Winterbourne View failures lead to care system review

“Fine and ban care home abuse bosses,” the Daily Mirror demands, while the Daily Mail says that “there must be a complete culture change in treatment” for care centres.

Both headlines are in response to a Department of Health report into staff mistreatment and abuse of patients at the private Winterbourne View Hospital. These events first came to light in May 2011.

The 24-bed hospital was registered to provide assessment, treatment and rehabilitation for people with learning disabilities and autism.

Prompted by concerns raised by a former staff member, a journalist working for the BBC managed to get a job working at Winterbourne View. Using a hidden camera, he documented acts of bullying and physical and mental abuse committed by some of the staff of Winterbourne View.

This new report focuses on two main issues:

• Individual failings, that occurred at multiple levels, which resulted in the culture of abuse at Winterbourne View going undetected for so long by the authorities.
• The wider issue of whether the care system, in all parts of the country, is providing effective and appropriate treatment to people with learning disabilities and autism.

In light of the findings of the report, a programme of action has been set out. This addresses the following issues:

• an unacceptably high number of people with learning disabilities and autism are being kept in hospital facilities on a long-term basis – and people who are kept inappropriately in hospital should be transferred to community-based care by June 2014
• the programme of unannounced inspections of facilities needs to be expanded
• better accountability is needed – this may require new laws that make directors of private organisations criminally negligent for serious failures of care that occur under their management

The report says it aims to transform services so that vulnerable people, such as those with learning difficulties, mental health conditions and challenging behaviour, are cared for in line with best practice and that abuse is prevented from happening again.

Why was the report commissioned?

Transforming care: a national response to Winterbourne View Hospital was commissioned by the Department of Health in England.

The report is a response to a BBC Panorama television documentary that aired in May 2011 and raised alarm over the care of patients at a private hospital in Bristol.

The documentary, produced by a journalist working undercover and using hidden camera techniques, showed people with challenging behaviour being bullied and physically and emotionally abused by staff at the Winterbourne View Hospital.

This hospital has now been closed and all 11 staff members who abused patients have been sentenced for criminal acts. Six have been imprisoned.

The Department of Health’s report follows an earlier investigation by the Care Quality Commission into its own role in the events leading to the abuse of patients at Winterbourne View.

What evidence did the report consider?

The Department of Health’s report drew its conclusions from:

• evidence from the criminal proceedings of the 11 individuals who were sentenced
• a review of all services provided by the organisation Castlebeck Care (which owned Winterbourne View) as well as an additional inspection of 150 learning disability services and homes across England
• a review of serious untoward incident reports from Winterbourne View Hospital
• an independent Serious Case Review produced by the South Gloucestershire Safeguarding Adults Board that was published in August of this year (Serious Case Reviews are inquiries that can be commissioned by a relevant local authority when there are allegations of abuse or neglect affecting the care of vulnerable people or children)
• the experiences and views of different people with learning disabilities, autism, mental health conditions and challenging behaviours, as well as those of families and carers, care staff, commissioners (those who fund services) and care providers (such as nursing staff)

What failings were identified by the report?

The report into the events at Winterbourne View Hospital states that “staff routinely mistreated and abused patients” and that “management allowed a culture of abuse to flourish”.

According to the report:

• concerns raised by a whistleblower went unheeded
• patients’ reports of abuse were ignored
• warning signs were not picked up by the relevant authorities

Some of the missed warning signs cited by the report included:

• there was a high number of recorded physical interventions (for example, a staff member physically restraining a patient) – one patient was reported as being restrained 45 times in the space of five months
• there was a high rate of admission of patients to Accident & Emergency services, with no follow-up investigations to assess why this was the case
• the Serious Case Review found evidence of a general poor level of healthcare, with many patients being affected by conditions that are often preventable with good quality care, such as constipation and dental problems
• there was evidence suggesting an inappropriate prescribing of anti-psychotic drugs

They say there was also failure to assess the quality of care being delivered for the very high cost of Winterbourne View Hospital (an average cost of £3,500 per week per patient) and other hospitals.

The report also uncovered wider weaknesses in the justice system’s ability to hold the bosses of care organisations to account for the safety and quality of their organisations.

Importantly, it also found that many people are in hospital care who don’t need to be. Some of the patients at Winterbourne View had been there for a long time, with some there for more than three years.

Some patients had been initially ‘sectioned’ under the terms of the Mental Health Act, and then remained at Winterbourne after this period of being sectioned ended. Others were admitted on an informal basis and then became ‘sectioned’ after admission.

Being ‘sectioned’ means that a person is compulsorily detained on a temporary basis as it is thought that their behaviour poses a risk to themselves or others. But being sectioned should only be a temporary step and there should be ongoing reviews of a person’s mental state to assess if they can then leave compulsory detention.

In light of these findings, the report says that “people with learning disabilities, autism, mental health conditions or challenging behaviour have a right to be given the support and care they need in the community that is near to family and friends”.

Norman Lamb, Minister for Care and Support, said: “There are far too many people with learning disabilities or autism staying too long in hospital or residential homes, and even though many are receiving good care in these settings, many should not be there and could lead happier lives elsewhere. This practice must end.

“We should no more tolerate people being placed in inappropriate care settings than we would people receiving the wrong cancer treatment. That is why I am asking councils and clinical commissioning groups to put this right as a matter of urgency”.

On a more positive note, the report does say that some places are getting things right and that examples of good practice at these places have been published and are available on the Department of Health’s website to demonstrate what can and should be done in providing the best care for these people. 

What recommendations does the report make about care for vulnerable people and people with learning difficulties?

Recommendations and actions outlined in the report are:

• all current facilities will be reviewed by June 1 2013 and all people who are inappropriately in hospital care will move to community-based support as quickly as possible no later than June 1 2014
• that each area will have a locally agreed joint care plan by April 2014 to ensure high quality care for vulnerable people including children and young adults
• the introduction of a new NHS and local government-led joint improvement team to support transformation and monitor and report on progress
• strengthened accountability of boards of directors and managers for the safety and quality of care their organisations provide – with the possibility of new legislation, similar to the current corporate manslaughter law, that means boards of directors and managers have a legal liability for the levels of care their companies provide
• strengthened inspections and regulation of hospitals and care homes for this group of people, including unannounced inspections

The report says that, as a consequence of moving people from in-hospital care to community-based care, there will be a dramatic reduction in hospital placements and closure of large hospitals.

Alongside the report, an agreement is being published that sets out shared commitments and key actions with key organisations.