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******9th Nov 2017 until further notice.********
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A Serious Case Review

WINTERBOURNE VIEW HOSPITAL

Many readers will have read accounts on the report by Dr Margaret Flynn and Vic Caterella, on the events which lead to the closure ofWinterbourneViewHospital.  The report, which is more than 150 pages long, could only be published after the conclusion of the prosecutions against 11 former staff at Winterbourne.

Winterbourne was a new, purpose built facility which opened in 2006 and closed within 5 years.  Closure only happened after BBC’s Panorama programme “Undercover Care: The Abuse Exposed”  in May 2011.  The report includes many revelations which will

disturb and disgust readers. They include:

  •  residents of Winterbourne attended the local A & E 76 times between January 2008 and May 2011 for treatment for epileptic seizures, injury, self harm, lacerations, removal of a foreign body and for a fall – but no one at A & E alerted the relevant authorities.
  • South Gloucestershire Council received 27 allegations of abuse by staff to patients at Winterbourne, 10 allegations of patient– on–patient assaults and 3 family related alerts – yet took no action.
  • Avon and Somerset Police recorded 29 incidents, including 9 carer-on-patient incidents which included staff head butting and punching patients – they only instituted prosecutions after the Panorama programme.
  • Castlebeck recorded 379 physical interventions – such as restraint – during 2010 and 129 for the first 3 months of 2011 but did nothing.

Dr Flynn said “the silencing of complaints by victims was scandalous”.

Castlebeck Limited, who owned Winterbourne received £3,500 a week from the NHS for every mentally ill patient placed in Winterbourne.   Despite this there was no registered manager for two periods, one of 7 months and the other for the 18 months prior to the closure of the hospital.

One problem sometimes associated with serious failures is lack of cash, but turnover was £3.7 million.  The report’s verdict was that “Castlebeck appears to have made decisions about profitability, including shareholder returns, over and above decisions about the effective and humane delivery of assessment, treatment and rehabilitation” and “took the financial rewards without any apparent accountability”. 

Castlebeck has now closed Winterbourne and 2 of its other residential homes.

There are a number of recommendations in the report which include:

  • greater investment on community based care to reduce the need for in-patient admissions at assessment, treatment and rehabilitation units like Winterbourne.
  • outcome based commissioning for hospitals detaining people with learning disabilities and autism.
  • discontinue ‘t-supine restraint’ where patients are  laid on the ground and staff use their body weight to restrain them.
  • notifications of concern, including safeguarding alerts, hospital admissions and police attendances to be better co-ordinated and shared amongst safeguarding organisations to allow earlier identification of potential problems and earlier action.

 Extracts from the Daily Mail and Brunswick’s Healthcare Review Volume 7 Issue 30.

RESCARE

The Society for Children and Adults
with Learning Disabilities and their Families

 

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