Winterbourne View: Why does this happen?

If Twitter has become the new barometer of the public mood, there were an awful lot of furious people watching TV last night. Most were effing and blinding at Britain’s Got Talent, or rather the lack of it, but for quite some time during and after the screening of Panorama on BBC1,  indignance, rage and even tears appeared to be the order of the evening.

It isn’t often I start throwing metaphorical chamber pots at the television but if you haven’t yet seen ‘Undercover Care: The Abuse Exposed’ and don’t have too many throwable items nearby, this is surely a ‘must see’ piece of tele-journalism. It will have you foaming at the mouth.  Here we have documentary evidence of cruel, callous staff supposedly offering care to vulnerable adults while actually doling out little more than institutionalised torture, bullying and assault.

Why does this happen?
It’s heartening to see the collective hive of Twitter so furious at the treatment of people who get precious little attention from anyone apart from those of us actually involved with learning disabled people or, like me, providing the training to help facilitate their care. But is it enough to simply tweat indignance  about what we see on a secretly filmed expose? After all, by the time you’ve read this Panorama won’t be ‘trending’ anymore and we’ll all have gone back to ranting about BGT, Sepp Blatter, or Jeremy Kyle.

We may see some commentary in the left-leaning media as to how savage cuts to health and social care budgets are the inevitable precursor to many more instances of barbaric, privately run institutions like Winterbourne View. Well I can’t disagree with that point of view, and we’ll return to that theme later. But to really understand how ‘care staff’ come to be filmed aiming drop-kicks at learning disabled patients or acting out Nazi Officer fantasises in the faces of frightened young men, we need to dig a little deeper and go back a little further.

‘A Degrading and Odious Employment’     
About seventeen years ago I published a research paper with a nurse colleague of mine called Chris Challoner. We had both worked in secure hospitals for some time, myself in medium secure units and Chris at Broadmoor Hospital. We were fascinated by the schism between two very different ideas of the term ‘nurse’.  

The more public perception of the nurse was (and probably still is) the idea of the ‘angel’. The little girl who’d been given a toy uniform for Christmas with a big red cross on the front and a plastic stethoscope. She (for this remains a largely gendered profession) couldn’t wait to become a nurse. Having got her treasured qualification she guiltily scoffed chocolates on the Medical ward, the box of Quality Street left by just about every grateful patient as they left for home having enjoyed the tender ministrations of those ‘lovely’ nurses.

And then there was us lot. Much more testosterone, no nice uniforms, key-laden lanyards swinging from belts and certainly little in the way of a lifelong yearning to look after dangerous psychopaths behind electronic doors. We’d just sort of drifted into it, and with a bit of overtime it paid the bills. And our patients never left us chocolates.

Myself and Chris wanted to test whether nurses working in secure environments really were the sort of right-wing, Daily Mail reading lock-up merchants of the stereotype that abounded at the time alongside the notion of the ‘sandal wearing tree hugger’ found in more normal, open psychiatric units.

We were testing a stereotype and achieved what research nerds would know as a ‘null hypothesis’ – there was no statistically measurable difference between the secure unit nurses and those who worked in more ‘therapeutically inclined’ environments, at least on measures of responses to our standardised measures of political and therapeutic attitudes. But we did find out a few other things that didn’t show up in our number crunching, and which, I think, have a direct bearing on the horrors seen on last night’s Panorama.

Firstly, while doing a little research on the history of psychiatric nursing, we came across this little gem:

The evils arising from the generally indifferent character of attendants, and from the deficiency as to the resources they ought to possess, are so great that few things would benefit the insane more than devising some remedy for them.

Very topical. But this was written in 1847 by a Dr. John Connolly, Medical Superintendent at one of the Victorian Asylums, pioneering mental health reformer and a chum of Charles Dickens. It has often been said that psychiatry attracts both the best and worst of the medical professions. Mental health has never been a fashionable specialism, but does attract the intellectually curious doctor as well as those who got a medical degree but weren’t quite bright enough for a scalpel. And to some extent, the same could be said of some of those attracted to psychiatric nursing.

