened or tortured?

It links in with your previous post about how we view minorities, too. A lot of the work I do is in listening to people who have been abused, starved, hit, mocked, ostracised or worse by those who were supposed to care for them, and it takes year after year to get their confidence back again.

What can Christians do to speak out against inhumanity towards vulnerable people right here in our own communities and parishes, and support those who are trying to make a difference? Big questions, but important ones.

It's good that we have excellent people in the form of our disability advisers and social care groups, but how can we make sure their work is well known and well respected in our communities, I wonder? How do we encourage church leaders to see it as part of their job to wonder what goes on in the local care homes or other care-in-the-community settings, and whether their quiet and caring presence can help make a difference there?

Red said...

My Grandmother, until very recently, was residing in a care home for the elderly. In visiting her regularly I have had an insight into the staffing of the home and the characteristics of those who work there. There were some who were brilliant, they were obviously called to this kind of work and did so with the utmost compassion and love for those they cared for. On the other hand there were also those who clearly couldn't care less, were rude to the patients, everything was too much trouble and they didn't even have the courtesy to speak to those in their care. I found this quite hard, not least because my grandmother would complain about some of the staff and I just couldn't tell how much of it was true. I am incredibly thankful that none of it was as bad as featured on the BBC programme, but I drew the conclusion that work in this kind of profession is actually a vocation. And there just aren't enought people willing to do it or feeling that it is their vocation. It is poorly paid and so you end up with a wide selection of people doing the work who probably shouldn't be. And that doesn't even take into account for the bullies who obviously do it for other reasons.

Tregonsee said...

A distrubing story. Almost as disturbing as the ignorance of the facts implied by "... seemingly run along similar lines to Guantanamo Bay."

Erika Baker said...

Is there anything to stop CQC and similar organisations to employ undercover staff to check out every establishment rather than pay official visits every now and again?
It seems to be cheaper and more effective.

Lay Anglicana said...

My own experience with my grand-mother's nursing home bears out the stories of bullying. The grand exterior of the house set in rolling parkland, together with the high fees, did nothing to prevent this, which I fear is very widespread. The CQC gathers information from 'inmates' which they say is confidential, but the general belief amongst patients was that any criticisms would leak to the carers, who would be sure to punish them.

Who is to be sacked? If the problem is as widespread as I fear, apart from the occasional scapegoat, it is difficult to sack staff because it is difficult to find replacements.

Lesley's idea of unerring kindness as a model must be the answer, but it needs to come from the top and supervising staff. As UKViewer, some of the main offenders also come from their ranks.

Acetate Monkey said...

An awful situation, from an empathic point of view, but also (if I'm honest) fueled by the fearful knowledge of my own future vulnerability. Of course the reasons for bullies and abuse are hard to pin down. Is it that some people are 'evil', attracted to areas of work where vulnerable potential victims exist, or are they like you-or-I but pushed beyond endurance by high work demand and low pay? Until I had 2 small children very close together i couldn't believe people could be driven to harmful acts, but sometimes when both were crying and 'unreasonable' I could see if I had had less support or personal insight...

It makes me think of a few things:
Freidson’s (1970) analysis of medicine concluded that ‘[d]epersonalization [sic] is most marked when the client is most helpless’ (p170), and that such helplessness comes from both the status of the client and through the limited provision (and therefore choice) that tax-funded systems can offer. I suppose it's obvious, but once people lose their personal status (which might be easier to do if you have LD) they are more 'objects' than 'subjects'.

Your Guantanamo comment reminded me of this excellent talk by Philip Zimbardo at TED http://www.ted.com/talks/lang/eng/philip_zimbardo_on_the_psychology_of_evil.html

Finally the CQC failure reminds me of a talk I once heard by some sociologists discussing the MHRA, who raised the question Quis custodiet ipsos custodes? Who regulates the regulators? Undercover agents might well be a way forward as there is a need for objective evidence of the form in the programme rather than a 'surprise' visit (which if like OFSTED isn't a suprise and merely results in short-termist change for the sake of the visit) or reliance on testimony from people who quite rightly can't tell if the assurance that their 'being a grass' won't get back to the abusers. Like any bullying- work, school etc., this vulnerability has the power to silence the victims for fear of a worse future.

Ann Memmott said...

Does high work demand and low pay causes people to become abusers who trap people under chairs, stamp on them and force them to endure freezing conditions until they are blue from cold? No, it doesn't.

These were not incidents of momentary and regretted loss of temper after many months of sleepelessness, but a systematic campaign of torture, mocking and abuse from staff who had access to all the right breaks and training.

