Abuse in carehomes

BBC Panorama did some filming in a care home (Winterbourne View) where staff allegedly abused vulnerable adult patients in a manner that appeared arbitrary, cruel and verging on the sadistic.

Surprised?


The (in)famous Stanford experiment in 1971 divided college students into two groups. One group would take the role of prisoners, the other of guards. The experiment had to be ended prematurely as:  "In only a few days, our guards became sadistic and our prisoners became depressed and showed signs of extreme stress."

Now both groups were Stanford students: well-educated with high self esteem. Not poorly trained staff on minimum wage looking after vulnerable adults with a range of challenging conditions and behaviours. Power, it seemed, had corrupted the students playing the role of jailer.

Perhaps the experiment should be re-run with students divided into a group of 'carers' and a group of 'patients'. How much difference would these labels make? My hypothesis is 'none'. Power corrupts.

So Winterbourne View is no surprise. What is surprising is that we see so little abuse in the UK's fragmented care system. But the fact we don't see more is just that: we don't see, because we're not looking, because we don't want to see.

And therein lies the answer. The only remedy is for care homes (and prisons for that matter) to be transparent, witnessed environments where relatives and volunteers can and do visit at any time.

• My mother ended her days, well cared for, in a modern, four storey care home where I could visit at any time and where other patients received a constant stream of visitors. 
• A cousin, in contrast, was in a typical UK care home - a modestly adapted Victorian dwelling. Visiting was by appointment but few relatives ever visited. Responsibility for her (and the other patients) had been shuffled off onto the care system. Out of sight, out of mind. She drowned in the bath, aged 40.

My mother's care home had a number of other helpful features:

• a library
• an activity room
• a lovely setting to explore by wheelchair
• a quiet space with enchanting art by a local artist
• a patient council, where for some time she was a representative
• regular meetings with care and medical staff to discuss progress (or lack thereof) and take account of her care wishes
• and, evident from all this, an ethos that valued patients as individuals to be assisted in achieving their full (remaining) potential and enjoy as best as possible their (remaining) life. Such an ethos demands highly trained staff, but also inspires staff to maintain the highest ethical and professional standards. Patients and their frequent visitors would demand no less and would be quick to complain.

Where in the UK do we see such best practices? Not in Winterbourne View, evidently. Not anywhere, I sometimes fear. Tell me if I'm wrong.

From the contrasting examples of my mother and my cousin it is also clear that the attitude of relatives makes a difference. 'Out of sight, out of mind', is an invitation to abuse. But if that is the prevailing culture (or sub-culture) it is even more important that the architecture of the building allows those who do visit to see as much as possible of what is going on. And the capacity of the building should be such that a sufficient number of friends and relatives visits every day. (The lower the cultural propensity to visit, the higher must be the number of patients.)

Whether such a facility is publicly run or privately run is immaterial. Transparency, and a mechanism for holding the operator swiftly to account and to force a remedy, is what matters.