But Panorama featured a private hospital catering for a group of people whose care tends not to attract even the academic curiosity inspired by Bipolar Disorder or Anorexia. As a registered hospital, Winterbourne View provides secure care under the Mental Health Act for people with autism and other learning disabilities. Care doesn’t get much less glamorous than this. It’s a neck of the therapeutic woods which doesn’t attract the starry-eyed little girl with a plastic fob watch pinned to her nurses outfit.

Even a few decades before Dr. Connolly’s scathing attack on ‘attendants’, another Medical Superintendent was waxing lyrical on the same subject:

Although an office of some importance and great responsibility, the role of the attendant is held as degrading and odious employment, and seldom accepted but by idle and disorderly persons

John Haslam’s observations probably weren’t featuring in the 1809 equivalent of a Job Centre. The typical interview of the time was a quick twirl in front of the asylum boss to prove you were a) a bloke and b) a big bloke with muscles.

So hospitals dealing with learning disabilities and challenging, aggressive behaviour have hundreds of years of historical form in recruiting nurses/attendants who are more adept at ‘decking’ aggressive patients than providing any semblance of ‘care’.  But two questions remain to be asked. Has anything changed, and what other reasons are there behind such appalling abuse?

A Question of Management
Our research was partly inspired by the ground-breaking 1979 documentary ‘The Secret Hospital’ which investigated the systematic abuse of learning disabled patients at Rampton maximum security hospital. Older readers may remember the horrifying story (among others) of a male patient with a particularly large penis who provided ‘entertainment’ for the nursing staff by way of a snooker table and a cue. If you didn’t see the programme you can guess the rest as I’m already traumatised by last night’s revelations.

As a separate but recent finding on the sometimes appalling state of elderly care in hospitals has shown, the NHS is certainly no grinning standard bearer of quality care. But last night’s damming evidence did make me think of the private sector organisations with whom my company now refuses to work. In these organisations we see ridiculously high staff turnover, with the few minimum wage staff who actually show some signs of competence being quickly  promoted to management as a kind of ‘golden handcuff’. They leave behind a floundering workforce struggling with the demands of what are often difficult and challenging circumstances, often with a limited command of English and barely a passing awareness of the cultural norms and unspoken rules so important to working with vulnerable adults and challenging behaviours.

For our blacklisted companies (several of which were started by entrepreneur property developers suddenly made aware of something called ‘Supporting People’. Kerr-ching!) the level of training required to work with challenging adults is often summed up by the following management-speak: “Oh shit, we’ve got an inspection next month. Somebody book a course for Christ’s sake!” If anyone from CQC happens to be reading this, no. We cannot infer client abuse or malpractice from the comfort of the training room, but on at least one occasion my classroom suspicions have been proved well founded. 
Fortunately, for every vision of Gothic Bedlam I come across in my travels, there are many more examples of very fine care providers who do actually commit to training and prioritise the support of staff who do what is a bloody difficult job. So why the difference?

Let’s return to the research study for a moment.  Our data gathering involved travelling to various different NHS units. Acute psychiatry, drug and alcohol and secure units all came under scrutiny.  We met the managers of each unit to discuss the purpose of the study, meetings which, with hindsight, told us more about the attitudes and therapeutic orientation of our sample than the wads of questionnaires and measuring tools we brought.  The managers ranged from the bright and enthusiastic sorts who exuded a culture of care from every pore, to the sort of indolent, world-weary pen pushers who, then as now, are so sadly common in NHS management.  We were there to measure the effects of therapeutic environment on our nurses, not the impact of management culture. But as we debriefed and analysed our data after each visit (let’s just call it having a pint before anyone asks) the parallels became obvious. The attitudes and therapeutic orientation of the nurses in each unit were far more a reflection of the management of that unit than the environment itself. In research nerd language, positive management correlated positively with positive patient care.

