Panorama and Ash Court – Towards Improvements

I watched Panorama last night. The programme, as explained yesterday, focused on the abuse by care workers at Ash Court of an older woman with dementia whose daughter filmed her secretly on a hidden camera in the home.

The footage of the abuse was sickening and involved both physical and psychological (neglectful) abuse by those employed to care for her. Most indicative was the lack of regard that the care workers had for Mrs Jane Worroll as a human being as we saw the treatment dehumanising her.

It was clearly uncomfortable viewing and links are being made with Winterbourne View but there are vast differences and this time, although I almost surprise myself, I think it’s important to defend the role of the Care Quality Commission in this case.

With the Winterbourne View Panorama expose there were whistle blowers and the regulator should have taken action as a result. With the situation at Ash Court, there was a hidden camera and while some of the cultures could have been known to exist within the home itself, it’s clear that the regulator did not have a way of knowing what was happening before it happened.

As they say in the statement that they make on the programme that what they (the CQC)

cannot do is to identify and stamp out deliberately concealed abuse. By its very nature, concealed abuse takes place away from the eyes of managers and inspectors and can even take place, as in this case, in a well run care home. Abuse of vulnerable people is a criminal matter, and is rightly handled by the police and the courts.

That’s the big difference between Ash Court and Winterbourne View. The disappointment in Panorama is that it tried to merge the agendas of both and while there is a common narrative to both programmes about abuse of those who have power of those who do not, the solutions and causes are different.

I mentioned on Twitter during the programme about the discrepancies of procedures and powers for adult safeguarding and safeguarding of children.

Personally I see ‘safeguarding’ and ‘abuse’ as the use of power by someone against another person who has no power. That might be as a result of physical ability, mental capacity or understanding or just some of the institutional structures in place. Whether the person who is abused is 6, 65 or 85 shouldn’t have any sway within the processes. What I’d like to see is a unified process that deals with the effects of abuse and the power differentials – rather than provide so many more hoops to jump through and weaker processes when the person to whom the abuse happens is over 18.

The effects may be different according to the stage in the life cycle but they may not be. The criminal act is around the abuse of power and the abuse within the relationship that takes place along with the eventual effect.

I’m sure those with more knowledge than me will come back to attack my somewhat simplistic judgements and thoughts on this but it’s frustrating working within an adult safeguarding process that lacks so many of the potential teeth when we see some of the abuses that take place and see so few taken to court due to unreliable witnesses or lack of scope for action.

Another disappointment of Panorama (although unsurprising as they wanted to squeeze out all the ‘abuse’ footage for shock value and only had 30 minutes) was the lack of attention to some of the systemic problems that have led to warehousing of older adults in institutions when they need residential care. The pay of the staff was mentioned but pay is not the only consideration.

I worked quite happily at a very low wage as a care worker myself for a number of years but what matters as much as pay (although pay helps) is the value placed on the members of staff. Staff who are not respected and who are treated as expendable and with little respect are more likely to pass that feeling of powerlessness on to others. It isn’t an inevitable link – you get good staff in bad homes and bad staff in good homes – but it’s more likely that if staff feel linked to and attached to those whom they care for and those for whom they work – they are more likely not only to pass on that feeling of respect but to feel vested in the organisation for whom they work.

Too often care work is seen as ‘easy’ and care workers are seen as ‘replaceable’. Organisations like Forest Care (and many others I know) bring staff over from the Philippines en masse to carry out these roles or put staff on zero hour contracts and push out unionisation. Organisations have to regard staff better – and pay is one of those aspects but not the only one – in order to create cultures of care and compassion. The other aspects are good and robust supervision, including peer supervision and giving staff responsibilities and a stake or voice into the organisation they are working for. Whistleblowing has to be easier and better regarded. Complaints improve care and processes and they should not be feared.

Local authorities and the government needs to be willing to pay more for care and for monitoring inspections which don’t need to simply come from the Care Quality Commission. If LAs push prices down to rock bottom quality will suffer. Some people do need 24 hour residential or nursing care and it shouldn’t be accepted as being ‘sub-standard’ as default. It doesn’t have to be.

Panorama didn’t shock me, unfortunately. It saddened me. I hope it doesn’t become just another blip in the process of change. I want the processes and structures to be pushed to positive change. Blaming the CQC won’t do that – changing the expectations and systems might.

As for hidden cameras in residential care homes and in people’s own homes – I see it increasing and have a sense of discomfort about some of the rights to privacy that are impeded however finding and challenging abuse is important. Would Mrs Worroll’s abuse have been discovered without them? Unlikely unless one of the care staff attending her raised concerns with their own manager. I may be tempted to use hidden cameras myself if I had a family member in a similar position but that’s the key – it’s only those people who have family members who will have recourse to such action – what we need to do is find the reasons these abuses happen institutionally and act on them.

Of Hidden Cameras, Care and Panorama

Tonight’s  Panorama is focusing on care of the elderly or rather, lack of care. Maria Worroll was placed by her mother in a care home in Camden which had an ‘excellent’ rating by the CQC (Care Quality Commission).

Jane Worroll, Maria’s daughter, noticing something amiss and perhaps having concerns, set up a hidden camera in her mother’s room to observe how her mother’s treatment. Mistreatment and abuse were filmed and it led to a conviction by a care worker, Jonathan Aquino, under the provisions of the Mental Capacity Act (2005) and a jail term of 18 months.

There are a few key points to take into this and to note. Prior to June 2011 (when the filming took place), the previous assessment and inspection by the CQC was in 2009. It was an unannounced inspection and as described above, the outcome found the home was excellent.

There were a couple of ‘compliance’ visits after the incidents films came to light but the important thing to note is that an excellent care home can provide appalling care if there is one abusive care worker. Similarly a care home which may have a poor inspection report can provide excellent care if there are caring and good quality care staff. Historical reports of care by regulators actually tell us little about the quality of the care today, at this moment, as staff in these care homes tend to be transient and low paid.

There is an issue about management culture of course. I have seen a switch in manager making both a very positive and very negative effect on residents in these homes. While more regular ‘spot’ inspections – perhaps by lay visitors as well as official regulatory bodies – may be one answer, it may not root out the individually abusive members of staff. A much better way to do that is to firm up whistleblowing procedures and supervision procedures for care workers – perhaps more peer discussion and supervision as well as managerial supervision.

As for the effects I see, I am no longer surprised by the increase in surveillance by family members which is a definite increased trend that I’m seeing. While there may be issues of privacy, the concerns of families are very real.

Until our care systems can provide better qualities of regulating and monitoring care – and not only from the CQC but from commissioners – whether they be local authorities or privately funded – there will always be these questions that linger at the back of the mind.

I expect I’ll be watching tonight, if I am able. I think I know what I’ll see but it is important that these incidents come to light so that changes in the systems can be made. This is one incident but it is very far from isolated. Our society needs to deliver the type of care and the methods of monitoring of care and the financial provisions for care that are not age-dependent. Until we do so, I can only infer that the systems of social care in this country are inherently ageist.