That the Care Quality Commission, the watchdog in charge of health and social care in England, is considering hidden cameras and mystery-shopper exercises in care homes and domiciliary care sounds plausible. But it is rather missing the point.
One episode of bad care is one too many. We hear repeated pleas that “something has to be done” when yet another report comes out of the abuse and neglect of the most vulnerable people in our communities. However, the idea that to promote and sustain ethical practice we need to introduce more surveillance and spot-checking is seriously misguided.
The end of the appalling violations of human rights that took place at Winterbourne View was attributed to secret filming by the BBC’s Panorama. But what we should be taking from this is not the success of covert filming but rather the failure of other processes to protect service users and ensure that staff are well-prepared and rewarded for the roles they assume.
We are currently engaged in social care ethics research with staff who work in domiciliary and residential care. These workers are among the most diverse, undervalued and poorly rewarded individuals in our society. They are often expected to do the impossible - provide full care to an older person with dementia, for example, in 15 minutes - with few resources and little acknowledgement.
They provide intimate and sensitive care to those who are dependent and often go the extra mile to enable the people in their care to feel valued and cared about. The workers I met talked of the satisfaction derived from making progress with people who were previously despondent (helping an elderly person to regain continence for example). They talked of helping to “shine a light through the fog” of dementia and enabling those even in the most severe stages, to experience joy and love. They told us about the patience they exercised as they worked with people at home who choose to live in circumstances that non-carers would balk at. They shared their satisfaction at the small steps of progress they made in their everyday work.
These workers demonstrated pride in their care activities and talked of how demoralising it is to be constantly on the receiving end of criticism and ignorance regarding the complex nature of their work. They were also wise enough to know that “a care worker went the extra mile today” was not likely to be newsworthy, particularly in the tabloid press. They were also not blind to the fact that their work prevented many elderly and disabled people from being admitted to hospital thus saving the NHS a significant cost.
Rather than moving to install surveillance systems in care contexts, the CQC and other governmental organisations would do much better to invest in the workforce. A workforce that is rewarded well and has continuing education on ethics will be in a much better position to police itself.
Let’s focus on revaluing care then, on celebrating the contribution of care workers and on making care work attractive to our young people. Or do we want to perpetuate the view that all we need is some technology so we can weed out bad practitioners?
This risks violating the dignity of service users and further demoralising a mostly heroic workforce. A much more constructive approach is to learn from practitioners and services that provide exemplary care and work to roll out the education and support systems that we need to make this happen everywhere and for everyone. Not just because people feel they are being watched.