​The ghost of Winterbourne past

This morning Claire, the mother of our client Ben, is on BBC Breakfast to talk about Ben’s horrendous treatment at the private hospital Winterbourne View from 2009 - 2011. Nine years on, the nurse who punched Ben in the face while Ben was an inpatient there, resulting in Ben’s jaw being broken, has finally been struck off by the Nursing and Midwifery Council (NMC).  

Following persistent campaigning and pressure from Ben’s family, it took a police investigation and two disciplinary inquiries for a decision to be reached by the NMC in December 2018 that ‘punching a patient would never be appropriate’. That this needed to be explicitly stated would shock most people; however the previous NMC panel in 2017 had found that the physical force used by the nurse was proportionate. 

The length of time it has taken for Ben to achieve some justice for the assault is echoed by the slow progress - or lack thereof - of improved treatment and care for adults with learning disabilities.  

Winterbourne View was an Assessment and Treatment Unit (ATU), a supposedly specialist unit designed to provide short term secure placements for people with learning disabilities, before they moved back into the community. Placements in ATUs can last far longer than intended, often because community-based services are not available in the local area and the institutionalisation can entrench behaviours that challenge. Life in an ATU or inpatient unit is often highly regimented and patients can be subjected to routine physical restraints, or kept in seclusion. These forms of ‘treatment’ only appear to be on the rise: between 2016 and 2017, the number of recorded restraints on patients in such placements increased by 50%, and the number of recorded isolations increased by 40%.[1]

The continued use of ATUs by local authorities and NHS commissioners is highly controversial. After Panorama exposed widespread institutional abuse and mistreatment of residents at Winterbourne View in 2011, NHS England announced its ‘Transforming Care’ agenda to completely overhaul service provision for people with learning disabilities and autism. This included closing 900 learning disability inpatient beds, and reducing the number of inpatients with learning disabilities by 35%, by March 2019. 

The latest BBC figures show that NHS England is far from reaching its own targets: in December 2018, it there were approximately 2,400 people in England with a learning disability or autism in an inpatient unit. The average length of their stay was 5.4 years. 

Behind the figures lie the real experiences – often prolonged and traumatic – of the individuals who have little control over their lives in inpatient settings.  

Take James, our client who remained in an ATU until 2013, over six years since his initial placement began. During this time, James was subjected to repeated physical restraints, including incidents where it is alleged he was held face-down in a prone position on the ground.

Or Bethany, the 17-year old teenager with autism, whose ongoing seclusion in a hospital in Northampton for almost two years has garnered a public outcry following evidence given by her father about her treatment to the Joint Committee on Human Rights.

Or indeed Ben, who remained in Winterbourne View for 12 months after his jaw had been broken, and then suffered further abuse and mistreatment at his next placement, Veilstone. 

What links the families of Ben, James and Bethany is a burning sense of injustice not only for their own relatives, but also the thousands other vulnerable adults who are routinely subjected to seclusion, restraint and deprivation of their liberty in inpatient units. How many more high profile scandals of abuse and mistreatment of adults with learning disabilities need to be exposed before urgent change is implemented? 

The mistreatment of people with learning disabilities in ATUs and other inpatient settings is one of the key human rights crises in modern day Britain. The Care Quality Commission has announced a review of restraint and seclusion of people with mental health problems and learning disabilities; however the CQC’s work won’t be completed until March 2020, over a year after the NHS’ own deadline for its Transforming Care agenda.

Many reasons have been put forward for the painfully slow pace of change, including a lack of funding or political will to remodel an entire system of care provision. The true causes may well be more insidious than that: systemic discrimination against adults with learning disabilities remains rampant in our social care and health system, backed up by ill-informed public perception about the ‘challenges’ such individuals pose to society. Until we accept that the current models of institutional care are far more likely to trigger adverse responses or challenging behaviour – rather than enable people with learning disabilities and autism to lead meaningful, supported lives – the chances of real change seem far too distant. 

For the thousands of adults spending another Christmas in an ATU or inpatient unit, rather than in the community or with their families, yet another review into their care may be met with scepticism. The scandal of Winterbourne View and the Transforming Care agenda already exposed the outdated models of care – which can so often be susceptible to abuse - that so many adults with learning disabilities experience:  now the NHS and local authorities need to get on with implementing it. 

Some positive steps you could do:

• Sign the petition to stop the detention of people with autism & learning disabilities in ATUs 
• Visit the Rightful Lives exhibition