Abuse of care home residents will continue without radical reform, warns Peter Beresford.
The first thing that needs to be said about what’s come to be called the Winterbourne View scandal, is that it was systemic and that the pressures that gave rise to it are likely to be on the increase rather than on the wane. The first Panorama programme which broke the story in May 2011, showed the most squalid and routine abuse of people with learning difficulties. One of the authors of the serious case review report on Winterbourne View talked of the failure of all involved in the scandal, psychiatrists, management, support staff and police.
The second Panorama programme, aired on 29 October 2012, showed that this was not an isolated incident, reporting an even more disturbing back story of people routinely being shunted between locked hospitals, unsafe and at risk of further abuse. The government has said that it will be announcing policy reform shortly. This will need to be radical and far-reaching.
It is now nearly half a century since progressive commentators made a convincing case that people with learning difficulties should not be kept in hospitals and that these and ‘treatment’ approaches were ill-suited to meet their rights and needs. Instead of institutions in the NHS, what was needed was community-based support that responded to the individual, addressed their unique needs and built relationships between them and skilled practitioners. These would be the basis for empowering service users and dealing with the so-called ‘challenging behaviour’ that has long been recognised as a by-product of isolation and institutionalisation.
What seems to be making matters worse has been the shift in this field to the private sector as service providers of choice for successive governments. The authors of the serious case review of Winterbourne View spoke of its owners, Castlebeck’s preoccupation with profit rather than need, even though they in turn denied it. For-profit providers are associated with higher levels of abuse than third sector providers. They are also associated with more traditional and institutional provision, rather than more progressive services, more supportive of the choice, control and independent living that policymakers pay lip service to.
Yet as is so often the case with such systemic failure, it is only those on the front line who seem to be subject to control. Eleven workers have been convicted since Panorama broke the story, with sentences of up to two years imprisonment for the criminal abuse of service users. They all bear a responsibility. But so do many others; the Care Quality Commission for doing nothing at the time, Castlebeck for making a profit out of misfortune; the commissioners for taking the easy way out of their responsibilities for people with learning difficulties and their families, and government after government for only responding to the crisis of care at the point of scandal and front page headlines.
As has long been recognised in the context of child protection tragedies, a process of policy development based on scandal, inquiry and ad hoc action, is a recipe for disaster. Large-scale problems don’t go away just because one case gains a high enough profile to demand a one-off political response. If people with learning difficulties and other disabled people are to be safe in services and live full and equal lives, then services need to be democratised, independent advocacy needs to be resourced and whistleblowers need to be properly protected. The lesson of Winterbourne View is that none of these crucial components is close to being in place. Any government proposals for reform in this area must squarely address all these issues.
Peter Beresford is Professor of Social Policy at Brunel University. He is also Chair of Shaping Our Lives, the national disabled people’s and service users’ organisation and network.