Undercover Care : The abuse exposed – A Review of Panorama

I sat down to watch Panorama yesterday and the trailers and name of the programme were something of a giveaway so I wasn’t exactly unprepared for what was shown.

Panorama had been alerted to abuse within Winterbourne View near Bristol, which is a private hospital run by a company called Castlebeck for people with learning disabilities and autism and according to the description on their own website

..  is a purpose designed acute service, offering assessment and intervention and support for people with learning disabilities, complex needs and challenging behaviour.

It can also provide a service for those liable to be detained under the Mental Health Act 1983. It offers a stable, structured and therapeutic environment and the support of caring and dedicated staff.

Winterbourne View, which has 24 bedrooms, offers the chance for people to progress to more community-based living as part of their ongoing rehabilitation, at their own pace.

Winterbourne View charges an average of £3,500 per week for a place. I wonder how much is spent on staff costs and training.

Acting on the information from a former senior nurse there who had been whistleblowing, Panorama sent in an undercover support worker (journalist) and some hidden cameras. I knew I was prepared. I knew we were going to see abuse but nothing prepared me for the actual footage that I saw.

I try not to engage in hyperbole but what we saw was purely and simply torture of adults who have needs which make them more vulnerable.  Physical restraint was used as a punishment and some members of staff were deliberating provoking residents almost as if it were a sport and they were playing at bear baiting. It made for uncomfortable and emotional viewing.

I worked for many years in homes for adults with learning disabilities before I qualified as a support worker and the lack of humanity with with the residents in the hospital were treated was almost physically painful to watch. The programme showed a woman being given showers fully clothed and being dowsed with water outdoors on a cold, March day until she was shivering profusely. They showed her being pinned under a chair.

In one of the most troubling pieces of footage, a girl is shown as she had tried to jump out of the window and the staff mock her attempted suicide and taunt her to ‘try again’ and ‘make a better job of it’ saying things like ‘do you want me to open the window more’ and mockingly telling her she would make a ‘splat noise’. Even writing it out is difficult.

There were other things – comments made, pin downs and the use of martial arts techniques which are, unsurprisingly, wholly inappropriate and this footage was shown to a specialist psychologist with the Tizard Centre who would respond with the same gut horror that you didn’t need to be a psychologist to understand.

The footage really spoke for itself and I wondered about the position of the undercover journalist who stood by and watched some of the abuse occurring. There is an issue of ‘greater good’ versus ‘personal responsibility’ so the argument would be that the programme itself was able to prevent future harm coming to the residents by being transmitted but he admits that it was difficult for him.   He says here

I was watching on the sidelines, resisting putting a stop to this (abuse) and blowing my cover. Simone was staring at me as she lay on the floor, staring at the only person not abusing her.

I could not save Simone on that day. I had to resist my instinct to step in. I was there to gather the evidence that could help save others from a similar fate – and Simone herself from future abuse

Some of the more difficult responses came later in the programme as the CEO of Castlebeck was interviewed and of course expressed disgust and surprise at the levels of abuse in Winterbourne View. A company statement is published here and alongside all the usual guff is an acknowledgement that the whistleblowing policy was not adhered to when an initial complaint was made by a staff nurse on 11 October 2010. The footage was filmed between February and March 2011.

I was more furious by the response of the CQC. The whistleblower also contacted them, you see with the allegations of abuse. He contacted them three times.

Winterbourne View had last been inspected ‘two years ago’. Is that the kind of satisfactory inspection regime that we have, Mr Burstow? Oh, wait, it’s ok, because the statement from the CQC says Burstow has authorised a sample of 150 hospitals receive random unannounced inspections. Woah. Only 150? Only a random sample? Why just hospitals for people with learning disabilities? If random unannounced inspections are seen as necessary to prevent institutional abuse on such a wide scale, surely they should be the NORM for everyone who receives a service via a service inspected by the CQC.

No, you see, Burstow (and the Labour ministers before him) seem to think that self-regulation is the way to go. The way the man from the CQC squirmed as he insisted that the paperwork had been in order at Winterbourne View tells a tale all of its own.

And as for the staff, four have been arrested to be charged under s44 of the Mental Capacity Act which makes it an offence to ill-treat or wilfully neglect a person who lacks capacity.

It also begs the question – where were the Deprivation of Liberty Safeguards? Were any of the residents detained under DoLs  – or the Mental Health Act for that matter (as the hospital was assigned as such to accept people detained) and if that was the case, shouldn’t there be additional checks. Would independent advocates provide a further check?

