‘Unlike an exposé on child abuse, this will quickly fade to memory’

BBC File on 4 exposed the state of UK home care services - but until we shake off an ageist attitude nothing will change, writes Gary Fitzgerald

The File on 4 documentary on UK home care services was first broadcast on Sunday 26 February 2017. Photo: screenshot taken from BBC Radio 4 website.

By Gary Fitzgerald, chief executive of Action on Elder Abuse

Earlier this week, BBC Radio programme ‘File on 4’ revealed there were 23,428 safeguarding alerts about home care between 2013 and 2016*. Of those cases, 700 involved the police, but just 15 resulted in any form of prosecution. The concerns involved neglect, psychological, physical and sexual abuse.

The Department of Health’s response to this data was typically bland:

“This government has introduced tougher inspections of care services, given councils access to up to £7.6bn of dedicated funding for social care and will continue to challenge local authorities that do not fulfil their duties under the Care Act.”

The situation facing social care is now critical. More specifically, the situation facing frail, vulnerable and defenseless older people is now routinely degrading, humiliating and abusive. It is getting worse. It goes against the basic standards of humanity and it has been increasingly so for years. Yet whenever a report brings it to public attention, the government releases equally bland statements.

‘Human-made disaster’

The occasional abusive care worker does not cause this situation. There are some horrible people working in our care services and it is too easy to gain such employment. However, most do their best in very difficult circumstances, and many provide outstanding care despite those circumstances.

This situation is systemic. The root cause is the short-term and often ideological decisions taken by successive governments, of all political persuasions, over the last decade. It is the failure of directors and councillors to uphold minimum standards of humanity and instead making cuts that will inevitably cause harm. It is also the care providers who have chased contracts at a value that could never deliver any level of quality care, but meant they remained in business for a while longer. This is a human-made disaster, not an accidental one.

‘Nurses v. care workers’

Consider these issues:

Nurses must be on a professional register and can be removed if they fail to meet expected standards. This is a proactive way of controlling who can have access to patients. However, there is no such ‘positive’ register for care staff. Why? Because the coalition blocked the proposal when they came to office. Instead, we have a barring list – and even that does not include every care worker who has neglected or abused an individual.

Nurses must also have a level of training verified not by the employer, but by an external body. A care worker might have the Care Certificate – lauded by government as something that makes a difference – but is in fact not legally mandatory or independently verified. The employer signs it off.

The standards care providers are inspected against have changed several times since they were introduced more than a decade ago, and not for the better. They are now so conceptual that it is virtually impossible for a relative to use them as a means of challenging neglect or abuse. Why?

Finally, elder abuse is not prosecuted. Only 0.7% of cases actually reach court, and then it is not unusual for the sentence to be community service or suspended. This is hardly a deterrent for an issue that affects over 500,000 older people. It begs the question: Why is a crime against you prosecuted if you are in your thirties, but not if you are in your eighties?

‘Fade to memory’

At the heart of this is ageism – a belief that older people do not require the same human standards that they enjoyed when they were younger. Of course, no one says this. They simply allow it to happen. Everyone wants to get old because no one wants to die young, yet we still tolerate old age being subjected to inhumane and degrading treatment. We no longer recognise it for what it is.

The ‘File on 4’ programme broadcast the reality of what it truly means to be on the receiving end of services that no longer aspire to quality, but are instead about doing the minimum possible, as cheaply as possible. But unlike a programme about child abuse, it will quickly fade to memory. Government will not feel obliged to launch an inquiry, no minister will do anything substantive, directors will continue to arrange degrading care, and the Department of Health will prepare their next bland statement for the next media expose. This will continue until we shake off an ageist attitude that allows them all to get away with it.

The question is simply this: will we do it before we are on the receiving end of those services?

*The figures revealed by the BBC were obtained from only half of local authorities asked – the others failed to reply. 



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15 Responses to ‘Unlike an exposé on child abuse, this will quickly fade to memory’

  1. Stephen McCarthy March 1, 2017 at 7:39 pm #

    Exactly right. Time to call it precisely how it is and, as importantly, why it is.

  2. John beer March 1, 2017 at 7:46 pm #

    How often are managers allowed to get away with “I had no idea this was going on”. They recruit the care workers, theoretically induct them into correct practices , give them ongoing training and supervision and check their work. They also take on contracts they can’t decently deliver because the time and or the price is not good enough. If managers and Commissioners were held to account they might be more careful about what they get involved in

  3. Margaret March 1, 2017 at 8:08 pm #

    Agree – What will it take before the government actually stops using meaningless words and actually puts better powers into place to stop the abuse of older people.
    The numbers of cases of abuse will continue to increase as our population gets older, more frail and vulnerable.
    This needs to end now.

