Winterbourne View Lives On (in other places)

Castlebeck or should that be Castlewreck the Car(e) Wreck


Flocking Nursing Assistants in Outpatients

“A flock of hospital Nursing Assistants gibbering, clattering, jabbering, nattering, blathering and yammering away in small flocks, regardless of the bursting at the seams of the Outpatients Department, like an over stuffed haggis, definitely wasn’t the Outpatients who had staked their territory in these walls of benches and rows of seating, this was an environment home to these seemingly countless Nursing Assistants, who did nothing but flap their lips at speed, releasing clouds of gossip filled, moaning laced hot air”

I was in hospital today (not a sympathy bid I can assure you) and everywhere I looked in this vast Outpatients’ department were, well I guess I could call them, flocks of light brown uniformed Nursing Assistants standing in groups of three or four, sometimes sitting in huddled groups, all blinking gossiping. Every minor flock were surrounded by Patients, but they acted as if they were so use to the inconvenience of Patients coming into their Outpatients, that they could quite happily talk as if their department were empty. Chattering, nattering, and warbling away, as if some morose, hardly moving bodies, focussing all their energy onto the speed of their flapping lips (as these were wingless flocks), the most boring stuff coming out, and such variety of content within these minor flocks. There was variety in form too, straight ones, gay ones, married and single mum ones, specimens of the kaki coloured plumage disguised as uniforms, one looked ready for roots to be done, another had modern new-romantic on the go, and of course student grunge was there too, varied ethnicity was in full flow. Their Jabbering was varied too, to include the dullest of content, showing their evolutionary level was still at bird level intellectually, but did including the latest of Easter Enders and don’t forget ‘Get Me Out of Here’ (how apt considering how I was feeling) was soon to start, but what impressed me, as we all waited in this awful warehouse called Outpatients, was their ability not to do anything much at all – and you think it is hard to save money, give me 30 minutes in charge and I shall show you how to save the NHS some money without touching service quality at all, mainly because in Outpatients quality is much rarer than these flocks. My God, they hardly did a think but do their best to avoid the Patients – Grrrrrr!!!!!!!!!!!

Unless I have mistaken the spaces we were in, maybe this is where the flock of Nursing Assistants (by the way, the name bugs me when Nursing Assistants don’t do anything to assist, maybe their names in the NHS should be Nursing Non-Assistance) were corralled and contained, am so glad I wasn’t there long enough to watch them come into season, attract a mate and start nesting – oooooh yuk! But to get to the point in hand, one of the Nursing Assistants, who were ignoring the Outpatients perfectly, quite impressive how he totally blanked every one of them as if they were invisible, was talking about the very same Panorama programme I had seen the previous day. I managed this above the squawking and talking, the gibbering about pay, conditions, this Nurse, that Doctor, husbands, daughters, girlfriend, and Patients themselves being too demanding (made some Outpatients sat near them to shuffle awkwardly – was amusing). Over the drone of dullness Zone UK, was the scandal and I now recalling in detail.

The stench of Winterbourne View just won’t go away will it Castlebeck? The BBC 1 Panorama programme on 29/10/2012 at 8.30pm rehashed over last year’s exposé into the abuse, which was secretly filled and lead to 6 workers being imprisoned for the horrific and sustained abuse and assaults of people with challenging learning disabilities.

51 ‘in-Patients’ were systematically controlled through violent, abusive and aggressive behaviour from staff, leading to its closure after the original programme, yet the owners and shareholders are still allowed to be in the care market, as are the senior managers of Castlebeck – beggers belief. Over a year on and some of the same Patients are still being abused and assaulted in other institutions, these poor people are not treated as humans and have been through institutional abuse for many years. If what happened to these inpatients is anything to go by at Winterbourne View, the whole system is rotten. The court case against Castlebeck staff, six of whom were imprisoned, revealed what some may say as common practice when dealing with people, I mean that literally – PEOPLE, not animals, with Learning Difficulties with challenging behaviour, in order to control them.

