Face the truth: some people like to abuse the vulnerable
Last night Panorama broadcast a film, shot in secret, depicting yet more abusive behaviour of social care workers. This time the footage was of an elderly woman with dementia being slapped, roughly handled and verbally abused.
In addition to this mistreatment the staff the staff failed to interact in any positive way with the woman - not even a greeting or using her name. Her daughter said there was "no joy, no tenderness, no empathy- nothing".
Despite the concerns of her family, who noticed severe bruising and a change in their mother’s demeanour, no action, it is claimed, was taken. If this was the case, it was no doubt on the mistaken belief that staff could not possibly do such things; there must be another explanation.
Wrong, wrong and wrong again.
Sadly, it is a recurring and well known fact that there is a very small minority of people who are attracted to work in social care, nursing, teaching and so on precisely because they will have access to vulnerable children and adults. People who enjoy targeting and doing harm to others who are powerless to fight back; sometimes alone in the privacy of a bedroom or bathroom, sometimes grandstanding in front of others (such as the scenes in Winterbourne View), and sometimes invidiously causing harm and then being seen to be the one who gets the credit for helping (as in Munchausen’s by Proxy).
It is a very small minority but they have always been with us and few are caught and so despite the use of CRB (Criminal Record Bureau) checks, they continue to haunt the most vulnerable.
Yet we must continue to trust; good social care practice is based on a relationship of trust.
My experience, from the perspective of an employer, has always been that social care workers give of their best and show more goodwill when trusted; the vast majority would never think to deliberately harm another person. The steps taken to prevent the small minority of abusers from gaining employment or to weed them out of existing roles must be proportionate to the risk of not undervaluing the good work of the vast majority.
However if you are a relative of someone who is receiving a care service or you are looking for a service such scandals will understandably cause you to be very concerned. Simply checking the Care Quality Commission website is clearly insufficient reassurance.
I suggest there are some safeguards you can take and suggest you ask the following five questions:
1. Is the service aware of the risk of abuse and what steps does it take to create an open culture; for example are there well publicised whistle-blowing procedures in place and are staff confident in using these without fear of reprisals; can you speak to anyone at any time, are there any restrictions for access and are they just as welcoming when the manager is off duty?
2. Is the service proactive in notifying you of concerns, no matter how small and no matter how often they prove to be completely innocent; does the service always take what you say seriously, will it always investigate and does it do the same for all its staff by encouraging reflective practice and actively promoting whistle blowing?
3. How rigorous is the staff recruitment over and above simply doing a CRB check and taking up employment references? Does the service use personality profiling (PDF on external site), as MacIntyre does. Does the interview use scenario questions relevant to the service that try to predict how candidates will behave once appointed and does the employer use families and individuals in the selection process?
4. Once appointed, are all staff regularly supervised and their day to day practice assessed and developed? How does this take place, in particular to encourage reflective practice and again are families and individuals involved?
5. Finally speak to other families and the individuals living there and ask they what they think of the service; have their concerns been taken seriously, is the manager open or defensive, what works well and what is not so good, and so on?
One final thought about personal responsibility - it is essential that all social care staff are fully accountable for their own actions and this needs to be explicit in terms of their behaviours and actions. Values based interviewing and training is insufficient unless it is explicitly linked to practice.
Or, to quote one of my most common mantras: “People experience our behaviours and not our values”.