Winterbourne View: The problem with all care homes

Many people with severe disabilities should be cared for within the NHS, rather than in private facilities. People with severe disabilities, such as those at Winterbourne View, would have previously been cared for in large NHS asylums.

It’s difficult to know where to start with the case of the Winterbourne View care home, near Bristol. What happened at this institution is unforgettable – and unforgivable. I have worked in learning disability and I have met and cared for people just like the residents who lived at Winterbourne. I know how utterly vulnerable they are. Many were so severely impaired that they were termed preverbal – that is, their IQ was below that which is needed to communicate through words. Such individuals are absolutely dependent on others to see to their needs and to stand up for them.

Some of the care homes I visited were exemplary: they had well-trained staff who were compassionate, interested in and engaged with the residents. But, sadly, they were in the minority. All too often there was disregard and apathy. I would describe it as “benign neglect” – that is, not demonstrably abusive but having an insidious, malignant malaise towards the welfare of residents, who were fed and watered but little else.

I know the explanations for this: poorly paid staff, inadequate training, burn-out from the stresses of the job, and so on. But there comes a point when I just think “enough with the excuses”.

The independent inquiry into the abuse at Winterbourne View, which reported in scathing terms earlier this month, concluded that the home put profits before humanity. The sad truth is that this is how the private sector works. A private company’s primary obligation will always be to its owners or shareholders. If it can get away with cutting corners to increase the profit margin, it will. In other commercial areas, customers who feel that quality is being sacrificed can go elsewhere, but in health care this option rarely exists, especially for those who are severely disabled.

The point, of course, is that the state is supposed to step in and ensure that the profit principle doesn’t run away with itself. This did not happen at Winterbourne View. The local NHS department, the police and the Care Quality Commission failed to listen to those staff, patients and relatives who raised concerns about what was happening. It took an undercover investigation by BBC One’s Panorama to uncover the level of “institutionalised abuse”.

There are, however, more important question to ask: why there are vulnerable people subject to the whims of profit-making companies when we have a National Health Service? How did we arrive at a situation whereby the most needy members of society are so poorly protected from having their welfare jettisoned in favour of the bottom line?

The truth is that, due to a catalogue of well-intentioned but ultimately flawed government interventions over many decades, those with severe, profound disabilities have been thrown into the choppy waters of the private sector, with limited medical input, while the NHS looks after the rest of us (at least for the moment).

To understand how this has developed, you have to go all the way back to the end of the Second World War. The 1946 NHS Act and the 1948 National Assistance Act promised that the inequalities of the past would forever be put asunder. Or so it was thought.

What these Acts actually did, unintentionally, was create two parallel systems of care. The NHS would provide a universal system that was free at the point of access, while the National Assistance Act meant that local authorities would provide a supplementary system for those in need of “care and attention” or “personal care”. While the motivation for these two pieces of legislation was honourable, unfortunately they left a loophole that subsequent governments would exploit.

By drawing a distinction between those who were medically “sick” and those who needed “care and attention”, an artificial line was drawn that has slowly shifted over the past few decade. Many aspects of medical care have been moved into the remit of social services and away from the NHS. This is why older people who are deemed to need personal care have to pay for nursing homes, yet those who need care but also meet the criteria for being medically unwell receive NHS “continuing care”.

People with severe disabilities, such as those at Winterbourne View, would have previously been cared for in large NHS asylums. However, in the Nineties, with the widespread closure of these, the residents were moved out and cared for by the NHS in the community. While some were able to live independently with NHS mental health service input, some were too disabled and required 24-hour care. These people fell awkwardly between the criteria for NHS care and for personal care, and ultimately their welfare was placed in the hands of social services, despite them having severe and complex medical problems.

Legislation such as the 1990 National Health Service and Community Care Act, as well as the Supporting People initiative, enabled private agencies to develop and provide specialised housing. The result of this is that too many people with severe and complex needs, who were once looked after by medical staff in institutions, are now at the mercy of unqualified staff in the private sector. The issue is not just that there is abuse taking place in some of these homes, but that the level of care that residents receive in all of these homes is substandard because the staff are not medically qualified or trained to the standard expected on NHS wards.

While I wouldn’t advocate returning to the days of large institutions and asylums, the way in which those with severe disabilities have had their care and welfare taken out of the hands of the NHS and dumped unceremoniously in the private sector is the untold scandal of this whole sorry story.

Max Pemberton 20 Aug 2012



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