Graeme Archer: Rage Against The Machine

By Graeme Archer

The images from the Winterbourne View care home aren’t ones that will fade from your mind quickly, are they? I wish I believed that sentence to be true, but in fact I do not. Not you, personally, but we, culturally, are too inured against the horror of revelations such as those from Winterbourne View. In the years to come we will read of another institution failing abysmally in its care of the vulnerable, whether a child in need of protection, young adults with learning difficulties, or elderly patients in hospitals.

It’s only a few days since the Commission on Quality and Care (the CQC) revealed findings concerning the treatment of elderly people in some NHS hospitals: the patients who had to be prescribed water, remember, because otherwise staff would neglect to let them drink.

It was only a few months before that when the Health Ombudsman released yet another damning report on the treatment of elderly, vulnerable patients in some hospitals. Again, failure to provide food and drink featured strongly in the cases uncovered by that report, along with the - forgive me - predictable stories of patients being left in soiled clothing. I say predictable only because, in common with many of you I’m sure, I’ve been in a hospital ward where I saw exactly such treatment being handed out to an elderly man whose requests for a bedpan were not sufficiently stentorian to rouse the nurses from their station. (Yes, I intervened; but I was only visiting. Goodness knows what happened after visiting hours).

The horrific death of Baby P happened under the watch of the same institutions, remember, which had solemnly promised to have learned the lessons of Victoria Climbie’s murder.

Depressingly, I could list more. Any of us could. You don’t reach adulthood in Britain without absorbing the horror of these sequential institutional failures. Yet none of these organisations - that is, none of us - seem able to learn from history. Here are some of the reasons that are given after each and every act of inhumanity:

Resources. This is a common excuse made after the event. Social workers are not well enough paid, there are not enough of them, nurses have far too much to do, care home workers are on the minimum wage ... and so on. Each of these justifications make me sick, to be honest: is the idea that people who don’t earn a lot of money become actively cruel? Or that cruel people are more likely to be on the minimum wage? Either way round is an abhorrent implication. I don’t believe you think about your income when you see a man soil himself for want of a bedpan.

There’s not enough oversight, and we require a stricter regime of governance. This point contains merit. The CQC which I mentioned above has already highlighted the treatment of NHS patients, and later this month will appear before the Health Select Committee to describe how it will extend its reach into privately-run homes. But again, I can’t see oversight (or its lack) as a sufficient excuse for failure to speak up when wickedness is in front of your eyes.

Some people are just evil. I may agree with this, but I don’t think many people are evil, so again, the presence of some malicious agents within an institution could not of itself lead to torture without the quiet acquiescence of people who are not malign. Fraser Nelson made a thoughtful point about the Stanford Experiment in the Spectator this week, in relation to exactly this. The Stanford experiment, remember, found that some sort of peer pressure may take hold in institutional settings, causing people to act as they are told, even if they are told to act wickedly, rather than as they must know they ought.

Understanding that people in organisations will obey predetermined process, even good people, even when it contradicts their humanity, is absolutely key, I think. And yet we actively encourage the pretence that human interactions within an institution can be governed by a set list of acceptable rules. We serve the institution-as-machine, rather than the human, and define a job well done as “I have followed all the guidelines set down for this task in my operating manual”, rather than “I have used my eyes and acted as a human being”. We focus on the engineering of the machines themselves - because all modern management is about risk aversion, where risk is defined as damage to the institution - and ignore the psychological needs of the real humans who exist within those machines, both the carers and those for whom they care. Could the problem not be this? That the pathological limit of a culture which has prioritised the machine over the human is exactly the sickening abuse we’ve seen this week. The consequence of this may be that institutions require fewer guidelines, not more.

Of course, every case is different, and generalisations difficult. But what’s the alternative? Unless we face up to this, that a culture which prioritises systems over people is almost certainly going to lead at best to acts of unkindness toward humans, then perhaps the only alternative is to admit: maybe we don’t care that much, after all.