The Outlook?
So we reach a conclusion that those among us requiring the most complex, skilled care are being left to the support of those who, often through no fault of their own, are most poorly equipped to deliver that care. This is not a mitigation for the water torture, assault, bullying and abuse of vulnerable people, but in my mind at least it’s a hell of a lot more satisfying to try and understand why these disasters happen than to simply press the ‘disgusted and appalled’ button on my Twitter account.  

We’ve been left with a legacy  of front-line care donated by a New Labour obsessed with installing layer upon layer of Blackberry wielding apparatchiks constantly on the look-out for the next strategy group or working party to fill that long post-lunch window. We’re left stripped of the coalface people not wearing suits, who are now in turn getting their P45’s leaving an ever dwindling workforce to deal with problems of mental health, autism and learning disability showing no signs of declining in either quantity nor complexity. Companies such as Castlebeck will be invited, along with the property developers and former used car dealers, to pick up the slack. So-called care providers will carry on using celebrity detox as a front to their profit-yielding minimum wage efforts at managing some of the most vulnerable, difficult and disturbed people in the health care system.

Thank you, Panorama. You may just have stopped the rot for a little while. Not for long, just a little while. 

Visit JCK Training for details of health and social care in-house courses.


  1. Great post, I admire the writing style :) A little off topic here but what theme are you using? Looks pretty cool.

  2. We could go one step further to suggest that these 'ex-property developer types' are only playing the game. The name of the game is capitalism.The idea is to make as much money as possible, and there are no material rewards for 'caring' in the emotional sense.

  3. Thanks LSBF. The writing style is bitter, twisted and knackered, and the template is based on something called Watermark.

  4. Thanks Will.As I said in the article, there are some great charities and even private providers out there who pay above minimum wage, invest in training AND recruit high quality care staff. But (and it's a big 'but') the cuts are going to hammer the good guys.

  5. Nice piece of writing from one of those throwing stuff at the telly last night.

  6. I am also still shocked by what i saw last night. I work with adults who have learning disabilities and autism. I worked with one guy who came out of a long stay hospital and i was told he needed 6 people to pin him down there. I worked with him in a small home of 3 people in the community. It was hard to believe this was his history as he was such a calm and content guy. I can't see why any one in the programme could not live in smaller homes, with the right care, and successfully alongside everyone else. Such treatment will inevitably lead to challenging behaviour. I hope they all are supported to live the lives they want to now, but fear for all those who do not have the benefit of a panorama programme to defend them. We must close these remaining larger long stay institutions now!

  7. re budget cuts: Where i work has had budget cut for staffing of £20,000 this year. Later on, people will be stopped going to the day centres so we need to make extra provision for their care during the day. This means less suport time for each individual. Less hours means less opportunities to engage in meaningful, productive, stimulating activities. Less opportunities leads to more frustration. This can lead to behaviours which we may find challenging and this in turn may lead to "cracking down" of these behaviours and a downward spiral follows. I know where i work we won't "crack down" but it may happen in some places. Cuts will have an impact on abuse, but only if those that work in care allow it to happen. We must all stand firm and ensure we have a zero tolerance approach to abuse. Less funding is really no excuse for illegal behaviour from staff

  8. I was (and still am) a psychiatric nurse and was shocked at the level of violence and abuse foisted on the residents of Winterbourne view. This was totally idefensible and yes, I also cried bitterly when I saw the terrible way the residents were treated. However, Rob, I also worked for 20 or more years in a large Victorian psychiatric hospital (with 650 beds at the beginning of my career) and I never, ever witnessed anything like this kind of behaviour from staff. Yes, of course, there were some who cared less than others, but there was also a strong feeling of community within the hospital. When this hospital (also in Bristol) closed patients were moved in a fairly dignified way into smaller accomodation. Generally it worked well at the outset, but we have new generations of the mentally ill to treat and assist, with virtually no long term care facilities available. There clearly were some failings in the old asylums, but with a bit of imagination, oh and some proper funding, much could have been made of the old buildings. Now we have virtually unregulated (look at the CQC apologies…again)profit making schemes with low paid untrained workers bullying the most vulnerable members of society. Society needs to wake up to this and demand changes, not wait for Panorama to lift the lid again. Lets have some regulation with some teeth to root out these dreadful homes and "carers". Any nurse with a bit of experience and some common sense would be able to go into a home and see immediately things were not right, not some office bound fool who only cares about paper work. And yes, I have met with them as well. Care Quality Commission my arse!

