Fox (n): carnivore of genus vulpes; crafty person; scavenger; (vb) to confuse; -ed (adj): to be drunk.

Monday, 29 October 2012

Take care.

MEET Simone Blake.

Simone is 21 years old and was born with part of a chromosome missing. It is one of the most common genetic defects in babies, affecting one in every three or four thousand children. The lack of this chromosome can cause cleft lips and palates, heart and kidney problems, feeding difficulties, and an IQ about the same as Forrest Gump's.

None of that is Simone's fault, and while bits of it can be addressed lots can't. She's a handful to look after so once she was an adult her parents, who are both in ill health, paid thousands of pounds a month to a nearby private care home called Winterbourne View.

People that have met her say Simone has a very infectious giggle. When she smiles she lights up the whole room, and like any child she is more than capable of showing a sunny nature and doing as she's told when treated properly.

This is Simone having a wash. She had buckets of cold water thrown over her while she screamed for help.

This is Simone being taught not to hit her carers. She was pinned under this chair for more than 30 minutes, had her hair pulled, her face covered, and was put in a headlock.

This is Simone being helped with her beauty regime. The carer who pinned her to the floor told her she was ugly.

This is Simone enjoying the gardens. They left her out there until they noticed her shivering from head to toe.

She had been at the home for a mere four months when these scenes were filmed for an undercover documentary, and she was aged just 18. She was slapped, bruised, bullied and terrorised. One one day she was slapped and humiliated by seven staff for 11 hours, and threatened with a razor.

The last time she was seen by the reporter who took these pictures, she was lying on her bedroom floor calling for her mum, who had sent a bunch of flowers which were strewn all around her.

Other patients were dragged, punched, jumped on, and threatened. One tried to jump from a window after being physically manhandled. Patient notes were falsified by staff. Records show another patient somehow twisted and fractured her own wrist.

The court which sentenced Simone's abusers heard that she had learned a lot from them, becoming more aggressive with other people. Rather than the childlike tantrums she used to have, she now acts like an angry, abusive adult, with all the violence that entails.

After the scandal erupted, Simone was moved to another home where everyone thought she would be looked after better.

Her notes show that in one four hour period she was restrained in a chair 10 times, and twice more on the floor. In June she was accused of attacking two members of staff, but it cannot have been one-sided as four carers were suspended as a result.

Then, without telling her family, Simone was moved one day to a secure unit where she is now kept under lock and key. Her parents are an eight-hour round-trip away and because of their health cannot visit her, something which Simone probably has trouble grasping.

Simone is not easy to look after. She is big and strong, doesn't always understand, and thanks to the mistreatment she has experienced needs lots of love and care to unlearn all the bad behaviour she was taught.

Instead she's locked up, because that's easier than taking a long, hard look at what is laughably called our care system.

A 'care' system which allowed dozens of girls from children's homes in Rochdale to be raped, coerced, drugged and abused by gangs of men for years and ignored them whenever they reported it.

A 'care' system which allowed Jimmy Savile access to vulnerable youngsters in hospitals, prisons, and council-run residential homes.

A 'care' system which lets the elderly starve to death, which pays peanuts, expects no or few specialised qualifications, whose employees are undervalued by both their bosses and society at large, and in which stories like Simone's are actually not that bad.

The reporter who exposed the mistreatment of Simone and others got the job without any experience or qualifications - not by duplicity, but because none were needed. I know of someone who, jobless after leaving university, was offered night shifts at a care home and was frequently the only person in charge.

A 21-year-old without a clue, running an entire care home, for ten hours at a stretch.

Oh, there are standards and commissions and ombudsmen and routes of appeal and complaint. But they're a fat lot of use when unqualified, cheap staff write what they like in the log book, when profit is put before everything else, and when what few rules there are treated more as guidelines so long as you look clean and professional for a pre-arranged inspection every now and again.

There are no rules about CCTV, or making it easy for staff to whistleblow. There are no rules about why you can't employ a random off the street. There are no rules about how care is the same as protection and love, and that the system cannot be relied up on to do either.

There are many people working in care who do so in spite of all of that. They have a vocation to help others and stick with it despite the profiteering, low wages and abuse they often see because they think that if they throw in the towel the people who need them are going to be even worse off.

And most of us think this is about 'them' - that it's nothing to do with us.

But if it weren't for people who care, we'd soon notice. The people who care for relatives at home, at their own expense and to the detriment of their own health. The staff who stick it out on minimum wage, the ones who do home visits which last longer than the regulated 15 minutes, the carers who know they're banned from physical touching but give patients a hug when they need it anyway.

If all those people went on strike we'd see there is no system - just a few good people doing their best to keep the care system at bay for as long as they can. A system in which average hourly costs have risen 10 per cent in the past two years while its reputation has sunk ever lower with constant stories of abuse, mistreatment and neglect.

Even if we do not have a condition like Simone's, we will all need care one day. There are close to a million people with dementia and rising and we will expect the system to look after our loved ones or after us, and we shouldn't have to factor in the purchase of a secret camera to make sure that happens.