  4. Stephen James March 2, 2017 at 9:27 am #

    At long last someone has accurately and more importantly truthfully covered this topic, which is a national disgrace, and something that successive governments should hang their heads in shame over. This article has struck so many chords with me and I would suggest all that are working in the sector. Thank you Gary for speaking out for not just social care professionals, but more importantly those who are most vulnerable in society who don’t have a voice.

  5. Veronica Gray March 2, 2017 at 10:19 am #

    Too much rhetoric about principles and values from those in power, not enough of this translated into real person centred, valued care with a rights based approach to give protection that every older person deserves.

  6. Lesley March 2, 2017 at 10:30 am #

    I was pleased to hear File on 4 covering this story, but disappointed that it didn’t receive the media attention it deserved. Imagine if this had been a story on child abuse – it would have been the top story of the day, the public would be up in arms, and the government would be promising action. Instead, there seems to be a growing perception that this is just something to be expected when you grow old, and there’s not much that can be done to put an end to it. There is, but no one wants to talk about it.

  7. Gerald March 2, 2017 at 1:59 pm #

    “Care in one own’s Home” has been promoted now for years and pursued by National and Local Government vigorously as the preferred replacement of Care Homes ,in my opinion it has no chance of working and never will have. Care Homes, for all there faults, are the only plausible solution for a 24/7 solution, and with the advent of an effective CQC, better quality standards are evolving on a National basis, all the time.Local Authority and NHS Funding has now to be improved to match .

  8. Mary March 2, 2017 at 3:24 pm #

    The situation will only get worse as there is a real race to the bottom in regards to standards and the price local authorities can afford to pay. Those who commission their care privately, also face the same problems. This is not just a issue for those who are older, but a issue for those who are living with a long term disabilities and in receipt of care in their own homes.

    Every time there is a chance to make the system more accountable for individual staff and organisations it gets kicked into the long grass and poor organisations and individuals get to work for another day. As far as I am concerned, most of what is written when something goes wrong is just platitudinous nonsense.

    We all will get older, there is a bleak future for those that need care now, I am at a loss to think just how bad it could be when I need support when I am older.

  9. Ruth Cartwright March 2, 2017 at 5:11 pm #

    Picking up on Gary’s point about registration, I think requiring care workers and their managers to be registered with the possibility of sanctions and de-registration might help. When the GSCC was set up the idea was that they would move to register care workers in children’s and adults services as well as social workers but they never managed it. And since then the politicians have decided it is not necessary. I recall some members of disability organisations arguing against registration on the grounds that they wanted to be able to employ former criminals as personal assistants, OK perhaps for those with full mental capacity, a good support network and able to assert themselves, not so perhaps for someone with dementia or extreme physical frailty. Of course registration of care workers would be a huge task, but is not the safety of our older people and those in vulnerable situations important? We used to talk about how there would need to be a ‘Granny P,’ a case as horrendous as ‘Baby P,’ before anything was done, but I believe there have been cases in this league with older and disabled people, but as others point out the media and public interest is just not there. Why do we seem able to put ourselves in the position of children but not of adults with disabilities and older people? Probably for all sorts of complicated reasons around denial and fear, but I wish the politicians and powers that be would at least try.

  10. Dr Dan Nightingale March 2, 2017 at 8:13 pm #

    Dr Fitzgerald is absolutely spot on with what he says. As a clinician, I have a different mindset than ‘management.’ For me, quality of care is a number one priority. For the suits, it’s all about the bottom line. Society would rather forget about its lonely and vulnerable citizens than sit up and advocate on their behalf. This is because respect is not something people are taught in modern day Britain – we really need to get in to schools and bring seniors and youngsters together. Where this has been done, we do a huge difference. Also, the government had to support Action on Elder Abuse – not doing so simply sends out the message that any abuse against older people is not something to be taken seriously.

  11. Emma Frost March 3, 2017 at 8:12 am #

    When I told professionals that my Dad (who had Alzheimer’s), had been eating maggots, what shocked me most was their total lack of shock! It would have hit the headlines if a young child ate maggot infested food.