The list, and these are just some of the staff behaviours revealed and filmed secretly, which was the evidence used against staff at Winterbourne View, included:

  1. Patients’ heads pushed into the toilet and toilet flushed on numerous, near daily, occurrences;
  2. Patients given fully clothed cold showers;
  3. Patients kicked to the floor;
  4. Patients “playfully” restrained;
  5. Patients hit;
  6. Patients so terrified of using the toilet because of what has happened to them at the hands of staff, they would rather wet and defecate themselves;
  7. Patients being thrown to the floor and having a dinning chair placed over their heads and staff sitting on them “playfully choking them on and off, as well as slapping them;
  8. “Dead-Arm” and “Dead-Leg” punching by staff to Patients;
  9. Patients being chucked into a secure garden, covered in cold water from a washing up bowl, and left outside in freezing temperatures;
  10. Patients dragged by their hair;
  11. Patients dragged by their ankles;
  12. Patients’ trousers and underwear pulled down in front of other residents and having their bottoms slapped;
  13. Patients slapped round the face and head;
  14. Patients pinched and skin twisted by staff;
  15. 129 ‘formal’ restraints in less than 3 months;
  16. 11hrs of abuse directed at one patient involving 7 different staff over two shifts;

(I am sorry but if I add to this list any more I am going to cry, I have another 2 pages of behaviours including the emotional and verbal abuse categories)

Is this surprising when even the trainers employed by Castlebeck advised, when it came to dealing with Patients who were being aggressive suggested not using the approved Management of Aggression training but “Kick them in the balls”, he then went on to say, “whatever it takes to manage them”! As a healthcare professional who has dealt with some of the most difficult individuals the country has to offer, to say this about vulnerable adults with Learning Disabilities is just disgusting and the trainer filmed should be imprisoned as this is how such a violent culture of physical abuse starts, when those setting the example indorse and promote violence against Patients.

But for me there is another pressing question, is this just at Winterbourne, my previous blogs shows it was/is rife in prisons, but in our hospitals for vulnerable adults with Learning Disabilities? Panorama said that a quick snapshot survey was carried out of people with Learning Disabilities in hospital/unit based care (I used the word care and it sticks in my throat!) and the results were shocking:

  1. 1/20 stated they had been assaulted by staff at least on 10 different occasions in the previous few weeks;
  2. 1 person surveyed had evidence they had been restrained for 4hrs on one occasion;
  3. Another reported being restrained 10 times in a chair and 4 times on the floor on one day alone;
  4. ‘Formal’ restraints were at the same level as in the previously demonised Winterbourne View, i.e. 130+ restraints in 12 weeks;

The average fee for keeping a person in such conditions, of which there are at least 2,000 in England (secure places for Learning Disabilities) is £3,500 per person per week; whilst in comparison it can cost at the most £2,000 to keep people with such behavioural problems in the community and in 99% of cases never using restraint but the skills of communication, understanding, empathy and patience for the individual. The differences between community and Winterbourne Views’ approach (and it would seem similar hospital/units & other institutions) are, in some cases, that these vulnerable individuals:

  1. Are seen as people needing support and not people needing controlling;
  2. Are listened to;
  3. Are respected;
  4. Are seen as the leader of the care team;
  5. Have consistent teams of carers;
  6. Have family contact;
  7. Have involved dedicated Advocates;
  8. Have as near normal a life as possible;
  9. Are kept within the community;
  10. Have a variety of activities that may also include work or volunteering, day centres, creative & expressive arts, etc.;
  11. Have a routine that they want, they are in control of and their carers deliver;
  12. Have a staff team they have helped recruit and train in many cases;

You cannot deliver the above in an institution, I know as I have tried, as you have to cater for several people and not a few living in small group home or on their own with carers.

