Five Things to Learn from Panorama’s Dementia Exposé

In many ways it was déjà vu, with more than echoes of that same programme’s exposé last year of abuse of people with learning disabilities at Winterbourne View. Whilst the BBC gave us limited background information (more of that later) the similarities were clear. For example:

• A disregard for the rights and dignity of people because they were in a care home with a label (dementia in this case)
• A failure to listen to the voices of the people concerned (in this case the lady clearly expressing pain and unhappiness to the staff that were abusing her)
• Criminality by staff, believing that the position of power they held over care home residents meant that the law (such as common assault) did not apply to them
• Low paid, unmotivated, unsupervised staff lacking or not applying basic skills and expertise
• A lack of basic oversight and quality review from a large provider whose management appeared disconnected from the day to day reality of some of their services
• An apparently large institutional style establishment that fostered an environment where this sort of behaviour could go on undetected
• An apparent absence of external voices or scrutiny to speak up for people until subterfuge was employed (by the family in this case).
• CQC rating the service very positively prior to this issue being raised

So was this an isolated incident (and if it was that in no way makes it more acceptable) or are variations on this occurring in other care homes across the country? The answer is simply that we do not know. We do know that thousands of care home staff and hundreds of managers and owners are well motivated and committed and were as appalled as I was by what they saw on Panorama. Amongst them, however, are a small number of individuals who will exploit their position to the detriment of people living in those care homes.

The response isn’t simple, and it isn’t quick. Ignorant Twitter comments about sacking and deporting Philipino care staff are merely the more bigoted end of what could be a tokenistic reaction unless we think deeply about what allows situations like this to arise. Can I suggest five places to start:

1. This is fundamentally about power. When people move into a care home, they hand power and control over significant elements of their life to the staff and system of the establishment. It is sadly in the nature of human behaviour that some people will misuse the power they have. (I recall a badge from my student politics days – ‘power corrupts – and absolute power is even more fun’.) If we create a public service system that involves an imbalance of power, particularly if those losing power are deemed more ‘vulnerable’, then there must be a public policy responsibility to ensure that counter-balances are in place. Yet the things that can offer that protection against misused power, such as the regulatory and inspection framework or investment in advocacy, are being cut back in the current economic climate. Free-market principles and a belief in the goodness of people (a.k.a. Big Society) are inadequate strategies when services create this power imbalance. National and local Government has to intervene and/or create basic entitlements and requirements beyond adult protection that proactively enable the voice of people to be heard.

2. Closed environments create the capacity for abuse. We know this, so why do we continue to encourage, support and fund large care establishments that are more susceptible to developing ‘closed’ characteristics? Regulation and inspection cannot, on its own, root out bad practice and neglect. Alongside this has to be (i) service design that is focused around individuals and their real or potential communities (ii) the day-to-day openness of service setting to communities, families and other elements of service support and (iii) mechanisms to ensure the voice of people is heard and responded to. Evidence shows that the large care setting where people are effectively ‘warehoused’ is likely to develop characteristics that are causal factors to abuse. Such services may sometimes be cheaper, but the cost is poor outcomes. Too many people are confusing cost effectiveness and lowest price. They are not the same thing.

3. The way society and public policy views older people is part of the problem. The last twenty years has seen rights and equality go to the heart of policy and attitudes around people with disabilities. Not so with older people, who are still significantly seen as a burden on society – they are ‘bed blockers’ in the NHS or part of a ‘demographic time-bomb’ that is costing the taxpayer. The service system risks treating older people as the ‘financial commodities’ that, in recent NDTi research, many people in residential care said they felt they had become. Older people have made huge contributions to our society and will continue to do so if we choose to plan and organise support and services with inclusion in mind - rather than apply negative stereotypes. Only 12 hours before Panorama, the Today Programme’s John Humphries was making jokes about ‘GrannyNav’ - a satnav system designed to make instructions easier to follow. He concluded with the quip “maybe it’ll remind them when they arrive why they went there in the first place”. Would you make a joke about someone’s disability, John?

4. This isn’t just about older people. Despite my earlier points about policy on older people and ageing, the factors that enable abuse and neglect are broadly the same as for people with learning disabilities (reference Winterbourne View), people with mental health problems and others who society often marginalises in different ways. We need a collaborative response from all sectors that is fundamentally about rights and respect for every section of our society.

5. The BBC should do more than play the ratings game. Glossing over the patronising attitude of the Panorama presenter - would you stroke someone you had never met before on the cheek like a pet dog - what is the BBC’s agenda? It was good that they covered this issue – but the programme was superficial. There was no attempt to understand or analyse why the situation had arisen – just a simplistic attempt to blame the CQC for failing to stop it. I suspect that ratings are better for films of people being abused than they are for intelligent debate about how to enable older people to live as valued and equal citizens. Having screened the neglect, does the BBC not now have a moral responsibility to programme debate about what we do in response? (As well as training their presenters in human rights and respect.)

We all have a responsibility to do something. At NDTi we are trying to do our bit. Last month the Joseph Rowntree Foundation and NDTi hosted a round table on the challenge of closed environments. We’re trying out circles of support for people living with dementia, enabling older people with mental health problems to develop as leaders in local service planning and working with large service providers as they strive to become more community inclusive. This, though, is only a drop in the ocean. In needs collaborative actions by and with the whole range of stakeholders.

Thank you for reaching the end of this blog. How society views and supports older people needs our time, attention and channeled anger.