It's worth looking at the work of Phoebe Caldwell, whose gentle approach to those with LD and autism is world-class, and who has only twice in her entire long life found herself in a dangerous situation with those with disabilities. Why? Because she respects, loves and adapts her behaviour to meet our needs.

Interesting indeed that this particular set of care homes was given 2010 Healthcare 100 "Best Employers" Award. Not quite a sweatshop for poorly paid staff, then. The residents 'received' £3500 a week for that 'care'. Money was not in short supply.

Alas, cruel people don't need a reason other than that it feels really good to hurt vulnerable people.

Bishop Alan Wilson said...

Many thanks to all for your perceptiveness and care about this. Ann, I was horrified to hear hw many gongs this particular management had won for running care homes. I coem o the depressing conclusion that you're exactly right. Cruel exploitation of the vulnerable can only partially be controlled. The best antidote is positive imagination and humanity..

Acetate Monkey said...

I would hate to think that I am "trying to justify why so many sit and just watch it happen". That's certainly not what I meant. I certainly didn't mean to imply that such conditions as low pay/high work load (should they exist, which as you say they didn't) in any way justify or explain such appalling and degrading acts. They are outrageous and unjustifiable. Period.

Having said that, as humanity's history demonstrates it is less clear than simply 'us and them'. This is the "banality of evil" (Hannah Arendt) which showed it's ugly head in the concentration camps of WW2, the Stanford Prison experiment and Abu Ghraib. There are myriad factors in it, that is the problem of evil. As you say, one of which is that cruel people don't need a reason other than that it feels really good to hurt vulnerable people. I would question why it feels good though? Why have they no empathy? How did that happen? Systematic abuse is not always due to sociopathy alone.

Regardless of the micro-causes, we all have a choice regardless of our circumstances. The culture which operated and normalised such inhumane treatment could be resisted- otherwise there would be no whistleblower and no programme.

Thank you for directing me to Phoebe Caldwell. Her work looks fantastic, and is certainly something I shall look into.

As you wrote in your first post, there are big questions about how Christians demonstrate kingdom values and engage with those who champion the various vulnerable people around them. Big, but certainly needing to be considered.

Peter said...

Thanks for this...

The Care Quality Commission (CQC) was the brain child of New Labour’s ‘if it’s not broke, we’ll fix it anyway...’ school of government that saw, during its thirteen year tenure of office, a massive growth in mega-quangos. It replaced – by the amalgamation of this predecessors – the Commission for Social Care Inspection (itself, within the life of the Labour Governments, had replaced the Social Service Inspectorate and the National Care Standards Commission. The creation of these non-governmental agencies was one of Labour’s greatest mistakes and I am certain was a deliberate attempt to remove the regulation of social care services away from local accountability. Before the rise of the CSCI, NCSC and their reincarnation as the CQC, the registration and inspection of residential care had been the responsibility of local authorities under the requirements of the Registered Homes Act 1984.

Local authorities were duty bound to have a Registration and Inspection Unit (R&IU), staffed by inspectors who had a social care (and often a management) qualification and experience of working and managing a residential home. Their task was to inspect all residential homes within the local borough twice a year – a once a yearly announced inspection and a once yearly unannounced inspection. The R&IU was also responsible for the vetting of potential managers and owners of residential homes. In addition it could also perform spot checks of a home following an allegation of abuse or malpractice. As a student social worker, earning a bit of spare cash, I worked a night at a local residential home and found one of its practices for dealing with a resident with behavioural problems at night was to make her sleep in the staff cloakroom, on a mattress on the floor. Because she was elderly, once she was laid down on the floor she couldn’t get up. The next morning, instead of returning home to my bed I went to the local social services offices, asked to speak to someone from the R&IU, made a formal complaint and the home was inspected that very night (at 1am) and appropriate action was taken against the home. The system worked – and because it was part of the local authority’s social services, it was also accountable to the locally elected council. For reasons I have never really understood, New Labour had a habit of doing as much in its power as possible to augment its own power, therefore pruned local authorities of departments that had large financial implications for central government; taking away both local accountability and its contingent local working knowledge of social and cultural topography. Now, as the Bristol case highlights you can report your concerns about a residential home and nothing happens, because the CQC doesn’t actually have any powers of investigation – you have to go to the Local Authority Ombudsman (LGO). Goodness knows why, when it is highly unlikely an officer from the LGO will have the expertise for investigating a residential home in the same way that officers from R&IU would have had. It is yet another example of Labour wasting hundreds of millions of pounds to solve a problem that didn’t exist.

I hope our present government returns to the Registration and Inspection system. It did the job, it was cheaper than the CQC and was also locally accountable. You could write to your councillor about any issues you had with the local R&IU shoudl you wish. Now it is just a muddle!


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