As someone who worked in one or two of the old Victorian institutions at the time Care in the Community was introduced and later in communtiy units, I read this novel with a sense of horrified nostalgia. Of course, the reality was worse than what the author portrays, probably because the whole truth would be deemed too horrific, too unlikely to believed. But he gives a good impression of how wrong it all was. The only other book I have read that does a similar job would be William Horwood's Skallagrigg, which is, to be honest, a much better novel but only slightly comparable as it has a very different plot.
The disabled characters were all recognisable types I had come across time after time and well drawn. I thought the staff and other 'normal' characters tended to be stereotypes and lacked originality. The thriller aspect of the plot was a bit weak, much more so than the care critique which was very powerful. The author might have doen more about the economic and political angle of this sort of care - the need to spend as little as possible (my final budget before I left care was £2 per person per day to cover everything from food & drink to cleaning materials and my boss was wanting me to cut it!), the MP's safety in the knowledge that there are not many votes in community care, the fact that care in the community when the community doesn't care is an oxymoron too far for many people.