Winterbourne View Abuse Scandal 10 years on

Last month marked ten years since BBC Panorama revealed appalling abuse of people with learning disabilities and autism at the Winterbourne View Hospital near Bristol. Footage filmed by an undercover journalist showed patients being subjected to physical assaults, unlawful restraints and taunting by numerous staff.

In recent weeks, families of many of the victims of this abuse have written to the Prime Minister to demand better care for adults with learning disabilities. Their letter emphasises that, tragically, the families are far from alone as countless others have experienced similar trauma in the decade since Winterbourne View was closed.

As our downloadable timeline shows, the 10 years since Winterbourne View have been characterised by repeated human rights failures for people with learning disabilities and autism.

What has happened since Winterbourne View?

Following the Winterbourne View scandal, 11 staff members were prosecuted and six were jailed. The sentencing judge found there was a “culture of cruelty” at the care home.

The Panorama documentary sparked a national outcry and widespread calls for urgent reform of the way patients with learning disabilities and autism were treated in inpatient settings. As a result, the Government promised to “transform care” by June 2014 for people with a learning disability and/or autism who display challenging behaviour.

However, this deadline was missed and, in October 2015, NHS England (NHSE) instead committed to leading a three-year closure programme called ‘Building the Right Support’. The objective was to reduce the number of inpatient beds for people with a learning disability and/or autism by 35-50 per cent and to ensure the right community support was developed, across England, by March 2019.

Once more, however, this target was not met. As such, NHSE moved the target of a 35 per cent reduction in inpatient beds to March 2020 but, yet again, the deadline was missed. The NHS Long Term plan has now extended the Transforming Care target of 35-50 per cent reduction in inpatients with learning disabilities and/ or autism to 2023/24.

According to the latest available data, there were 2,040 patients with learning disabilities and/or autism in inpatient settings as of April 2021. 1,195 (59 per cent) of these have had a total inpatient stay of over two years. 405 patients were reportedly restrained at least once during this month alone. The data on restrictive interventions is not complete and therefore the actual figure is likely to be much higher.

In October 2020, a CQC report on the use of restrictive practices in the care of learning disabled, autistic and mentally ill patients concluded that majority of hospitals where learning disabled and/or autistic people were treated were “not therapeutic environments”. Nearly all of the services visited by the CQC were found to use some form of restrictive practice (restraint, seclusion or segregation).

Most shockingly, there have been several high-profile examples since Winterbourne View of similar abuse being perpetrated in inpatient settings. In 2019, another BBC Panorama investigation unveiled a catalogue of human rights abuses at Whorlton Hall Hospital in County Durham. In graphic and distressing footage, the programme revealed staff members at the privately run hospital deliberately taunting and goading residents, using their treasured possessions to simulate sexual acts, sharing tips on how to hurt patients out of sight from CCTV and openly admitting to assaulting the very people they were employed to care for.

As we wrote at the time, “the evidence - not just from Winterbourne View and Whorlton Hall, but in inpatient settings up and down the country - shows that individual human rights simply are not protected in an institutional model of ‘care’.”

It did not take long for the stark failings in the current system to be highlighted once more, with a damning CQC report leading to the closure of Cygnet Yew Trees Hospital in Essex in September 2020. CQC inspectors that over 40 per cent of CCTV footage they viewed from the hospital revealed “inappropriate staff behaviour”, which included staff dragging, slapping and kicking a patient and using unlawful restraints. It was evident from the CQC report that this abuse was facilitated by the hospital’s management and culture, as there was evidence that, even when staff reported concerns to managers, these were not acted on and no steps were taken to safeguard patients.

Has any progress been made?

Clearly, the above paints a very disheartening picture of the lack of progress made in the past 10 years. However, it is worth noting that practice does vary regionally across England and some areas have made much more progress than others in respect of reducing the number of inpatients with learning disabilities and/or autism and improving support in the community. While some areas are still struggling to achieve the level of inpatient bed reduction promised by March 2019, others have already met the 50 per cent target for reducing in-patient bed numbers, which was due to be achieved by 2024.

There are examples of good practice where people have moved out of inpatient units and are flourishing with the right support in the community. However, it is evident this is still far from being the norm.

What needs to change?

Multiple reports and investigations have clearly and consistently identified the issues that must be addressed. These include the following:

• An underfunded social care system and a lack of suitable housing;
• A lack of investment in early intervention and prevention (to prevent crisis situations, which can lead to admission to inpatient units);
• A failure to listen to the expertise of people with a learning disability and their families;
  the commissioning of new hospitals and care homes that are still reflective of an ‘institutional’ model of care;
• A lack of appropriate skills and specialism to meet the needs of individuals (even in high-cost, so-called ‘specialist’ services);
• Safeguards in the Mental Health Act not being tailored to the needs of people with a learning disability and/or autism;
• Perverse funding incentives in the system and a lack of joined-up working between health, social, education and housing.

These are fundamental and structural issues which can only be addressed by government and would require a clear shift in its approach when it comes to protecting some of the people in our society who are most vulnerable to abuse. We reiterate the many calls that have been made in recent years for the government to take a stronger stance in addressing these issues and giving effect to the Transforming Care programme.

However, while these underlying issues remain, there is also a clear need for stronger measures to take effect when further incidents of abuse and inappropriate practice occur, as sadly appears inevitable at present.

Following the publication of the CQC report regarding abuse at Cygnet Yew Trees Hospital last year, we called for the introduction of a duty of mandatory reporting of suspected abuse in regulated activities. This would make it a criminal offence to see or hear of inappropriate staff behaviour like this and not make an immediate safeguarding notification to the CQC.

The human rights team at Leigh Day act for learning disabled and / or autistic people who suffered abuse and mistreatment. Dan Webster assists Merry Varney in representing bereaved families whose loved ones have lost their lives following abuse, neglect or mistreatment in care homes and hospitals, and in challenging poor care provided to learning disabled and / or autistic patients. Alison Millar and Catriona Rubens have brought claims for mistreatment and human rights breaches at Winterbourne View, Veilstone and Yew Trees Hospital.

10 years since Winterbourne View: a decade of human rights failures

31 May 2011: BBC Panorama exposes the systemic abuse of autistic and learning-disabled patients at Winterbourne View, a private hospital run by care company Castlebeck. Six staff members were imprisoned for crimes against the residents. Families and campaigners call for the end to institutional care for people with learning disabilities and / or autism, and campaign for people to be cared for in their own homes in the community.

October 2011: a Care Quality Commission (‘CQC’) inspection reveals the widespread abuse of residents with learning disabilities and autism at Veilstone and Gatooma, care homes run by Atlas Project Team in Devon. Residents were punished by the use of bare and unsanitary seclusion rooms, physical restraint and psychological abuse by staff. Twelve staff members were later convicted of criminally mistreating residents.

June 2012: the CQC publishes its national overview following inspections of learning disability services. This found that 48% of 150 inpatient services failed to meet the CQC’s basic standards of care, welfare and safeguarding.

7 August 2012: the Department of Health publishes Transforming Care and its Winterbourne View Concordat Programme of Action. At the time of the report, 3,400 people with learning disabilities were inpatients in NHS funded facilities. Transforming Care commits that all hospital placements for people with learning disabilities and / or autism would be reviewed, and that everyone inappropriately placed in hospital would move to community support no later than 1 June 2014.

4 September 2012: South Gloucestershire’s Safeguarding Adults Board publishes its Serious Case Review into Winterbourne View. It recommends greater investment in community-based care to reduce the need for inpatient admissions.