But as I watched the programme, and then again today when I listened to the jabbering of the Nursing Assistants in the hospital, I wondered how rotten the whole system of care seemed at the moment, I mean totally reeking of putrid abuse and neglect, every aspect of the so called care system:

  1. Let’s put the whole child abuse at the top of the list, not sure you agree, well think of Winterbourne View and Savile to name but two;
  2. Following the whole Castlebeck affair similar homes around the country, looking after, back last year 1,500 people with challenging behaviour with Learning Disability, over ½ failed to meet the minimum standards of care needed;
  3. Many staff involved in these reactive inspections did not take into account that the Patients in their care had feelings or would not understand a system based on aggressive management, in turn would almost certainly blame themselves – staff were unaware;
  4. Staff being jailed for abuse of Patients;
  5. Care homes for the elderly being starved of cash as councils cut the expenditure to health and social care;

Again the list could go on and on, near daily care and health environments are on national and local news, always in the papers, always being exposed near every week. But what is causing this deterioration in caring in the careering professions?

The inspectorate that has been charged with maintaining standards of care in organisations as large as the NHS, national chains of care home, nursing homes, GP Practices, care companies, prison hospital units, private hospitals, private physiotherapists, and it just goes on, anywhere where care is given the Care Standards Commission regulate. Unfortunately for CQC and the people they are designed to protect through regulation, quality & standards enforcement, and regular inspections, the CQC has replaced ½ a dozen regulatory bodies and lost all their expertise at the same time, saving the Government £millions but crushing the CQC’s effectiveness, and I suspect for every pound they saved and incident of abuse or neglect occurred. Simply put they cannot cope with their workload and the breadth of experience and specialists have been lost through these cuts. So when the regulator cannot regulate effectively, companies can focus on profits at the expense of training needs of staff (nearly always the first to be cut when profits need to be upped), expensive senior staff (with the experience) are let go in favour of newer cheaper staff, and you get standards of care crashing into the basement, so low in some places they subterranean. Thus one sees Winterbourne View becoming the norm, not the exception, in the pursuit of profit and not in pursuit of quality; again I speak from a voice of experience in health and social care provision.

But as I said in a previous blog, the cutting of fees to care organisations by local authorities is at the heart of the companies cutting their own investment to ensure their profit margin is maintained, shareholders are kept happy and quality becomes just too expensive. No Chief Executive, again I have been there, wants to report a drop in profits to their Board of Directors and shareholders, so training is cut, staffing levels reduced, activities reduced, minimum physical care becomes the bench mark, and people that are supposed to be cared for become deficits on a budget line, profit drainers, profit reducers, and this is the same view that staff are seen as, deficits in an expenditure budget.

One of the biggest shocks I had from the Panorama programme was to hear that the average length of stay for a person who has Learning Disabilities and challenging behaviour is up to 7 years, and usually they were only admitted for an assessment, and then end up being labelled and sent from one hospital secure unit, private secure unit, to another. Years of abuse they face, well they learn from the people around them, the care staff, so when the staff are aggressive in order to control (or get their rocks off in some sick cases) the individual becomes more violent, labelled, drugged and the evil spiral of institutionalisation commences. It’s what happens when Patients are tagged with labels that pull down huge amounts of money for a company to keep them, why would that company want them to go, £3,500 a week – nearly £200,000 pounds a year, these vulnerable adults become a commodity! By the by, I know of private secure environments that charge £4,500 a week as a minimum, and I mean a minimum – nearly a quarter of a million pounds per person per year. These people become too valuable to be let go in the community, is this the reality we are ignoring.

There are some things we can do to incentive increased training, resources and quality:

  • Companies should be allowed to claim back VAT on training only if they reinvest the claim back in more training;
  • Review how many Nursing Assistants are actually needed in departments like Outpatients and save a few million in salaries and get rid of some, diverting the money to the regulator of all care – CQC;
  • Increase the funding to CQC so they can inspect Units and hospitals, where the most vulnerable are being held, and inspect them every 6 months with both announced and unannounced visits;
  • Start using hidden cameras and more secret undercover type workers in homes, hospitals and other high risk establishments, lets flush the bad down the drain and support those that are in the CARE industry for the right reasons;
  • Let reduce the number in these units and save some money by getting them really decent quality of care in the community, money saved can go back to the councils to invest in the care industry they are supposed to be funding and managing in their areas;

I hope this has genuinely made you think about what is happening every day in care and ways we might fix this crumbling but vital system of health and social care.


Jonathan Wade

Smiling Cat Ventures and Innovations Group



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