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Hidden Trauma: Accident and Emergency Nurse Reveals Abuse of Disabled by Family Carers

Stephen Colegrave speaks to an Accident and Emergency nurse who has witnessed the unreported abuse of vulnerable people

Photo: Photograph: Peter Byrne/PA Wire

Hidden TRAUMAA&E Nurse Reveals the Abuse of the Disabled by Family Carers

Stephen Colegrave speaks to an Accident and Emergency nurse who has witnessed the unreported abuse of vulnerable people

Editor’s Note: This article contains content that some readers may find distressing

Nearly every day, Jane (not her real name) – a nurse in a busy Accident and Emergency (A&E) department at an NHS hospital trust – cares for middle-aged and elderly disabled patients who she believes have been abused by their family carers.

Most of the victims are female, she says, and the abusers tend to be male if they are their partners. Other abusers, if they are family members, can be either male or female.

“It was happening daily, but now with COVID-19, twice daily” explains Jane. “It is easy to see the signs but much harder to get the disabled patient on their own to talk about it. It is difficult to do anything about it if they don’t [want to talk], unless they are in a really bad way.”

If Jane’s experience is also that of nurses in other hospitals up and down the country, tens of thousands of already vulnerable people could be being abused in this way. Why is it happening and why isn’t anything being done about it until its victims arrive in A&E?

It is important to note that the majority of family carers of disabled people do an amazing job. Sadly, however, there is a minority who don’t and are, in fact, abusing those they are meant to be caring for.

Worryingly, neither the Government nor local authorities seem to understand the problem, meaning that the safeguarding which could stop it, is not being put in place. Indeed, there is an incentive for the Government not to challenge informal, family care, given that it is estimated to save the taxpayer more than £4 billion a year.

The Government pays carers an allowance of up to £67.25 a week, in addition to the carer premium and the Carer’s Element – top-ups to the Universal Credit benefit that are worth up to £37.50 a week each. To qualify for these, a person has to be providing at least 35 hours of care a week.

The cost to the Government of £278 to £590 a month for what is often 24-hour care, could be encouraging the preservation of the status quo, to the detriment of those who are being abused.

The Signs of Abuse

Jane says that physical abuse is often the easiest to spot.

“You would not believe the neglect that some of the disabled patients have received. It is not uncommon for patients to have been left in their own excrement for days. In the worse cases, their clothes have welded into their skin because the acidic excrement has eaten away at the cloth and the skin has become raw. Infection can set in such as sepsis and, in some cases, this has led to death.”

Jane explains that she encourages any patient whom she is worried about to let her do a ‘body map’. This requires the patient wearing a gown, allowing her to see any signs of physical abuse that are not normally visible.

“Many disabled patients have bruises, often finger marks at the top of the arms and on the breast, but also cigarette burns, broken ribs and bites,” she says. “But mental abuse is far harder to identify.”

Mental abuse also has some tell-tale signs though. Often an abuser will not want to leave the victim and will often answer questions for them, Jane explains. She tries to find ways of getting the victims on their own so that she can find out what is going on, but this isn’t always easy. An abuser typically has all the power in the relationship; all the money comes to them – with the abused totally reliant on them for care.

Jane is convinced that these abusers view their victims as cash cows. To her, it is a form of financial abuse: controlling all the money, not letting the victims have anything, and keep them virtually imprisoned in their homes.


Jane is often the first person to see the effects of abuse and so has the difficult job of deciding when to escalate the issue, either to the police or social services.

Unless the patient arrives unconscious or seriously injured, the police will only investigate the matter if a victim complains. Often, Jane says, the abuser applies emotional pressure to their relative and any charges are dropped.

Referring people to social services is not an easy process either. The services are so stretched that often weeks pass by before any action is taken. Until then, the victim is usually sent home with the abuser, whose actions are likely to escalate. Even when a victim is able to leave their home, any alternative arrangements are often not preferable – being put in a refuge, for example, with no disabled facilities available.

All too regularly, the abuse continues and the victims keep returning to A&E.

“On the front of their notes I can see how many times they have been in,” Jane says. “It’s usually many times. One disabled woman had been to our A&E 45 times, but there was nothing we could do.”

No Safeguarding

Talking to Jane, it became clear that a number of individuals within the NHS will know that this abuse is happening. Staff receive annual training about abuse, in which disabled victims are mentioned – so why is nothing being done?

“There doesn’t seem to be any safeguarding checks done on people receiving carer’s allowance and other carer benefits, just that they qualify financially and the disabled person has the required level of disability,” says Jane. “There is no training or any checks or monitoring over time. It’s no wonder this keeps happening. Basic safeguarding, training and monitoring would really help.”

It is incumbent on the Government to put in place more rigorous checks, to make sure that disabled people are not being abused, and to ensure that entitlements are stripped from carers who are not up to the job.

Until this happens, the system remains rife for exploitation.

A spokesperson for the Department for Work and Pensions told Byline Times: “Most people receiving carer’s allowance provide vital and important support to those they are caring for. If safeguarding concerns are brought to our attention we immediately alert the police and/or social services as they have a statutory duty to investigate and safeguard anyone at risk.”

Jane’s name has been changed to protect her as a whistleblower

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