What’s really behind the crisis in caring?
Last night’s BBC Panorama showed how grim some care homes are. But more bureaucratic monitoring is not the solution.
The BBC’s Panorama report on ‘undercover care’ broadcast last night made grim viewing.
The programme told the story of Jane Worrell, who was concerned about bruising on her mother’s body and a general decline in spirits since her mother began her residence in a care home. But she could get no one at the care home to give her an acceptable explanation. The bruising was attributed by staff to the amount of aspirin being taken by her mother. As a result, Worrell took direct action and placed a hidden camera in her mother’s room.
The resulting film footage shows her mother being manhandled roughly, slapped, sworn at, fed too quickly and barely being acknowledged as a human being. The programme highlighted the procrastination and obfuscation on the part of both the care-home managers and the Care Quality Commission (CQC) in responding to Worrell’s evidence of abuse. One worker was charged and found guilty of assault and is now in prison. Another four care workers were reinstated after obligatory training but later sacked. The eventual CQC report on the care home basically gave a clean bill of health with minimal mention of what had happened. The refusal of the care authorities to face up to the reality of what had happened to Worrell’s mother only added insult to injury.
The programme was depressing in several ways. The inhuman way of treating a vulnerable person was bad enough. But then there were the care workers, mainly foreign and unable or unwilling to speak much at all. The one vociferous carer talked about the poor wages, the physically tiring nature of the work and how ‘there was no joy or love’. She recognised that the residents there needed more of both, but clearly felt unable or unwilling to act upon this herself when it came to Worrell’s mother. An expert in dementia watched the footage and discerned a damaging culture present in the care home.
Unfortunately, the programme provided no sense that this cultural problem could be the result of something more than personal cruelty or indifference on the part of either individual workers and managers, or bureaucracies such as the CQC. At one point in the film, Worrell asks how the CQC, having seen her film and inspected the home, could report that the home was now ‘compliant’. The problem is that it is highly likely that institutions such as care homes spend a lot of time, effort and money ensuring that they do indeed comply with measures and criteria set by other institutions whose job it is to create and monitor these measures, such as the CQC. But the mistake lies in thinking that such ‘compliance’ has anything to do with the human reality that is, or should be, the substantive heart of the work of caring.
Care homes are supposed to provide care; this doesn’t mean every carer has to personally love each resident. It does mean that all involved in the work of providing care understand and accept certain common ideas and values that govern the form of their interactions with people in that specific setting. So being a carer involves being part of a common group or profession through which you hold yourself accountable for acting with care to all within your charge, irrespective of your own personal feelings about any particular resident. So it is a contradictory affair. On the one hand, it is very personal; the other, it requires a degree of detachment based upon certain values and standards that you hold in common with other carers.
Now this complex and fragile structure of affiliation and care sounds nebulous and hard to measure. It is. Its existence is affirmed in the actual practice. In the case of caring, the ‘practice’ encompasses the formation of relationships with those being cared for, as well as the practicalities of lifting and feeding properly. And its existence is undermined by compliance with new bureaucracies. Today, having criteria-referenced forms and technical systems for monitoring are now the normal method of deciding whether a job has been done, and whether it has been done ‘effectively’.
The result is deeply corrosive: the human qualities of judgement, responsibility and feeling upon which the work of caring depends are rendered invisible. Instead, carers are encouraged to perform actions according to a checklist. When this becomes the norm, there is actually less need for individual responsibility. If the ticked-off ‘evidence’ of good care is kept and submitted to periodic checks, then all is thought to be well.
The response of the CQC was a prime example of this. Their response to Worrell’s complaint was firstly to stress that they had talked to other residents and staff. Fair enough. But they didn’t speak to Worrell herself who had been present at the time of inspection. Their report emphasises how new systems were in place for online reporting of abuse; there were also phone lines where people could report information that would be analysed by the CQC who would then decide what further information would be required. While appreciating the need for thoroughness in investigating serious complaints, this sounds like creating even more bureaucratic layers, which further expands the scope for evading responsibility.
The really depressing conclusion we were left with at the end of the programme is that the answer lies either in more ‘compliance’, or in more individuals resorting to hidden cameras to expose malpractice. Neither idea bodes well for the future of caring.
Alka Sehgal Cuthbert is reading for a PhD in the philosophy of education. She is a member of the Institute of Ideas Education Forum.