A stream of distressing cases has revealed the desperately low standards in too many care homes for older people and people with learning disabilities and challenging behaviour.
The horrific expose by BBC's Panorama of the culture of casual cruelty at Winterbourne View was preceded by example after example of neglect of the frail and vulnerable in hospitals and care homes. The aim of the Care Quality Commission (CQC), the independent regulator of all health and adult social care in England, is "to make sure that better care is provided for everyone, whether it is in hospital, in care homes, in people's own homes or anywhere else care is provided".
Last week, the CQC told the Castlebeck Care Group, responsible for Winterbourne View, now closed, that it has serious concerns about four of the other services run by the group, while a further seven do not fully comply with essential standards of quality and safety.
Among the concerns, based on inspectors' unannounced visits, are a lack of training for staff, inadequate staffing levels and a failure to notify relevant authorities of safeguarding incidents.
In sum, that all adds up to a life of misery for the residents.
Almost certainly, the faults in these homes are not exclusive to Castlebeck. If standards of care in England are to rise to a premium standard, then the CQC requires a radical overhaul. At present, it is underfunded, understaffed – even if its current high level of vacancies are filled – and its inspections are neither frequent enough nor sufficiently detailed.
Good regulation costs money. Last week, for instance, Ofsted launched a consultation that could mean that, in future, inspections of local authority children's services will consist of two-week unannounced visits.
One result of inadequate regulation was revealed in an investigation by the magazine Community Care. It discovered that nearly one in five people in learning disability hospitals such as Winterbourne View has been resident for five years (the average is 23 months) even though these facilities are intended only for short-term stays. Primary care trusts are paying, on average, ?2,770 a week to place people inappropriately.
So what role has the CQC played? Inspection of adult care services plummeted by 70% from 2009 to the beginning of this year because of the demands of new legislation and insufficient staff.
So, for example, Terry Rooney, aged 29 and who is autistic, entered a learning disability hospital for a six-month stay. Five years later, he has yet to return home.
Lack of care in hospital is matched by the absence of care in the community. The council allegedly offered only one hour of daycare a week. The result is a high cost to the taxpayer and an even bigger price paid by Terry and his parents.
The CQC is proposing a new "excellence" scheme for adult social care. The consultation process closes this week. It's intended that the scheme will be voluntary and care providers who apply for the award will pay a fee. This sounds dangerously like instituting a two-tier system: first class and steerage.
Aspiring to excellence is be welcomed. The concern is the fate that could befall others in less caring hands when the system of regulation is so profoundly flawed.
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