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.

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4 Responses to “Panorama and Ash Court – Towards Improvements”

  1. That was an interesting read, thank you, however I’m not sure I know anyone who is happily employed on a very low wage, no matter how noble the work is. I too am a low paid yet reasonably well trained health care assistant and although I enjoy my work I do not enjoy my wage which I feel is hard earned and the work poorly recognized by employers, the general public and respective involved organisations. There’s nothing like being blanked by a nurse, OT or social worker because one is nought but a mere care assistant.
    On the other hand: I have often wondered how we become insensitive to conditions of the environments we work in. Having recently returned to care as an agency/bank worker, I felt my senses assaulted the first time I walked into a nursing home for emi’s. Client’s seemed ill cared for, staff seemed too young, naive and dare I say it, uncaring. Yet after a few shifts, it became a little more “normal”. A good home, good facilities, well run, a good CQC report… yet first impressions are that residents are “wet”, bored, neglected, dirty, under or over medicated. Is that a truth? Requirements are being met so why should I have that initial impression? Perhaps it’s an attitude, perhaps it’s the way staff are not trained adequately to use correct handling techniques (to the detriment of MY back!), do not use basic dignity protection practices during pc, do not seem to be aware that chances are Radio 1 is probably not the listening preference or choice of their elderly clients. I seem to recall covering this sort of thing in my NVQ2 and thought it to be the very basic training/knowledge requirements for staff. I still can’t seem to find someone to blame though. Is it the ignorant 18 year old? Is it the duty nurse? Is it the office manager? Is it the owner? Is it the local council? Is it the CQC? Is it the government? There are valid reasons to excuse each party and so no action is really taken, no solutions are really found, nothing really changes… except maybe more paperwork…

    • Thanks Robyn.
      I can understand where you come from because I worked as a care assistant for 7 years or so before I decided to train as a social worker – I know the ‘blanked’ feelings and having had that job, can appreciate status or lack of it. It was partly what pushed me into social work to be honest – but it was also the first job I had and I didn’t have high wage expectations – to me, as a single person living in a shared flat, I didn’t know what other opportunities (or salaries) were out there.
      As for the blame – having worked in good homes primarily and occasionally in less good – and from looking in from the outside as a social worker – I think the culture of management has a lot to add or subtract from the process. If you have a decent manager and staff who aren’t bullied (yes, I’ve seen that too and been subjected to it) then you are more likely to create a culture of care which encourages people to raise issues and highlight those people who may be more abusive.
      There’s always going to be a possibility of people going into ‘care work’ without having tendencies to care but rather because the power differentials are too appealing. While I think everyone has to be responsible for there own actions, management cultures can promote better conditions and on from that, the local authority commissioning processes can be blamed for driving prices down.
      I genuinely think the values of personalisation and choice have yet to be explored in residential care for older people because the cost implications to commissioners are too high – but they must. This is an indication of the ageist cultures.

  2. Another depressing programme that I made myself watch out of some idea of duty to acknowledge such horrendous practice. I am so glad that this programme did show everything and yes I agree it was probably for the shock factor but I have to question why do we need such programmes in the first place?
    I remember talking with a colleague once about how each group of people reflects the world or our society in miniature. In a care home therefore you can see all the values and beliefs of the society where it sits. Is this how we value our older people? Is this what we can all expect in later life? Where is the recognition of the human being as a person with individual differences and diversity?
    I fear that there are many more places like this that it would not be too hard to find now that we have the technology ( I was trying not to get too interested in that amazing hidden camera), but they are simply reflecting a society that does not value its people who are old or disabled. Individual people are not only to blame for these horrendous events but also the systems and society in which they live and work.

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