There are a lot of questions that remain and the main one is the way that institutional abuse can fester in a residential care setting. There are wonderful care homes and hospitals around. I see them and I worked in them and often the ethos trickles down from top to bottom. Staff who see other staff abuse residents can ‘join in’ to be accepted – it is a classic position of bullying and unfortunately sometimes people who enjoy this kind of power play are attracted to work in social care. There needs to be an environment that does not accept this and that stamps down on it immediately and that was the real failing of Castleview.

This was not about 4 rogue members of staff. This was about an environment that allowed them to abuse and for that the senior management up to the Chief Executive should be responsible. Where is the support and training for staff who have to work in stressful environments? Where was the supervision that would have stamped out some of the abuse.  That doesn’t excuse those who were responsible for mistreatment  but it draws interesting parallels with the sacking of Shoesmith.  Wouldn’t we be baying for the blood of the CEO of Castleview? Or perhaps because the abuse took place in a private setting there are different lines of responsibility.

I think we should look long and hard about how we, as a society, seek to push people on the peripheries of society, because of age, disability or capacity to the margins of society and people to provide care who are not regulated and not supervised.

When the regulator fails so substantially as to ignore someone who whistleblows explicitly, do we not see a problem the ‘system’ that is increasingly reliant on proactive ‘complaints’ to trigger assessments?

There is much to do and much that needs to be changed.

I wouldn’t say I enjoyed the programme, it upset me and it angered me but I think everyone involved in the sector should watch it.

It can be viewed here on the BBC iPlayer.

18 thoughts on “Undercover Care : The abuse exposed – A Review of Panorama

  1. I wrote to my MP Yvette Cooper asking her to defend the NHS against Tory plans. I added that New Labour were not blameless in introducing privatisation. She sent me a standard type reply with a hand written postscript:-
    “….You are right that the private sector was used in some areas under Labour, however you will be aware of changes Andy Burnham made to provide safeguards…..”
    It worries me to read tweet after tweet from people who just want to blame the low paid care workers. Some extend this to the management of Castlebeck but no one is blaming the politicians. Its happening on their watch!!

  2. John – thanks for commenting. That’s a good point. By no means do I absolve the Labour Party from their role in destroying the regulatory system and privatising social care more and more.

  3. Great post. This programme has continued to upset me to the point that I dreamt about it. I work in child protection & have witnessed some horrible abuse, but what I saw last night on tv has shocked me to the core. The residents were spectacularly failed by a system meant to protect them. As a parent of a teen with autism & a learning disability I have spent a lot of time thinking about her future, perhaps in some supported housing scheme. However, I am now fearful for her future & Perhaps this is another good thing to come out of last nights programme. It will make other parents sit up & think about the type of care that should be extended to their loved ones.

    What I saw on Panorama will haunt me for a very long time.

  4. Some stories just make you want to weep. This very public story is unfortunately the tip of the iceberg and we can only hope that some good comes from this case. The reality is that even though arrests have been made and the private operator has apologised, the wheels of justice and change will grind slowly. I only have to mention the notorious Fiona Pilkington case as an example of how badly wrong these situations go and how little and late is the response. In the meantime, people with learning disabilities will suffer, with the result being mental/emotional anguish, injury and even death. Bear in mind that the whistle-blower went through all the appropriate channels to register his concerns and was rebuffed before turning to Panorama as a last resort.

    I hate to sound like a broken record, but this is simply down to poor practice evidenced by a lack of training. As long as people are put into situations in close contact with people with severe learning difficulties this will continue unless the cycle is broken and comprehensive training and awareness is put in place. As the clinical psychologist Mr McDonnell says, this was supposed to be a theraputic environment – where is the therapy?

    I would go further – this was supposed to be a caring and supportive environment – where was the care and support? Only a full investigation will bear out the true scope of the failings. But at the fundamental level, if care workers don’t have a proper awareness training programme to give them knowledge of how to successfully deal with developmentally delayed people who have challenging behaviour, they will lapse into a reactive mode which can only lead to the kind of situation that occurred at Winterborne View. Make no mistake, this is happening across the UK.

    The saddest part is that the young woman, Simone, tried to alert her family and even they did not believe her. Think of the thousands of learning disabled people who cannot even do that much – the ones with no speech or language.

    Care workers are just one class of workers who need this very fundamental training. The same can be said of any profession that has this close contact – doctors, nurses, ambulance staff, police, fire and rescue personnel – all must be taught an awareness of how the learning/developmentally disabled person views and reacts to the world and how to successfully interact with them. Sometimes the simplest thing is the one that puts the most stress on them – and it is important to understand what triggers are present. Communication is a huge piece of the puzzle.