  9. i have yet to see the programme. i work in social care and your article makes me glad my managers seem to possess more common sense and look after staff as well as the clients.

  10. Hi Connor, This all seems spot-on.It seems to me that care of this nature should not be privatised as we need both control/oversight and every penny we can get, not least to spend on paying and training the care workers properly, and attracting more good people. I have written to my MP (fat lot of good that will do) and will watch further developments with concern. James.

  11. Really good article that explains the issues that staff are under. I do not feel that their behaviour is justified and that if a company gets 3,500 a week to look after these individuals i cannot see why it is not a better paid job, afterall, its an important job!

  12. I watched ONE minute of this on the BBC website and was reduced nearly to tears. I've worked very briefly with adults with LD and I can't imagine many circumstances where violence could be required to "control" people. It's unbelievable.

  13. Couldn't agree more with the indignation/shock and horror. Two questions I would like to know the answer to:1. Where was the manager of the unit in all of this and2. Did BBC REALLY need to film for 5 weeks – possibly the 'worst' footage was obtained as the reporter became more trusted but surely to God it could have been exposed sooner?Just a thought Dee

  14. First off I'd like to thank you for your well written article.Secondly I'd like to say how disgusted I am by the scenes that I have seen so far (only the brief clips on the BBC Breakfast show).And then thirdly… I have been working in care now for almost four years, as I support worker. I am currently based in London working with abused children. However, I started in Nottingham at the Castlebeck unit there.The unit that I worked at was considered to care for the most challenging clients that the company worked with. As such our staff turnover was very high and we often found ourselves too short to cope with the usual shifts. Support workers were brought in from other units to help out, in particular Winterbourne View.My experience of most of the staff that came (I believe it was six or seven in total), was that they prided themselves on the way in which they dealt with violent individuals. I, as well as many of my former colleagues, carry scars from scratches, bites, punches, kicks and objects being thrown. The staff from Winterbourne View were of the opinion that we weren't working correctly and – in their own words – 'give us a couple of weeks working with x and you won't have any more problems'.It seems that the approach favoured at that unit was to cause the clients to fear you so much that they would not dare come close to you.Whilst I didn't leave Castlebeck with the best of feelings towards them, I can't really fault them as a company. There will understandably and rightly be a massive backlash at them, but I think a lot of people will be wrongly caught up in this. I started there with no experience of the care environment; for the first two weeks of my employment I was shadowing an experienced member of staff, and this was followed by a period of mentoring. I was given a huge amount of training, including correct physical intervention techniques (MAYBO) and, because of this I am now seen as a highly qualified and experienced support worker.I'm not really sure if my point has come across too well, or if I even had one to make, but I hope this has been interesting to somebody.And, in closing, I'd like to state that it is my understanding that Castlebeck and CQC were both well aware of the abuse before Panorama were involved. And I also know that the CQC began unannounced inspections of the other units this morning.My heart goes out to the individuals who have suffered, as well as their families, and to the workers doing a good job and genuinely caring that are getting caught up in all of this.

  15. Thanks to everyone for the comments – there are some really key questions and comments here that I'd like to address but only after some sleep! In the meantime I'm on Radio 4 The World Tonight at 10pm – 10.45 with Alision Giraud-Saunders, Co-Director of the Foundation for People with Learning Disabilities. You'll soon discover I write much better than I sound.

