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Manifestations Of Mind

The team leader, demonstrating to the team how you abuse someone, this technique involves the use of a chair to pin the vulnerable adult, in this case Simone, and the application of foot to hand.

Last month, BBC’s Panorama programme, Undercover Care-The Abuse Exposed, explosively provided not only an insight, but literal window, into some of the abuses that can take place in the UK care system.

From waterboarding to a knee in the throat, from prompting suicide, to slapping someone in the face, the actions of a wide group of support workers at Bristol’s Winterbourne View care home, Castlebeck’s unit for people with learning disabilities, and the failure of the regulator, the Care Quality Commission, to act on information provided by whistleblowers, demonstrated to a shocked and disgusted nation the ‘standards of care’ currently stalking the corridors of these 21st Century Bedlams.

To date, 13 have been suspended, and nine have been arrested and bailed, and Castlebeck have apologised. As has the CQC, and the Government has not ruled out a public inquiry.

What has been exposed demonstrates the need for the largest overhaul of the care system, and the services provided to people with special needs, to date. I am addressing the concerns for this group specifically, as anyone with any experience, will understand, ‘one size does not fit all’.

I must start by declaring an interest: I am a support worker with adults who have autism, aspergers and other complex needs . I also have a younger brother, who uses non-residential care services. This provides a rather dynamic view, and approach, to the work I do, the standards I apply to myself (as well as those which regulate my profession), and, just as importantly, the standards of my colleagues, and, my employer. This doesn’t mean I think I’m some sort of one man justice league or Six Billion Dollar Support Worker; it’s my job.

Blogger, mental health author and former nurse, Connor Kinsella, writing in his blog about the state of care, and the evolution of the system from the asylums of the early 19th Century, asks,

Has anything changed, and what other reasons are behind such appalling abuses?

Well, money matters

Castlebeck, the provider at the centre of the abuse scandal, is ultimately owned by Swiss based Lydian Capital Partners, an independent private equity fund which

invests in market leading businesses in order to achieve long term capital growth (The webpage this was retrieved from, strangely, is no longer accessible, along with contact details. Hmmm)

It counts amongst its senior team Irish tycoons and entrepreneurs JP McManus, John Magnier, and Dennis Brosnan, as well as home-grown businessman Mike Parsons.

This group has investments, and ownership, in numerous service providers, including Cygnet Healthcare (a secure mental health care provision), Wellness Foods, and Barchester Healthcare, about to become the third largest private social care provider, assuming it consumes the failing Southern Cross.

What we must ask, armed with this information, is this: is being rich a good enough qualification to be operating a care provider?

the business is supported by strong future demand based on the demographics of the UK population, the long-term growth in older population and rising affluence continue to offer opportunities for investment in the sector (from the financial report of one of Lydian’s businesses)

I mentioned evolution of the care sector. It would appear that funding care has, sadly, yet to grow a thumb, as the problems, moral and ethical, were noted by John Connolly, resident physician at the Middlesex County Asylum in 1830, when he wrote:

care…being generally lucrative…the prospect of certain profit allures some capable of no feeling but a desire for wealth

Of course, this case brings to light more than just the question of private vs public care. I disregard the argument that if carers were paid more these abuses would never take place. What this argument means, is, if the pay was better, it would attract better people. No, it wouldn’t, unless providers ensure better recruitment practises.

Recruitment, training, care

Imagine, you struggle to understand the world and communicate. You don’t understand why you have to get dressed, what the green light at the crossings means, or what people are saying to you, you can’t tell others you need to go to the toilet, or understand and explain why, when you have to go in the bath, it upsets you, or even makes you angry. You need someone who is going to be your champion, your voice, your comforter, your translator, your support. Someone who understands you.

The right people must always be recruited. How do you know who are the right people, I hear you ask. Well, the CRB check is a start…at least they’re not on ‘the register’. Then, maybe, just maybe, there should be say, a qualification? Should this be combined with some experience? Of course!

