Why we should bring a ‘hate crime’ perspective to abuse in care settings

by Dr Chih Hoong Sin, Director, OPM 

Panorama’s undercover investigation into the abuse of older people at the Old Deanery care home in Braintree, Essex, was broadcast on 30^th April 2014, and attracted keen interest. Seven members of staff were sacked, almost immediately, and there have been two arrests to date.

Anglia Retirement Homes Ltd., the company that runs the Old Deanery, issued a statement clarifying that only a small number of staff were involved in the incidents and that such behaviour was not tolerated and was not indicative of wider practice.

One cannot help but recall another Panorama expose, aired on 12^th May 2011 that brought to light the abuse of people with learning disabilities and autism in another care home: Winterbourne View. Just like in the Old Deanery, the parent company issued a statement emphasising that it was an isolated incident.

Andrea Sutcliffe, the chief inspector of social care, has been quick to say that the Old Deanery abuse case is a minority issue. The typical response, each time a scandal of this nature comes to light, is characterised by shock and assertions that these are ‘one-off’ incidents. There has, unfortunately, been a long chain of ‘one-offs’ and one cannot help but wonder at just how deep the roots of the problem goes.

After all, in the aftermath of the 2011 Panorama expose, many charities reported a surge in inquiries from concerned families while the Care Quality Commission (CQC) admitted that in the 20 months preceding the programme, more than 4,300 whistleblowers had come forward to complain about the treatment of older and/or disabled people in care.

Similarly Nick Triggle, writing for the BBC, noted that 1,200 of the 17,000 care homes registered in England have been issued warning notices since 2011, of which more than 400 still have warning notices in place. Regulation is only as good as the information provided to inspectors, and it is notable that the scandals at both the Old Deanery and Winterbourne View were uncovered after whistleblowing.

How many are out there and still unknown? Indeed, a Care Quality Commission inspection that took place at a time when the Panorama’s undercover investigation was being conducted gave the Old Deanery a clean bill of health.

An earlier blog I wrote for OPM in response to the Winterbourne View scandal highlighted the following issues that are also relevant when reflecting on the Old Deanery scandal:

• While the attention is often on ‘rogue’ carers/practitioners, we cannot ignore the fact that some health and social care services are still being commissioned in a way that is not always person-centred and may paradoxically compound risks to the individuals receiving treatment, care and support;
• There are real challenges in joint working between health and social care agencies and criminal justice counterparts, which can sometimes lead to incidents ‘falling though gaps’ and not being handled effectively;
• Health and social care, in general, can still treat such events purely as ‘care failings’, thereby failing to address some of the criminal dimensions involved. Opportunities are missed in relation to working with health and social care agencies not only to tackle but also to prevent such crimes.

Using the terminology of ‘hate crime’ in discussions of what happened at Winterbourne View and the Old Deanery may strike some people as being odd and unsuitable.

Yet, the Crown Prosecution Service recognised that what happened at Winterbourne View can be understood as hate crimes, as these were demonstrably based on “hostility and prejudice” against the person as a result of his/her real and/or perceived identity (e.g. disabled, black, gay, etc.). The CPS asked the judge to treat the offences as disablist hate crime, as this would allow for an increase the level of sentences.

Health and social care services and settings can support the perpetration of violence against patients. Yet, they are also self-evidently key players in treating and supporting victims of hate crime and other forms of violence and abuse.

It is sadly still the case that health and social care professionals do not always draw the connection between the two, and can often simply treat the physical and mental symptoms without tackling the root causes of these that may lie outside the realms of the clinical and physiological.

It is also lamentable that health and social care agencies do not, as yet, play a significant role in the early identification of signs of often repeat victimisation which can be crucial in helping to prevent their escalation into more severe criminal events. This is something I discussed in a chapter I contributed to a book edited by Neil Chakraborti and Jon Garland: Responding to Hate Crime, published in May 2014 by Policy Press.

The closer working between health and social, and criminal justice agencies, was something I called for in a piece of research I directed and published in 2009.

I am thrilled that Leicestershire Partnership NHS Trust has responded to the ‘call to action’, and has been working to make this a reality. Through effective engagement of multiple stakeholders, including primary care, mental health services, victim support, the City Council, the County Council, charities, A&E departments, the police, and more; the Trust has mobilised a broad-based support to kick off an exciting and ambitious initiative to strengthen and improve the health service response to hate crime.

I am deeply honoured to have been invited to support the Trust to design a hate crime care pathway that will provide a joined up approach across Leicestershire and Rutland to treat and support people who have experienced hate crime and other forms of violence. The pathway is also intended to help healthcare professionals recognize their roles in identifying early signs of victimisation and to help prevent the escalation of such incidents.