    People with learning/developmental disabilities are just that – people first. They have rights as well as desires and likes and dislikes. They don’t always understand what others want from them and some awareness and communication training can go a long way to creating a more harmonious environment, not only for them but for the staff that work with them. But it is up to the responsible bodies, public and private, to make sure that this is on offer – and not on a voluntary basis. If a professional in any field has significant dealings with learning disabled people they must as part of their professional training be required to take some awareness and best practice training in order to be effective and successful.

    The alternative will be more and more cases like Winterborne View.

    Sharon Dolan-Powers
    Beacon Learning Disabilities Consultancy

  5. “Would independent advocates provide a further check?”

    An independent advocate would work to help voices like Simone get heard and help her to get legal representation to make a formal complaint/ legal action.

    But the company had already ignored whistle blowers, and so had the CQC. They aren’t listening to the voices.

  6. Has anybody seen if the NMC have made a statement yet relating to the qualified nurses who stood by and let it happen?

    I was disgusted by the abuse going on, I’m not sure though that handing round sweets to staff members pinning someone under a chair means that you are innocent enough to have your face hidden. Watching without reporting this can surely also be considered abuse.

    The recommendation was to close down the home and set the clients up in smaller group homes. My question would be hat safety and inspection systems will there be to ensure abuse doesn’t happen in these more intimate venues. How can recruitment of staff (qualified or otherwise) pick up on people that are likely to abuse others? What ongoing training and support will the staff get?

    I hope that the clients from the programme last night never have to experience anything like that and that they have been offered support and counselling as anybody else who has experienced abuse should be. I also hope that those abusing them (and letting the abuse happen) are bought to justice.

    Finally I commend the undercover journalist. It must have been so hard to not step in, I certainly couldn’t have done it, and I am sure that he would have if the abuse had escalated further. That was real journalism, not trailing around after vastly overpaid footballers. But why did it take a journalist and not the inspection and safeguarding processes that are already in place?

  7. As a mother with a son who has LD, I wept when I saw the vile torture of Simone. I could hardly bear to watch. It was gratuitous violence for the fun of it. I am so glad that my son is still living at home with his loving parents. Unfortunately though we are pensioners and that will not be the case forever. We have nightmares about his care after we die because we fear society really does not care enough to stop this abuse of vulnerable adults. (Remember Macintyre’s exposure of a care home some years ago?). We are not any further along the line from stopping this abuse are we?

    If this is out in the community, you can keep it. If there had been a day centre that these people could have gone to socialise with others it would have at least spared them the daily boredom and abuse that occurred in that horror chamber.

    I can only hope that Castlebeck and its senior managers and executives learn by this exposure, but I will not hold my breath. As for CQC, sack them now! They are taking money under false pretences.

  8. It’s the kind of evil that is such a thorough denial of the person having any independent right to space and the bureaucracy often confirms that. The place where we could actually see the ‘strange behaviours of clients’ constructed before our very eyes in this Panorama programme.
    Privatised care can only be successful on the back of guilt (real or imagined), so that people who set up ‘care companies’ of any kind for profit are secure in the knowledge that they have ‘won’ the ideological battle with the ‘state’ and that individual social workers or quasi governmental inspection bureaucracies no longer have any moral or legal power to move the service beyond what it becomes as their ‘cash cow’ and power base.
    Professional qualifications in this environment become the ‘carrot’ for Ill educated workers or workers often themselves with learning disabilities or other problems, to accept unacceptable conditions and terms of employment. The privatised environment is suspicious of learning and education and its liberal impulse towards equality. Thus, in a privatised environment, workers can be exploited and then abuse their authority and responsibility, they become socialised into a dysfunctional way of seeing their vocation.
    It’s interesting to reflect how Social Workers have great powers in the space of the vulnerable individual but absolutely no power, training or resources to deal with the environments that are created under privatisation.
    Yet this really is what should be at the centre of service, being able to use your eyes in the moment, to act, respond in a human way. It struck me that when Simone was being abused, that noone responded humanly, even Mr McDonnell talked about Simone’s shivering as ‘an adrenaline fuelled response’ -and thus the gap between humanity and professionalism objectifies Simone rather than enrages the caring professional. Because it would be ‘unprofessional’ to show your normal feelings and possibly, professionally embarrassing to admit that you really have no control over the institution that created this environment. And, you’re frightened of challenging authority because you don’t want to be hounded yourself.
    Because caring professionals know that they have no control over this ground and that they are often colluding with abusive environments, abusive because what’s left of ‘community’ and ‘reciprocity’ often depend on the whim of the staff on duty. Human Rights are seen as tick boxes to be conveyed at Inspection.
    But when does the moment come for that spontaneous disgust to express itself? (Fighting Monsters was never truer than in this context!). Are we all really that cowardly about what it means to be human these days? As my mum would say ‘they’re all one sack, one sample’.
    Get rid of the lot of them and start again!
    Responsiveness, accountability and vocation should be the benchmark of care and should be visible in every care setting. Care should be seen to be a social enterprise where all the profits go into training, education and community development.