  16. Not finished the article yet but:I found this piece while searching for somewhere to post a comment after watching Monday night's Panorama (in order to partially relieve my outrage). Although this behaviour is completely unacceptable, from my experience in care both public and private, I can see how this behaviour begins and is propagated. I was thinking for somewhere like Winterbourne to have reached this level of abuse there HAS to be an attitude within the management that the service users are not entitled to the level of care that most others would receive. Since your research backs this up I am satisfied that there is a top to bottom staffing problem within this institution (cos, lets face it, it's not a care home) and that there ARE ways of avoiding these situations in most cases. And so, outrage dissipated (for now).

  17. As you say…not for long.

  18. Thank you for this insightful piece, words of sense in the midst of the hue and cry.My heart is bleeding for those young people and their families, their unbearable hurt.My OH was mistreated and bullied by staff during a 3 month stay in a general hospital. When I complained, the abuse escalated so he begged me to let it pass. We were lucky, he came home and I had his case transfered to a hospital nearer to our home where we found a wonderful DR, now Proff, who ran a department well.Saddly we have a horrible habbit of blaming the coal face workers while management incompetancy goes mostly unchallenged. Management set the framework and if it is flawed the system down stream is set to fail. And, frankly, this can happen is any setting, public or private sectors alike. Systemic abuse.

  19. Loved your piece! Sooo insightful and sooo true having worked in both statutory and private. Its about the nurtured culture…and beleive me…these kind of cultures exist in statutory as well as private! Having worked in a very incestuous young persons secure unit i was appauled at the degrading attitudes and care which went unchallenged by management. Camera's and external professionals (hands-on)ones to regulate and pick up on cultural rot.Keep up the good work ( and loved yr real life swearing!)

  20. Good work.It's an endemic problem in the UK, crap management leads to crap training and craply motivated staff.Low wages and high taxes compound this and has done for 40 odd years.If you want to read some sound real world analysis of why we really are underpaid and overtaxed I highly recommend;"When will the workers wake up?" Understanding Sovereign Modern Money and the Job Guarantee, Decent Living Wages for anyone unemployed for over 26 weeks, the JET Job Education Training Guarantee for the young has abolished NEETS and long term unemployment in Norway for the last 5 years or so, better still set the time limit at around the 2-4 weeks mark.

  21. Its a great piece – but I don't think the sort of culture you are describing just exists in the private sector, I've seen it in a number of charities too. In particular that devaluing of the workforce and over valuing of management. I was brought into one major charity at a national level to troubleshoot problems across their "estate". What I found were staff going though a kind of evolutionary process. They'd start off as enthusiastic, move onto angry about the lack of resources/respect accorded them, become militant and start to raise the issue with management at a regional and national level and then finally wholesale disenchantment would set in and they would internalise (in terms of their own behaviour) an ethos which basically said the clients/residents don't matter. The business matters – and the commissioners and inspector matter only because the business matter. Most problems I looked at were far better understood by staff than by management. And let me repeat this was a charity. Driven by money, driven by profit. The same place got rid of most of its most experienced middle managers in one of its regular reorganisations. When it came to replacing them they advertised for people with solid sales experience and actually stated that while experience in the care sector was desirable, it wasn't essential.

  22. In the days before the private sector really got going and 'abuse lit' was all the rage, the horror market was dominated by reports of NHS hospital abuse scandals. See a long list of brutal NHS institutions here:, this has bugger all to do with the private sector as root cause.We know from the occupational psychology research literature that money doesn't motivate (though its absence demotivates). People at work cry out for connection, meaning, personal development and opportunities for engagement. When the culture contains these, the money doesn't come close. If it did, the NHS, a place of low pay historically, wouldn't function and yet it is groaning in examples of good, humanitarian care. It is a system that is the envy of the world.About 10 years ago, the Corporate Leadership Council established that fair, accurate, informal feedback was the number 1 performance driver in the workplace and was the factor that was head and shoulders above all others. People who received this feedback experienced a performance hike of 40% compared to those who did not. The Panorama programme showed weak, qualified nursing staff who gave nothing approaching leadership. I suspect that the care staff are not psychopaths and that they experienced a sort of boiling frog culture in which they individually tested the waters then gradually slipped unchallenged into abuse. I agree that managers hold a great deal of sway over working climate and can create high levels of discretionary effort, (as well as cultures of abuse). The causes of abuse are complex and over-determined. We must attend to management and leadership, regulation, removing constraints on the organisation being an open, porous system with lots of external contact (and therefore oblique scrutiny and safeguarding). We need systems that make abuse detection, then immediate consequences, a certainty. We need mechanisms for staff engagement (already the unqualified staff are being disgracefully storied as feral scum, when some of the finest human beings I've ever worked with have been unqualified care workers). Studies show that torturers can be perfectly normal people, like you and me (well, like me, anyway :-).The announcement by CQC/government of unannounced visits (anyone else spot a slight contradiction here?) is a woefully inadequate response. The bad guys simply stop what they're doing when they hear officialdom fetch up at the door. Stupid, stupid, stupid.