There needs to be a professional body to discipline, campaign and train. There needs to be qualifications ranging from simple, cheap, care-for-mum-at-home-yourself options all the way up to degrees if you want to run a residential home. There needs to be a junior minister devoted to it, at the very least.

There needs to be a change so that when we meet a carer we don't think 'Oh, stale wee and Winterbourne' and instead say 'Wow! Really? Well done you'.

Care is not a luxury - it's a need we all share with Simone. And more than anything else, we need to start caring about our care system before it's too late and there's nothing left worthy of the name.



The Kraken said...

That's a fucking brilliant piece of writing and I agree with every single word and comma of it. While we look at these pictures and films we should remember that one day that could be us our our own sons and daughters. The horror and fury and desperate sadness of that realisation should drive all of us to push a culture of change rather than us simply shrugging and thereby underpinning the cruel excuse of a system that we're currently living with.

Anonymous said...

BBC tell me today there are still fears for the same people who resided at this home. Abuse is normal for violent young people without lots of money and very high staffing levels. The shame is that everyone is running round on a dead Jim'll Fix it character to learn what we already know. The police should be investigating the here and now and stop sucking up band wagons which are dead and buried.

mrbrew said...

needed to be said, but fuck that is depressing.

KD said...

This makes me realise my decision never to allow my 14 year old disabled son have respite, ever.
I will carry him upstairs until I am no longer able than ever trust anyone else to care for him.
Care is lacking, my old neighbour died in hospital after being in for a routine operation, he starved to death as no one helped him reach his food, whichh he would have been able to feed to himself.

I myself worked in a care home, aged 17 with no experience or qualification and left as I was horrified by the staff and their appalling attitude to the elderly in our care.

Spudgun said...

I was originally penned in to be the UC for this job. Fortunately, I was still tied up, working on another documerntary. I Would have completely ruined this exposé because I would not have been able to maintain composure and impartially film, and refrain from punching abusers.

Steve Dunstan said...

I took slight offence at the Forrest Gump comparison, Foxy was kind enough to reply to my tweet complaining about this to explain the context of the comment. This is a horrendously difficult subject to tackle, and I'm grateful for a thoughtful and sensitive story. And I'll admit to being a coward, I don't think I can bring myself to watch Panorama tonight.

Anonymous said...

It does not what sector, regulation in the UK is so weak as to be almost non-existent. This is the "light-touch" regulation so applauded by the market dogmatists that now pervade government and the civil service. The last Labour government was no different.

The existence of the regulatory bodies reassures the public that wrong doing can not take place. However, the regulators appear to exist for show only, not to actually oversee that institutions perform to standard.

If someone blows the whistle, or otherwise complains to a regulatory body, the regulator is likely to reply "this is not within our remit", or "that is a matter for the management (of the complained about organisation)". One may well ask for what purpose the regulators exist if not to address the concerns of whistle blowers or other complainants.

Where was the regulator in the case of the Castle Beck scandal? Why have there not been top level dismissals for being asleep on the job?

Where was the regulator in the cases of the kids in care who were sexually abused by an organised gang in Rochdale? Childrens' and other care homes are supposed to be inspected thoroughly by the regulators. Thorough inspections clearly do not happen.

Where was the regulator when the banking crisis happened?

What is the electricity and gas regulator doing to stop customers from being ripped off by a near monopoly industry? Nothing it seems.

What is the water regulator doing to stop year on year above-inflation rises in water charges? Again, nothing it seems.

The list of failed regulators can be extended to include trading standards and myriad others.

These questions need answering. So-called "free market" Britain, which allows people at the top to get away with so much at the expense of every one else, is not working. Strong, independent and adversarial regulators are needed. Not the current cosy, chummy, ineffectual job creation schemes for toffs that the current system of regulation provides.

The Agent Apsley said...

The truth of many psychiatric units is not much better, despite the better wages, the qualifications needed for nursing posts, and the supposed systems, regulation, monitoring and inspection.

I am not detracting in any way from the seriousness of the abuse to which Simone (and, of course, others) have been subjected (although the reported judicial sentences might make you think that the courts did not think the issues documented important), but it is just that the factors singled out do not constitute a cure, because they are present in 'therapeutic' mental-health settings, which I know:

* Have staff who closet themselves away in the office, and make it as discouragingly difficult as possible to rouse them as a matter of policy so that they are not interrupted from the important duties of case-notes and other paperwork

* Tell patients that Dr A. wants to see them that morning, so they do not take ground leave, wait in all morning, with their anxiety rising and rising, asking, when they dare, from time to time, how much longer, and risking the odd moment unavailable in the toilet from time to time, only to be told eventually that Dr A. couldn't make it, and is now busy for the rest of the day

* As the above, but there's a denial from any other member of staff than the original one of any knowledge of Dr A. visiting, and, when that person eventually comes back on shift (this was just before going off shift), he or she (maybe a day or two later) says that the patients must have got it wrong, or he or she does not remember

I could go on, but, because the patients have a psychiatric issue, it is obvious that the best way of getting at them is this range of techniques that are conducive to frustration, anxiety, even rage - and, whatever reaction the mind games have elicited, it itself can be the subject of 'concerned words' from someone else still, who takes it all in, and then just blows any perceived therapeutic value in the meeting by saying something like 'It's a real shame that you can't appreciate that we are all here to help you, and that looking at things this way just makes out job of getting you better harder'.

