The Sunday Times

June 5th, 2011

Without blame, carers are free to carry on being cruel

The notorious Bosnian Serb general, Ratko Mladic, appeared in the dock in The Hague last week, accused of war crimes and crimes against humanity. But there can be peace crimes of this kind too — barbaric and institutionalised offences that cannot even be excused by the red mist of war. Last week a few men and women appeared in the dock of public opinion in peaceful Britain, for horrifying crimes against adults with learning disabilities in a Bristol hospital.

The evidence against them is incontrovertible, thanks to weeks of secret filming in a locked ward for a documentary shown by BBC’s Panorama. The camera caught them abusing and torturing very vulnerable men and women, who were entirely at their mercy, unable to escape or to protest: no one who saw it will ever be able to forget the images. It became clear that the abuse was constant, persistent and part of the culture of the so-called care staff. They seemed positively to enjoy taunting and tormenting their victims, making a game of it, ignoring their screams of pain and anguish. Senior nursing staff and management either ignored or condoned it.

Forcing a woman into a cold shower, pulling her hair, leaving her in a freezing garden, trapping people under chairs while treading on their hands and legs, squashing their necks and carotid arteries, taking away precious possessions with cruel taunts as a punishment, picking fights, punching, slapping, dragging, bullying and shrieking “nein, nein, nein” — this was all part of the fun. And this was done to people whose behavioural problems it was certain to make infinitely worse — the very reverse of treatment for challenging behaviour.

These crimes against humanity would be still going on today, had it not been for the persistence of a brave whistleblower, Terry Bryan, an experienced senior nurse who worked briefly at Winterbourne View. Having warned the management in vain, he resigned and contacted the Care Quality Commission (CQC), three times. Again he was ignored, so he finally went to the BBC.

How the heart sinks at the very mention of the CQC. This unforgivable incompetence is what one has come to expect of it. At the end of 2009, when the new commission had itself discovered appalling conditions and needless deaths at Basildon and Thurrock National Health Service hospitals, it posted a largely favourable report on the offending trust on its own website, with top marks for cleanliness and health, and actually kept it there, even after the scandal. This hardly inspired confidence. Nor did last week’s revelations. Missing three professional alerts about Winterbourne was bad enough, but giving the hospital a good report only weeks earlier, despite the recent conviction of a carer, is almost beyond belief.

What good is the CQC? What good, even, is its website? It is very unclear to the ordinary mortal how to make a complaint, or to whom; it would defeat anyone except the sharpest-elbowed of the professional classes. Last Thursday the page on the CQC’s enforcement consultation was down — surely rather embarrassing under the present circumstances. And the site actually says that, in accordance with recent legislation, the “CQC cannot consider individual complaints about the services we regulate”. Why on earth not? The only exception to this is for complaints involving the Mental Health Act — as with the “patients” at Winterbourne. The final insult is CQC’s website claim that “we act quickly”, which to it means responding within 25 days, “if necessary”.

But cruelty to the vulnerable demands an urgent response, or urgent redirection.

Grateful though everyone must be to Terry Bryan, it seems rather odd that he went to the CQC. The obvious first step for a trained professional after alerting his managers would have been to go to the local safeguarding team — one of the Safeguarding Boards for vulnerable people which every local authority has had in place since 2006 (if he did so, it hasn’t been reported). These teams normally act very fast and their websites are usually clear and user-friendly, unlike that of the CQC.

When something terrible happens like this, the cry goes up that lessons must be learnt — not that they ever are. But there are some clear ones in this case, apart from the uselessness of the CQC and all the other regulators and overseers involved.

The first is the lesson of Sharon Shoesmith, of Baby Peter notoriety, who so chillingly said: “I don’t do blame. I’m not in the blame game.” But blame is precisely what is needed in these cases. Blame should at long last be reclaimed: it is the proper sanction for incompetence, irresponsibility or inexcusable behaviour.

Shoesmith seemed to think that because health and police services, as well as her own social services department, were at fault, she deserves no blame — which is nonsense. In the same way, with the patients at Winterbourne, no one person or agency was responsible, or felt overall responsibility, for each individual, which means that nobody needs to accept any blame. This must change. Otherwise accountability means nothing; we need joined-up culpability.

The taxpayer was contributing £3,500 a week per patient at Winterbourne. Who was in charge of that money in each case, and how was it being used? Those people are blameworthy. In future there ought to be a named person for all very vulnerable people with complex needs, to take overall responsibility for everything that happens to each of them — not a regulator, not a team, not a complaints department, but a real person, who makes sudden checks, who listens and who notices what is happening to other real persons. And every one in the country should know exactly where to complain about bad care — at the moment there is total confusion.

The second lesson, despite all the uproar about it, is that the Winterbourne scandal has nothing to do with the pros and cons of private care providers. Most other recent scandals in old people’s wards and social services have been in the public sector.

And the most important lesson is that a learning disability is not an illness. It doesn’t need hospital treatment, it needs social care. Nor does challenging behaviour, as it’s called, need hospital treatment either, except perhaps in a few, extreme cases.

A final irony of this tale is that the Winterbourne “patients” are the only ones who ought not to be blamed for anything — yet they are the ones who have been most horribly punished.