  23. I am glad to see that training is seen as needing to be at the core of preventing abuse and creating a positive climate for people to live and for staff to work in. Cases like Winterbourne are never due to one factor but a building momentum of issues such as poor management, supervsion, coaching and internal culture.But training is the first to be cut in an ecomonic downturn and you do worry for the future of social care as we seem to be entering a second phase of the recession as public sector cuts draw deep into all providers.Pay levels and abuse are not related despite some media articles to the contrary, it is about staff attitude and training. But there is growing widespread concern that the gains the independent social care sector has made in professionalising the workforce will be lost as we are driven to a minimum wage culture and conditions by unprecedented cuts in fees and contracts by Local Authorities. I fear Learning Disbaility services will be at the fore of this.

  24. I work in Adult Protection in Scotland and agree that this kind of systemic abuse is not due to poorly paid staff or low care home fees. Many care homes provide excellent needs led care for the same money and have staff groups who are committed and caring towards a very vulnerable group of residents. In my experience it is definitely a cultural issue linked to poor management practice and this was illustrated by their lack of response to Terry Bryan. I find it incredible that in response to a complaint, naming staff and clearly alleging abuse, the CQC could find no evidence, and think (hope) they will struggle to justify their inaction. I am very pleased that a serious case review will be held and hope the lessons from this will benefit other adults at risk of harm. My fear, however is that this is only the tip of an iceberg.

  25. Well I am a Learning Disabilities Nurse from way back — 36 years and I have like Terry Bryan the whistle blower seen a few things in my time–but nothing like this. I was interested in the comments from the Castlebeck worker regarding staff from Winterborn–a culture had developed there, and anyone who stayed for pay, got sucked in. Some of the abuse was psychotic and I question the motivations, bullying thrills,sexual thrills, who knows. I am glad Castlebeck has other facilities that actually work as they are meant to. One other thing, this work is not boring, if done properly and you consider yourself a professional Cheers.

  26. Interesting points. It seems hard to disagree with the contention that it is management and organisational structures that contribute to the problem. It's funny you mention seeing a similar documentary years ago as I also recall seeing a similar undercover expose on an LD care home when I did adult abuse awareness training when I worked for a local authority a few years back. Personally I feel there is also an issue with the perceptions of wider society and as you point out many of those shocked by the programme will soon forget about it leaving the problem to continue until the next time an undercover reporter smuggles a camera into a care home.I did my own post on it a while back which explains it in more detail

  27. This is generally a wonderful website i should say,I enjoyed reading your articles. This is truly a great read for me. I have bookmarked it and I am looking forward to reading new articles. Keep up the good workBoundless

  28. Thank you. I shall try to keep new posts coming but the day job always come first!

  29. I like the design of your blog very much. It looks like a page from fairy tale. I’m really impressed!CCTV Karachi

  30. I wonder how you got so good. This is really a fascinating blog, lots of stuff that I can get into. One thing I just want to say is that your Blog is so perfect!security equipment

  31. […] sooner or later we come back to the big picture. As we’ve seen only too graphically at Winterbourne View and Mid-Staffordshire, dysfunctional environments may not be the genesis of dysfunctional staff but […]

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s


Get every new post delivered to your Inbox.

%d bloggers like this: