What happened at Winterbourne View Hospital was horrifying for both patients and their families. Many people were shocked,angry and disappointed by the way people with learning disabilities,autism,mental health problems and behaviour that challenges were treated. Six former members of staff at Winterbourne View hospital were jailed for the terrible crimes they committed. Serious concerns were raised by families,CQC and the public concerned for example patients placed in Winterbourne View were there a very long time,some patients there for more than 3 years,the number of times patients were restrained by staff was very high and unacceptable.
A family provided evidence their son was restrained 45 times in 5 months. Families were not allowed to visit patients on the ward or in their bedrooms,patients had very little access to advocacy and also patients complaint they were not been handled properly. The abuse at Winterbourne View should have been noticed earlier but was not despite many incidents being reported. Castlebeck Care Limited had policies and procedures that seemed really good. But the policies and procedures were not put into practice. The recruitment of staff did not appear to focus on quality.
The job description of staff did not ask staff to have experience in supporting people with learning disabilities,autism and challenging behaviour and staff training was focused too much on the use of restraint. The South Gloucestershire Council were told about safeguarding issues in Winterbourne but failed to identify a trend in the number of times they were contacted. The commissioners are the people who placed people at Winterbourne they should have made sure the hospital provided quality care. A whistle blower told the CQC that he was worried about the way patients at Winterbourne were being treated. The CQC failed to respond to the concerns raised by the whistle blower.
The Mental Act Commission were told about incidents at Winterbourne and said there was a need to improve but did not follow up to make sure improvements had happened. The Police did not follow up 29 incidents reported,8 of these reported incidents concerned staff using restrains on patients. The reports were not follow up because police believed the reasons staff had given at Winterbourne. Since the Winterbourne incidents a report now sets out the type of care that people with learning disabilities,autism and behaviour that challenges should get.
Local personalised services that meet their needs this support should be planned from childhood. People should be supported in the community. in their home or close to their home and family. People should only go to hospital for assessments and treatment if it is necessary and they cannot get the support they need at home or in a community service. People that do have to go to hospital for assessment and treatment should receive good quality of care as near to their home as possible.
People should be moved on from hospitals as quickly as possible either back home or on to other community support. Commissioners who place people with learning disabilities/autism in hospital or community support settings should have clear responsibility for each person. The commissioners should also make sure that people with learning disabilities/autism are able to see and speak to their families regularly.
There should be local services that stop people with learning disabilities from having a crisis if crisis does happen then there should be local services to help people deal with the crisis. Everyone has to play a part in making things better for people with learning disabilities,autism and channelling behaviour. This is why the department of health and a number of organisations have come together to make change better. Health and care commissioners will look at everyone with learning disabilities who are hospitalised. If people do not need to be in hospital they will be support to move them to the community support. Every area will have a local joint plan for very good care and support services for people of all ages with challenging behaviour.
The NHS and will start a new programme of work called the development improvement programme. This will provide national leadership to change services locally. The department of health says it will be law to have safeguarding boards for adults. Organisations and their directors are responsible for care being good and they will be asked to explain and be held to account for poor quality of care. The CQC will carry on inspecting hospitals and care homes without letting providers know first. With all these changes in place our care homes should be safe for services users and their families.