Put any vulnerable people at others' unrestricted mercy, and you are asking for abuse, just as certain people will be picked on to be bullied (or pick themselves as bullies) in any playground, because of this or that. But these are meant to be NHS mental health services, and yet there are too many people - as in Simone's experience - who will exploit it and are in the job for all the wrong reasons.

As I suggest, in psychiatric units, there is less reason to use the physicality of abuse because mind games can be so hilariously effective, but, if someone needs an injection, it can always be made to hurt as a covert punishment, although any competent nurse will tell you that injections shouldn't hurt, and that there are ways of giving them that make sure that they do. Get the patients behaving 'uncontrollably', and, of course, the scope for abusing restraint is unlimited.

So, no, it's not about how much the job pays, what 'A' levels the job-holder has, etc., but simply about whether our all-too-human temptation to play on others' weaknesses comes out in the so-called care - was it not a few years back when 'winding people up' was a favourite activity, with a language all of its own?

Amanda Kendal said...

Anonymous makes a lot of very sound points. I think that there are a number of issues here (but linking them is not a 'bad thing') about how we care for people, but it is certainly the case that privatisation does not help, when the need for a profit (and there's nothing wrong with that, per se) overrides concerns about the service.

In the case of Winterbourne and other similar situations, that means cutting corners on training and, indeed, on pay. You know what they say about monkeys and peanuts. Unfortunately, we see caring in general as somehow 'bad' or menial; not to be rewarded properly or encouraged.

And that's a very deep societal issue, to which I could not even begin to suggest solutions.

And indeed, also as Anon says, "strong, independent and adversarial regulators" are crucial. But to take a different issue, reading Ben Goldacre's 'Bad Pharma', where major regulatory concerns exist, one is left with the question of how best to do this.

It clearly was not just the BBC where abuse occurred – I think that we do understand, today, that many abusers (particularly of the sexual variety) will seek out institutions where they have most opportunity for abuse.

Even in what has emerged since the ITV documentary about Savile, we are seeing that the tendrils of abuse existed across institutions. We know because of the church (and it's also worth mention the scouting movement in the US, which has just seen its own massive relevations of abuse and cover up) and other organisations were home to abusers.

Even the quotes from Savile's own autobiography, now widely circulated, suggest that the police were abusing too. We know that the tendrils extend into politics.

I'd be very doubtful they don't extend into any place where authority and trust existed, whether in the private or public spheres.

My own opinion is that we have already learnt many of the lessons of this – we have in place CRB checks etc now, which did not exist before; plus a change of culture, whereby children can report abuse and will be listened to. We moved on considerably from the 'children shall be seen and not heard' attitude of the Victorian era, which lingered long into the last century – perhaps particularly in more formal institutions.

If we need a new inquiry now, it really should be one looking at institutionalised abuse – or abuse in institutions.

Depressing, ain't it? But I suppose at least we're discussing it. And hence Foxy's contribution today (and previously) is important in keeping it in our minds and linking the different forms of abuse.

One of my fears, though, is that the public as a whole will move on in a while to something else, when we need to be thinking about the entire issue of care within our society as a whole.

Amanda Kendal said...

Should also add that, as per Dr Phil Hammond's campaigning, we need to make it possible for people to 'blow the whistle' (ie tell the truth) without being ruined.

Anonymous said...

The first sentence above should read,

"It does not matter what sector, regulation in the UK is so weak as to be almost non-existent"

CrawdaddyClub Richmond said...

That made tough reading. It is worth saying that the majority of carers are exactly that, caring people. Despite the poor pay and difficult work they are dedicated to looking after their charges. There is a huge issue with lack of training and due to lack of regulation opportunistic operators focusing on making a quick buck.

During a period im my life I was recruiting cabin crew for an airline and without exception the applicants with a care home background (mostly from Eastern Europe) stood out for their caring attitude.

Anonymous said...

This should be top of the political agenda. We need to spend less on nuclear submarines and more on looking after vulnerable people. All the major parties are guilty here.

Anonymous said...

Brilliant article but mustn't forget incidents of abuse which takes place in old peoples' homes and also in hospitals - my dad was left to fend for himself whilst in hospital - had parkinsons and needed help to eat and go to the loo but was often left on his own. When Mum complained he was ignored repeatedly which meant he lost weight, couldn't get to the loo in time and had a dreadful time. It was horrific.

SoupWaiter said...

Another professional body, more reporting comittees, another minister for something, I don't agree. Piling on more beaurocracy, spending more, taxes up. These aren't considered answers it's just the same old soundbites, blame and off-the-shelf rhetoric.

Let the BMA do it. They regulate medical care, they are more than capable and tell them; in these austere times you'll just have to work it out within your budget. They won't risk their reputation, they should want to pull together.

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