Disabling the care relationship?

A recent ruling has given encouragement to those demanding a better deal when it comes to social care for people with disabilities. According to The Guardian, from now on ‘councils must make it clearer to service users how a proposed care package would meet their eligible needs’. This is an important step, say campaigners, toward greater clarity about what care the disabled are entitled to; and a challenge to the operation of a much-maligned and clearly unfair ‘postcode lottery’. However, while this ruling is welcome, the care problem for people with disabilities runs so much deeper. The Winterbourne View scandal was one of the more disturbing examples of why concerns about cuts, funding formulas and assessments – while important – are not the most critical issues facing the care system today.

Notoriously ‘secretly filmed footage’ at a care home by BBC Panorama ‘appeared to show residents being pinned down, slapped, doused in water and taunted’. Rather understatedly one commentator argues that Winterbourne shows that we need ‘more dignified and suitable types of support’ for people with learning disabilities. Of course this is true. As it is for those working at the Remploy factories currently being closed down by the government.  According to lobbyists the problem is to do with the ‘large institutions’ charged with, and clearly failing to, provide care. The institutions that serve the learning disabled so badly need to be torn down. And yet scandals like Winterbourne suggest that something else very worrying is going on. The neglect and abuse of so-called ‘vulnerable’ people, in particular those with learning disabilities, is a problem associated with institutional care but it is not the institutions themselves that are to blame. While the problem of poor care standards has been recognised for some time in both the NHS and in the social care system; anxieties about abusive and neglectful care, mostly overblown, have tended to focus on informal and private arrangements in the community.

But more often than not it is formal, state-funded provision that is found wanting. Half of the health and social care settings visited by the Care Quality Commission (CQC) inspectors following Winterbourne were failing to meet minimum standards. But what does this mean? And what can a body like the CQC do about it? Impose more standards? It is the administering of care itself that is at the heart of the problem. As the chair of South Gloucestershire’s Safeguarding Adults Board put it, on publication of the serious case review, Winterbourne ‘should have been a safe place for them to be treated with care and compassion’. The particular institutional settings, no matter how old-fashioned or unpleasant, are secondary to the quality of the caring relationship. It is the institutional culture that matters most. Indeed, one might argue that the CQC is itself a part of the problem. Might it be that an overly-managerial and target-driven care system is just not conducive to the fostering of professionally compassionate relationships between carers and the cared for?

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