  9. I haven’t sat down to watch the whole programme yet and I don’t know if I’ll be able to. I agree with the points about poor wages and training, but I think abuse like this comes from the manager of the place. If they tolerate it and encourage it, it becomes the norm and other staff join in because not to, marks you out. The manager sets the tone. I remember one hospital that I was involved with and there were two elderly care wards there. Their standard should have been the same, but in fact they were like night and day. One ward was very good and one was very bad. It boiled down to the behaviour of the ward manager and the example they set. It’s a very difficult situation. If you’ve got an ordinary member of staff that’s not pulling their weight or is abusive, you can just get rid of them. If it’s the manager, that’s a whole different ball game. Of course, the backdrop to this is; just how much do we want to know? Do we want to find out how much abuse is going on? Is this why we’re not doing spotchecks? Once someone with a disability is put in one of these places, there’s a tendency to think ‘job done’ and forget about them. Predators know this and that’s why they crop up in these places. I think we have to look at ourselves as well.

  10. Tears were in my eyes as I watched the programme – and almost still there when I woke up very early this morning.

    If anything comes of this outrage, I hope that it will be a radical shake-up of and within the CQC, but before that I really would like our government to take on board the fact that many of us have been asking very relevant questions about the standards and quality of care – or the lack of it – available to all vulnerable people in need of care. But our MPs have not cared enough to care.

    I also hope that the Winterbourne View disaster won’t result in the exclusion of residential care homes per se from the thinking and proposed-by-Burstow unannounced inspection regime of 150 hospitals. This chamber of horrors known as Winterbourne View was a residential home, rather than what most people will understand by ‘hospital’. And it’s not always the visible abuse that is damaging. The invisible neglect via shambolic care provider self-regulation and/or being economical with the truth even to the CQC, via shabby local authority regulation, and last but by no means least, via the abysmal regulation of the Regulatory Body aka CQC – they all destroy lives.

    They are all hand-in-glove with each other. People who are vulnerable and therefore at greatest risk deserve better care than we are sending their way.

  11. Just watched it on I player totally shocked how can carers be so cruel I work in mental health and would never disrespect or harm anyone.

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  13. Thanks everyone for your contributions and comments. I don’t think there’s much that can be added as I think we are all coming from the same position. I want to come back to the CQC again when I’ve calmed down a little.

  14. Utterly disgusting. 2 practical issues:
    1. Was the local authority Safeguarding team contacted by whistleblower &/or CQC?
    2. Abuse should have been stopped by the reporter in week one – end of. Thus no further horrific abuse, but also no ;compelling viewing’ for the public to throw up its hands – shame on BBC.

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  17. I am an OT working on an acute mental health ward for people with learning disabilities and was appalled at the abuse I saw on Panorama.

    I was just wondering:

    – Where was the local authority? Bristol council was not mentioned at all? Did the whistle blower contact the local safeguarding adults team?

    – The environment- it seemed very bare with no evidence of intervention to support the clients understanding or orientation. ie. accessible signs, visual timetables, evidence of activity groups, resources, etc. No structure to the day at all. How was this not glaringly obvious to the CQC inspectorate?

    – Community learning disabilities team involvement- It seems strange to me that for 24 clients no referrals would have been made for professional support to assist with achieving the goal of reintegrating with the community.

    – CPA/Mental health act/DoLs- If some of the clients were admitted under the mental health act did they not have their section reviewed regularly and have second opinions? Also CPA? For clients with complex needs surely they would have a care coordinator and CPA reviews with an advocate?

    – Placement funding- Each client would be funded by their local authority and it’s costly! I am surprised that the LAs were not more proactive seeking updates on therapy and rehab goals to enable discharge to potentially cheaper care settings? Probably passed to duty as soon as they were placed…dead end, out of sight out of mind.

    This is a terrible terrible failure of all services involved. It has really upset me but reminded me why I have so much passion for working with clients with learning disabilities and complex needs. They are the most vulnerable people in our society and I want to make a difference to their lives.

    With the governments plans to privatize health care I am glad this documentary came along when it did. Maybe it will make the coalition rethink…

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