Like everyone else involved with social care I watched Panorama (which showed hidden camera footage of abuse at a care home) the other night. I wanted to watch it live so I could time a couple of prepared tweets to pimp some new functionality on our BetterCareGuide web site, so I was also watching the #panorama twitter stream. I have been involved (albeit peripherally) in social care for many years and am no longer shocked by this sort of abuse. Saddened, perplexed, dismayed by my inability to find a quick fix – all of those, certainly. But as long as there are elderly or disabled people who need care, inequality (more of this later), cheap electronics and an audience, Panorama will have its regular care slot every 12-18 months.

So let’s deal with the simple stuff:

  • I was shocked by the amount of racism on the twitter stream. How people can take to a public forum to show how much they care about vulnerable people and then come out with such inhumane indefensible drivel is a mystery to me. At the worst times I think 10% of the tweets were borderline actionable under some form of equality legislation.
  • The male carer should NEVER have been allowed to do the bed bath for two reasons : the care plan specified that personal care should only ever be provided by females, and the handling and lifting should ALWAYS be done by two carers. Both of these points have to have been known by managers in the home, and senior managers at Forest Health Care should have ensured that robust systems were in place to prevent this happening or report on it immediately. So when they say “isolated incident” (as they have done), the response should be “Yeah? How do you know?”. I expect heads to roll at Forest in the aftermath, but it may take a while. You can do a certain amount with systems and processes and these people just plain failed. I was a supplier to a company involved in a previous Panorama (they were by no means the worst) and I am glad to say that they worked quite hard afterwards on making procedural improvements – but admitting you have a problem is the first step in fixing it.

The hard stuff

This is massively outside my area of expertise (my Mastermind subject would be programming languages 1993-1996) but I think there are two fixes – one partial that can and should be implemented now, and one full, long term and almost certain (sadly) never to be implemented.

It is impossible - for the regulator, the management, service user relatives or anyone else apart from the service users (who are often not able to speak for themselves) and individual care workers – to fully monitor the way in which people are treated in their room in a residential home (and even harder in a domiciliary care setting). So the response should not be to throw more money at the problem, it should be to try to make monitoring unnecessary.

So how?

Make care workers feel like more than just cogs in the machine. I have long been in favour of stimulating the micro-provider end of the market simply because here care workers are closer to (or are) management. So management can more easily see how care is being delivered and care workers identify more with the business and its aims and ethos.

One of the problems with the care system in this country is that regulation and training are proportionately less of a burden for larger providers. In these businesses the distance between senior management and the coal face can be vast, both in terms of geography and levels of management. So you can end up with carers like we saw in Panorama – but you don’t have to, and I have met senior managers who I think are doing the right thing to keep standards high in their organisations, but it is clear that the management of Forest Healthcare were not.

Longer Term

Safe in the knowledge that nobody on earth is going to read this far down, I can now get a little bit more controversial / speculative: Poor care exists in this country because of income inequality.

I just made this up, but I suspect there is something in it, and it isn’t too big a jump from the research that has been done by Kate Pickett and Richard Wilkinson in The Spirit Level to my unresearched guess. Perhaps they will include it as a case study in a sequel.