October 2013: Connor Sparrowhawk, a learning disabled and autistic teenager, dies following a seizure in a bath at an NHS assessment and treatment unit in Oxford. The jury at his inquest found that his death had been contributed to by neglect and ‘serious failings’ by Southern Health NHS Foundation Trust.

1 June 2014: the government fails to meet its target of moving all people with learning disabilities and / or autism inappropriately detained in hospitals to community placements.

26 November 2014: Winterbourne View ‘Time for Change’ report by Sir Stephen Bubb, commissioned by NHS England, is published. The report found that 2,600 people with learning disabilities and autism were still living in inpatient settings. It called for patients to be discharged to the community and for hospital admissions to be prevented, on the basis that ‘a hospital is not a home’.

30 October 2015: NHS England publishes its Building the Right Support ‘national plan’ to develop community services and close inpatient facilities for people with a learning disability and / or autism who display behaviour that challenges. The three-year plan commits to reducing the number of people in inpatient units by 35 – 50% by March 2019.

March 2018: the NHS England lead for Transforming Care confirms plans to decommission just over 900 inpatient beds previously used for learning disabled or autistic people during 2018 / 2019.

2 October 2018: BBC File on 4 covers the case of Bethany, an autistic teenager locked in a seclusion room at a St Andrew’s Healthcare Hospital in Northampton for almost two years. Bethany later received compensation for alleged breaches of her human rights.

January 2019: the NHS Long Term Plan reduces the Transforming Care targets to moving 35% of people out of hospitals and into the community by March 2020, and 35-50% by March 2024.

22 May 2019: undercover reporters at BBC Panorama expose the abuse and mistreatment of people with learning disabilities and autism at Whorlton Hall, an NHS funded unit run by Cygnet Health Care in County Durham. The footage shows staff swearing, mocking and taunting patients, and physically restraining them. The CQC had rated Whorlton Hall as “good” for its last inspection it in 2017. At this time 2,245 people with learning disabilities or autism remained inpatients in hospitals.

1 November 2019: the Joint Committee on Human Rights publishes its report on the detention of young people with learning disabilities and / or autism. The report finds that people living in hospitals and inpatient units regularly have their human rights violated.

March 2020: the government misses its target to move 35% of learning disabled and autistic patients to community settings.

April 2020: data shows that the number of learning disabled and autistic people in inpatient units has only fallen by 15% since 2015.

September 2020: staff at Yew Trees Hospital, a private mental health hospital run by Cygnet Health Care, are caught on camera dragging, slapping and kicking a learning disabled patient. The CQC had first identified concerns about the care and treatment of patients at Yew Trees in April 2019, but the unit was not closed until September 2020.

October 2020: the Care Quality Commission publishes its review of restraint, segregation and seclusion against autistic and learning disabled people in care settings. The review highlights the inhumane and undignified treatment of patients in hospital settings and recommends that learning disabled and autistic people be supported to live in their communities.

April 2021: NHS Digital data shows that the percentage of autistic people in inpatient mental health facilities has actually increased from 38% in 2015 to 56% in 2021. The average length of stay for an autistic person in an inpatient unit is 5.6 years.

May 2021: research by Mencap and the Challenging Behaviour Foundation (CBF) shows that 2,040 people with a learning disability or autism are still locked away in mental health hospitals, referred to by the charities as ‘modern day asylums’. The research found that 355 people had been held in assessment and treatment units for more than 10 years.

26 May 2021: families of Winterbourne View residents write an open letter to Prime Minister Boris Johnson to demand better care for learning disabled adults. The letter raises the failures of the government to ‘transform care’, instead pointing to the “succession of missed deadlines, and broken promises, 10- years of pushing-back expectations at unimaginable human cost, all too easily ignored by those with the power to effect change”.

June 2021: Barbara Keeley MP states in Parliament that, a decade after Winterbourne View, it simply is not acceptable that people are still detained, when they could and should be supported in the community. She calls for the government to provide bespoke packages of care and accommodation for learning disabled and autistic people, not institutions.