Care is a vocation, not a professional half way house. A lot of support workers have come from a background totally unrelated to care, usually due to unforseen circumstances, and without any intention. I was a retail manager before I was made redundant several years ago. However, it was that job that was the half way house for me. Social work was where I was headed in college, but, circumstances change. I’m now in the sector I felt I needed to be in.  I wish I had qualified in my social care studies, to back up my own personal experiences of care, before I’d started, a situation I’m rectifying with my employer’s assistance. Thankfully, a lot of providers do train their staff to the highest standards. Some offer degree courses, alongside their work based learning. This is great. But, these qualifications and experiences should be gained before you’re expected to put your arm around someone to comfort them when they’re upset, or, as sometimes happens, redirect and talk someone down when they want to jump out of second story window. As Panorama showed, Wayne would have been discovered long before he entered Winterbourne and terrorized its residents had this been the case.

Sadly, other factors affect the standard of care in residential units like this. On a Facebook group set up shortly after the abuses were shown on BBC, someone asked

How did they employ so many like that in one place? Did they get each other the jobs or what?

A very pertinent question. Sadly, it’s true. Best friends, husbands and wives, fathers, sons, mothers, daughters, sometimes whole families, all working under the same roof, with the same group of service users. This doesn’t mean that all such people are ‘bad’ or going to do something ‘bad’, or, would refuse to report something ‘bad’, but, imagine you work in a care home, as does your daughter, and your daughter pokes a service user in the eye, or, throws them in the shower, fully clothed, to cool them off because, they got angry when she poked them in the eye? What would you do? Of course you would speak up…or would you? What happens to family life, after you daughter looses her job, and is barred from working in care again, or, is imprisoned for her abuses? Or, your autistic son tells you he’s been hit by his carer. When you ask who saw it, the only other person there, the only other witness was the carer’s uncle? These are a desperate situations, surely ones which no one should ever face.

Firstly, and most importantly, because abuse should never take place, but secondly, because responsible care providers should act with some propriety and professionalism. Protecting vulnerable adults is ensuring their safety, at all times.

What’s just as disturbing, is care providers who don’t foresee such problems, and who, in fact, incentivize the employment of friends and relatives, and thus create a closed shop culture, in which instances of abuse or neglect are allowed to go unreported.

Earn £250 simply by referring a friend to work for any…home, contact your home manager (A message featured on a carer’s payslip)

The response ‘You know what kind of person you’re taking on if they’re sponsored by an existing employee’ is a very poor one. You can’t know everything about someone’s character, even your family’s, especially how they would react to strange and difficult situations. What if your care assistant son was punched by a client with mental health issues, who thinks they are a character from Star Wars, and he retaliated, punching them back, or pinning them to the floor with a chair, and you, their team leader, saw it?

Come off it. It’s a untenable situation.

Risk assessments are a major feature in care planning, but, it usually focuses on the use of lifts, crossing the road, the administration of medication etc. Surely, risks should be evident in the employment of friends and relatives.

This also makes a mockery of whistleblower procedures. Most services provide their employees with the basic, statutory protection under whistleblower laws, but, without the foresight to considers situations where, having reported the malpractices of carer A, an employee is left to work alongside their husband, carer B, who’s less than happy at what you did. What would you do? My advice: without hesitation, speak up, and weather the storm. Afterall, it’s someone’s life. But, some don’t for fear of retribution and revenge, and this will continue to happen, unless prevented by adequate statutory provisions, robust policies, and their application by fearlessly professional employees, from the top down.

Terry Bryan, myself, and all the other people who actually care, will keep on fighting, speaking up, and being a voice for those that have none. We’ll continue to laugh, sing, joke, explain and support. Not because we’re angels, or heroes, or anything like that. Simply because we care.

What all of this highlights, in an admittedly very poor way, is that NOT A LOT OF CARING IS GOING ON. There are too many self-interested people in the sector, where there’s an awful lot of money to be had by cutting corners and turning a blind eye, while the most vulnerable in our society undergo waterboarding, get kicked, slapped and punched.

This needs to stop. Things must change. Now.