News and Comment

The Panorama exposé of care home abuse – After the shock, what next?

Wednesday 1 June 2011


The Panorama special, Undercover Care: The Abuse Exposed, uncovered a regime of shocking abuse by staff against people with learning disabilities and autism in a private hospital near Bristol.

While all segments of society have expressed disgust and shock, we must not miss this opportunity for putting right a system that has long been known to have perpetrated violence and abuse against disabled people. The immediate attention, rightly, is on justice and redress, with implications for inspection and regulation. But there are other important issues we need to deal with.

Violence and abuse in institutional settings

In our work on targeted violence and hostility against disabled people, we found that one of the key groups perpetrating such acts is staff from statutory or other agencies working routinely with disabled people. There is evidence suggesting that victimisation by caregivers may be more common in institutional settings than in the community. People with learning disabilities have reported abuse by someone associated with disability services or through services provided specifically for disabled people. There have also been reports of sexual abuse of disabled people (particularly women) in institutional settings such as day centres or residential homes, forced intake of medication, and excessive use of physical force (e.g. in psychiatric hospitals).


These environments for care can, paradoxically, be environments that promote violence and abuse. A key factor is the unequal power relations between the care giver and the care recipient.

Perpetrators in these situations have been identified as being ‘predatory caregivers’ or ‘corrupted caregivers’. The former are considered to maintain opportunities (for example, through employment) to have access to victims. They are more strategic and are thought to commit both impulsive offences as well as planned offences. Predatory caregivers are thought to be likely to commit extreme cases of physical and sexual violence as well as low-level harassment motivated by a need to assert control over others they perceive to be vulnerable. In contrast, ‘corrupted caregivers’ are considered to be a consequence of inadequate training and policy, which can lead to abusive interaction with people in their care.

But such characterisations are inadequate. Lack of training and clear policies on their own do not necessarily lead to abusive interaction with patients. The experiences of patients at Winterbourne View hospital have been described as ‘barbaric’ and ‘like torture’. It is clear that the disabled patients have been actively de-humanised by staff. This finds succour in the sad fact that wider society is still trenchantly disablist. Disabled people are still seen as ‘lesser’ people, and incomplete. In extreme cases, such as in Winterbourne View hospital, staff stop seeing the disabled person as a person. Things happen, and are allowed to happen. This inequality of value, where a disabled person is not seen as equal to a non-disabled person, is widely reported in the evidence base on prejudice and discrimination.

Lack of effective response

Within the closed context of institutionalised settings, these attitudes and behaviours may be allowed to proliferate relatively unchecked. There are two fundamental challenges to effective response.

First, there is a blurring of responsibility between social care agencies and the criminal justice system when dealing with such incidents. The No Secrets protection guidelines published in 2000 gave statutory social care agencies the lead in responding to, and ultimately monitoring, crimes against ‘vulnerable people’. This led to a situation where mainstream criminal justice agencies failed to respond effectively to crimes against disabled people because the message the police gets is that social care professionals should ‘protect vulnerable adults from abuse’ rather than the police needing to support people to take action against offenders.

While Winterbourne View hospital is not a statutory social care agency, it still operated within a culture whereby ‘abuse’ and ‘bullying’ are treated as ‘care issues’ to be dealt with in-house, rather than by the police as criminal issues.

This hints at the second challenge, which is the inconsistent language and terminology used across different organisations and professions working with disabled people. While some of the incidents unveiled by the Panorama special can be considered criminal offences, there is still a tendency for social care to talk about ‘abuse’ even in relation to incidents that the criminal justice sector considers as ‘crime’.

Next steps

To take concrete steps in addressing the issues, we need to move away from a protectionist and welfarist paradigm that underpins a number of professional practice and wider social attitudes towards disability. This focuses on disabled people’s ‘vulnerability’ and can heighten unequal power dynamics. In the caring context, effective redress may not be provided as disabled people may simply be removed from the perceived or real threat.

In managing risk and promoting standards and quality of care, disabled people must be involved meaningfully in due processes. Suggestions by Castlebeck, the company running the Winterbourne View hospital, to tighten up auditing and to conduct checks of patient records will not suffice. The meaningful involvement of disabled people is a key plank of the Disability Equality Duty (now superceded by the Single Equality Duty).

The clarion call issued by the disability rights movement – ‘Nothing about us without us’ – serves as a reminder of the need for disabled people to have a say in every stage of service planning, implementation and reviewing.