Every now and again a television programme unleashes such public outrage that it becomes easier for the powers-that-be to do something than to do nothing. One of the first, if not the first, was Ken Loach's 1966 drama, Cathy Come Home, about homelessness. The result, beyond the outpouring of indignation, was a change in housing policy and benefits provision that remains in place, more or less, almost half a century later.
The BBC Panorama exposé of what passed for "caring" at Winterbourne View on the edge of Bristol could be on the way to exerting a similar effect. Residents, all adults with varying degrees of vulnerability, were shown being – as the commentary laconically put it – "slapped, taunted, pushed and teased". Sequences that followed made that catalogue seem a delicate understatement. Undercover film showed "care" assistants applying techniques not a million miles from what went on at Abu Ghraib. A former care manager even used the word "torture".
Even granting that some individuals, including those of sound mind and body, can be "difficult" (read nigh impossible) when they sense their powerlessness; granting, too, that even the most devoted carers can occasionally reach breaking point, the treatment meted out at Winterbourne View was off the map of what should be permissible in a civilised country. Worst of all, some of the most heinous excesses – the young man who was bludgeoned and the young woman who was dared to throw herself out of the window – were carried out with what seemed almost relish. Licensed bullying, no less.
Of course, once the programme had been aired, official responses positively rained down. The Government minister concerned, Paul Burstow, expressed shock and a determination to act. The chairman of the regulatory body, the Care Quality Commission, offered an apology, as did the health authority concerned and the private company, Castlebeck, that runs the home. Relatives expressed fears about what happens at care homes everywhere, once the visitors leave. The police made arrests. And campaign groups had a field day: had Panorama not borne out what they had been saying for a long time?
Well yes, and no. There are many aspects to the scandal of Winterbourne View – how often do such bucolic names deceive? – and some are more pertinent than others. One argument, to which this home categorically gives the lie, is that poor care mostly reflects poor and outdated facilities.
In material terms, this was a near-ideal home. It was only three years old. It was small – only 24 places – all the rooms were en suite; it was properly "accessible" for those with severe disabilities. The problem, as the undercover reporter, Joe Casey, made clear, was the "culture" that made possible and then turned a blind eye to ill-treatment. It was let down by the human factor.
A second argument, one being made vociferously, is that here we have an instructive microcosm of what happens when private business is allowed anywhere near the caring sector. The political motivation for this objection is clear: if it holds, then any whiff of extending the role of the private sector into the NHS will be doomed even more than it already is.
But Winterbourne View cannot be reduced to an argument about public versus private. And shortcomings in the "human factor" are not unique to the private caring sector. There are poor to disgraceful homes in the public sector, too. The idea that there are legions of Florence Nightingales ministering humanely to the sick and vulnerable, while struggling with the limitations of outdated Victorian accommodation, is wrong twice over.
It is wrong because the public-private partnerships encouraged by the last government produced a wave of new NHS hospitals and homes. Some of these are ostentatious monstrosities that will be liabilities for years, with vast mortgages still to be paid, enormous heating bills for unnecessarily vast spaces, and accommodation that still manages to leave patients in mixed wards with nothing like sufficient showers and toilets. These are scandals of funding, design and plain ignorance. Neither public, nor private, nor a combination is going to do the job without competent specialists and managers.
But it is also wrong because, as successive exposés in both public and private sectors have shown, the days of Florence Nightingales are long past, if they ever really existed. It cannot be assumed that staff employed to "care" are up to the job, and this is true everywhere in the system. With Winterbourne View, we have a new group of people to capture the headlines – vulnerable young adults with autism, learning difficulties or mental health problems – for whom "care" became almost the opposite.
The temptation will be to "ring-fence" this group and demand better treatment, more regulation, and more inspections for these particular homes. Spot checks, rather than the formulaic box ticking that mostly constituted the inspection regime until now, are to be introduced. Yet one glance at Winterbourne View's last inspection, in December 2009, clearly showed the place was not up to scratch. Barely one category in 10 was inspected, and one of the few found to be acceptable was "health and safety". It is hard not to suppress a cynical laugh.
The time is past for singling out one particular group of vulnerable people, and one particular type of establishment, as uniquely in need of new safeguards and inspection regimes. What began with revelations about elderly patients drinking flower water at Stafford Hospital has progressively turned up negligent and callous care of almost all vulnerable groups.
There is a sickness in the system itself that has reduced caring to a low-status, low-skilled and – above all, low-paid – occupation that "anyone" can do. Including, as at Winterbourne View, the kitchen porter. This is one misconception that must be addressed, with a complete overhaul of recruitment, training and management. Most of all, however, what is needed is a review of the whole economic structure of the "caring" sector, where everything has a price and a value – except the comfort and dignity of those who are the very reason it exists.