Panorama exposé: Winterbourne View and its implication for the Neo Regulators

A couple of weeks ago Panorama shocked us all with a fly on the wall expose of chaos and tyranny in the Winterbourne View Hospital near Bristol (BBC1, 31 May, 9pm: Undercover Care, the Abuse Exposed; Paul Kenyon and Joe Casey). Residents (whose 'care' costs about £3k per month, paid for through our taxation, and implicating us in the result) were being subjected to regular and nasty bullying by a handful of staff at the lowest level of the hierarchy who seemed to have the run of the show even though qualified nursing staff and a management structure appeared to be in place. The next day on BBC Radio 4 World at One reporters remarking on the programme had been unable to get a minister to speak to them on air, so turned to Unison to provide them with a speaker at the last minute. Perhaps the short notice helps to explain why Christina McAnea (Head of Health) said that what was needed was higher levels of medical intervention and statutory regulation of the care workers. The residents at Winterbourne View Hospital are not sick, but are categorised as having 'learning difficulties'. What they need is something to do, and decent people to do it with. The undercover reporter noted that there was no regime of any specialist medication. The question of why these people were in hospital is an important one to ask, yet no-one asked it.

McAnea's second point, that the care workers should all be statutorily regulated, is one that has been made at the HPC (reported on here recently when Julia Drown raised it at a recent committee meeting). Perhaps McAnea was thinking about how to increase her power base in future negotiations with the government. Perhaps, because she can't possibly be thinking about the reality of the situation presented on the TV the night before. What was happening in the care home was against the law of the land. It wasn't a matter of incompetent professional malpractice. For the last ten years statutory regulation has pretended to be about professionalisation, but the thinly veiled attitude has always been an attack on the status of the professional - here the veil is ripped away and we can see quite clearly the aggression behind the call to statutorily regulate.

One criticism of this highly important programme was that it dwelt too long on the violence (the point was very well made and convincing in the first half of the programme), and so did not spend much time opening up the question of what had happened to the back-cloth of local networks that should have been there to support the qualified staff (Terry Bryan) in his attempt to do something about it. The chief thug on the ward had been there for over three years. This raises a massive set of questions about the structures of reason and control that most of us expect to be in place, (it was there, say, ooo, ten years ago) which could have dealt with the problem before it took hold. The glimpses we got of the senior nursing staff in the programme should at least make us ask what had happened to the structure of support that would have given them the power to act against the thugs. It is this, otherwise invisible, aspect of structure that we really need to pay attention to.

Because no sensible discussion is had of what has happened to local networks of management, the door is left wide open to the opportunistic thuggery of institutionalised power. For example, Minister Paul Burstow (a lib dem in name if not in action) ordered the Care Quality Commission to up its game. A highly centralised arms length government agent is given the order to do more spot checks. Great. This completely overlooks the point that the CQC is not only structurally unable to do anything about the problem we watched on the television (a point made tangentially in the World at One programme), but might even be part of the problem itself. The more the government pushes this style of regulation the more it attacks the thing that might actually make a difference. We are creating a self fulfilling prophecy. Has anyone got the courage to say it out loud?

On Friday 3rd June the HPC published a statement commenting on the Panorama programme. President Anna van der Gaag and her CEO Marc Seale said "We welcome any initiative that will increase the inspection of care services and improve standards. However, this will only happen if it is supported by an appropriate level of regulation of all the individuals working in care homes." They go on to lay the ground work for all care workers to be put under their control. This is presented as self evident fact yet there is absolutely no evidence whatsoever to support the statement. It remains a blatant act of institutionalised self interest with no regard for the real lives of the people - the residents and their families - that matter.

Why did the local network of reason and control fail? What is preventing decent people like Terry Bryan from being able to do his job? It is not the absence of a data base with everyone's name and address on it. Of that much we can be sure.