    I arranged care in his own home which worked well – but only because we were incredibly lucky to get a fantastic live in cater who we built up a good relationship with – an immigrant care worker I might add, from a country where they respect their elders. We could learn from that.

    Having lost my Dad now I am training to be a Social Worker but the emphasis of the training is in children. Whilst children are obviously vulnerable and deserve to be protected I would argue that elderly people without mental capacity are equally vulnerable and equal emphasis should be put on training professionals to raise awareness of this. (I am only at the start of my course so I hope I will reflect on this comment when I qualify I will reflect on this comment and feel I judged the training too harshly.)

  12. Keith Lewin March 3, 2017 at 9:39 am #

    Having listened to the broadcast ‘Neglect: The Story of UK Homecare’ and having read the article by Mr Fitzgerald, it is clear that in order to focus the prosecutorial processes, and the decision-makers within the police and CPS, it is necessary to classify and count all incidents of wilful neglect and abuse. One way of achieving that is to categorise same as a ‘hate crimes’.

    One can see that having categorised other criminal activity as a ‘hate crimes’ there has been a change of approach and, over time, the public’s view changes.

    I have vested interests in eradicating such treatment of older people; first, because as a disabled man I currently benefit from domiciliary care, and in due course, God willing, I will become an older person… Second, I am a trustee/director of Action on Elder Abuse which is campaigning for wilful neglect and abuse of older people to be classed as a ‘hate crime’.

  13. Dr Farhad Cooper March 3, 2017 at 10:32 am #

    Thank you for highlighting this really important issue, Gary and team a team at Action on Elder Abuse.

    Local authorities and those delivering care have a pitiful knowledge of key issues like mental capacity, what constitutes neglect and abuse, and of their obligations under the law (The Care Act, the Mental Capacity Act, and the duty of candour are key here).

    Even when they are reported to the police and the local government ombudsman, they often try to derail these independent processes by saying “they’re conducting their own safeguarding investigations” and as demonstrated on BBC, File on Four, unsurprisingly – fault is rarely found.

    There is clearly a conflict of interests here.

    There is often just confusion or just a plain lack of understanding that these local authorities and agencies have broken the law. And don’t understand safeguarding processes. And moreover, a very overt attempt to deflect those trying to conduct independent investigations like the police and ombudsman – which is why so few prosecutions take place. Yet councils and agencies – who have a legal duty to cooperate under the care act, don’t. And have a legal duty to prevent further needs from arising, don’t. The list goes on.

    To my mind, no one should ever be allowed to get away with “investigating themselves” – if there’s any conflict of interest at all, which there always is between a local authority with a legal duty to care, who needs to work with care agencies.

    Any investigation must be impartial. And given the vast scale of the problem as we saw from the freedom of information requests, this is even more important.

    And it is very much in the public interest that we ensure that prosecutions take place and elders are treated no differently to any other vulnerable group in society.

    I wholeheartedly thank Gary and his team for helping to bring this very worthy issue up in the media.

  14. Paula Larter March 3, 2017 at 12:52 pm #

    Thank you Action on Elder Abuse for your frank and no nonsense comments particularly about the failings and ‘passiveness’ of consecutive governments to address this topic which comes up time and time again. As a regulated and registered health professional, I feel ALL care workers should be registered. As with my own profession, in the event of misconduct there should be a process of being ‘struck off’. Yes, it will be a costly – but it will give greater protection and may increase the worthiness of the registrants. It could also potentially deter those cruel individuals whose appalling actions cast so much negativity upon an undervalued workforce, who are often left to their own devices when visiting elderly and vulnerable people in their own homes. I can only reiterate what others have mentioned on previous posts and we all have a responsibility to ensure our older members of society are valued and do not remain invisible.

  15. Rachael Nicholson-Wright March 3, 2017 at 4:02 pm #

    While we continue without robust systems for registration of workers, a lack of consistency when recording information, disparity between reporting systems and an unwillingness to prosecute offences, we will continue to let down older people, our grandparents, parents, siblings.

    In Wales steps have been taken, the Regulation and Inspection of Social Care (Wales) Act 2016 will introduce compulsory registration for social care workers and domiciliary care workers with the aim of ensuring that workers are fit for practice, that they are able to care for older people. I look forward to seeing these measures implemented and the impact they will have.

    However, as Gary FitzGerald has written, this expose will fade from memory and we must continue to raise awareness about the systems that are failing our older people and call for changes to be made across the UK to ensure that every older person lives their life free from abuse.