Over a week has passed since the Panorama exposé of practice at Winterbourne View. Run by Castlebeck the facility is described on their own website as “a purpose designed acute service, offering assessment and intervention and support for people with learning disabilities, complex needs and challenging behaviour“. I am not going to go into detail about what the film covered, you can still see the episode here and there have been several excellent blog posts and commentaries published. There has been a lot of outrage, a few apologies, a lot of promises and a lot of anger.
What I thought I would just do was offer a few of my reflections on the programme – I’m not claiming these will be original, but they were what stood out for me:
1. Respect and Value As a society how much do we respect people with learning disabilities? What value do we place on their care and support – providing it in a building on the edge of an industrial estate. An industrial estate, seriously, how many of us would like to live on the edge of an industrial estate? I’m not sure what message that sends to the residents/patients/customers and their families and I’m also not sure what message it sends to the staff. If, as a society, we don’t show respect for and value people with learning disabilities, why would we expect the people who are paid the minimum wage to provide their care, to act any differently?
2. Boredom and underload The staff shown in the show were quite simply bored. They had too much time on their hands, they didn’t know how best to engage their residents and so they entertained themselves; as my Gran would say ‘Idle hands are the Devil’s playthings’. Rarely did the staff attempt to meaningfully engage the residents, and when they did they weren’t successful and got little feedback, so nothing would encourage them to persevere.
3. Aspirations The staff shown engaging in abuse at Winterbourne View were not people who aspired to be carers. One of them, Graham, had previously been the kitchen porter, I’m not sure how he came to be working as a carer but he certainly hadn’t applied to Castlebeck with that role in mind. One of the Senior Support Workers, the one referred to as the ‘ring leader’, Wayne, previously worked in a Young Offender Institution and had an ambition to open a tattoo parlour. These people were not people who aspired to be carers, that said they didn’t lack aspiration or ambition, but they were simply not doing a job that interested them. This relates to the earlier point about value, how much value do we place on care work? As a society do we value the work that Graham and Wayne do?
4. Isolation As an assessment facility, many of these residents were miles from their family, friends and support networks. These were not unloved, forgotten individuals though; they were not vulnerable and isolated residents with no support; they had supportive and engaged, loving families. However, the residents at Winterbourne View were kept on a locked ward, their families and friends never had access to where they lived, instead visiting in a visitors room. They were isolated by their situation.
5. Training These staff lacked training and support. They were working with people with complex needs, idiosyncratic communication, and arguably challenging behaviour. They were providing support for all of their needs. A lot of the media backlash has laid blame at the individual’s involved – and yes they should know better – but in amongst the awful behaviour there were attempts to engage with residents.
Wayne, who was so awful at times, was also the one who sat holding Simon’s hand (in the scene were the horrific abuse of Simone was the focus); on another occasion, before snapping and dragging a resident from her bed, he had knocked on the door before entering her room and greeted her with a cheery “morning princess”. In one scene he threatens Simon with flushing his head down the toilet – he has his head suspended above the bowl and as Simon screams his complaints, Wayne offers the reasoning that ‘this is what other people feel like when you give them bear hugs’ – at some level, Wayne’s behaviour could be interpreted as the attempts of a man who knows no better, trying to teach Simon a lesson.
Simon’s learning difficulties, and the difficulties of other residents, mean that they will not learn through tough love, no doubt the approach that Wayne’s parents or superiors took with him, would not work. I’m not so sure that he knows any better way of doing things.
I’m not suggesting that Wayne’s behaviour is forgiveable, but I do think he lacked support to do a better job. Remember this is a man who wants to run his own tattoo parlour, who has worked there for three years, who earns £16k a year, who has no qualifications for the role he performs.
We know what needs to change. We should have learnt these lessons by now, at least with regards to institutional abuse. There was a reason why long stay hospitals were closed down in the 80s, we know what causes institutional abuse.
Two years ago, research in practice for adults published Safety Matters: developing practice in safeguarding adults. This publication was the result of an action research project that I co-facilitated with Bridget Penhale (an academic and Joint Editor of the Journal of Adult Protection – alongside Margaret Flynn who will conduct the SCR for South Gloucestershire Safeguarding Adults Board), Paul Bedwell and Stephen Bunford from Essex Safeguarding Adults Board. We looked at the available research evidence, and combined it with practice knowledge about improving safeguarding practice, talking to professionals from across the country about their experiences and learning. The document, while in need of a refresh, still contains lots of information and ideas for practice. One of the checklists contained looks at pointers of institutional abuse, we should have been able to spot this, and prevent it, earlier:
I am delighted at the sense of national outrage in response to Panorama. I would be even more delighted if we could start by looking at the evidence we already have, and trying to use that to improve practice. As a society we have to ask ourselves some fundamental questions about how we value and treat people with learning disabilities and rather than pointing the finger at a few individuals uncovered by a journalist, we should ask ourselves what more or what different we could do.