Winterbourne View – Profit from Cruelty

Today I’ve been reading the Serious Case Review for Winterbourne View, and it makes for grim reading. A monumental tale of casual abuse and violence by staff against patients with autism and learning disabilities. Whistleblowers ignored. Police and regulators failing to take action.

But here’s something that makes it doubly sickening, from the opening paragraph to Section 6 of the review.

We have been here before. There is nothing new about the institutional abuse of adults with learning disabilities and autism.

Events witnessed at Winterbourne View Hospital recall the custodial treatment associated with decommissioned, long stay, NHS hospitals. However, unlike the hospitals and institutions described in previous inquiries and reports of institutional abuse, Castlebeck Ltd was not starved of funds. The financial costs of out of area services for people with learning disabilities, autism and or mental health problems are considerable, as reflected in the weekly average fee charged.

The fee they refer to was £3500 per patient per week, paid for by the taxpayer. Putting them up in the Savoy would be cheap by comparison. And what did the patients get in exchange for these generous payments, apart from the opportunity to be taunted and thumped?

The skill mix at Winterbourne View seems to have been surprisingly dismal, given what was being paid. The only professional groups employed were psychiatrists and learning disability nurses, and there weren’t that many of those. The overwhelming majority of staff were unqualified support workers. No psychologists. No occupational therapists. Some activities coordinators to organise recreation, but as is often the case in units with staffing issues, they regularly wound up being used as relief care workers instead.

During 2010, “on the job” training and inadequate staffing levels persisted with poor recruitment practices and further instances of unprofessional behaviour in an increasingly non-therapeutic hospital. Patients lived in circumstances which raised the continuous possibility of harm and degradation. Castlebeck Ltd’s managers did not deal with unprofessional practices at Winterbourne View Hospital. Absconding patients, the concerns of their relatives, requests to be removed and escalating self-injurious behaviour were not perceived as evidence of a failing service. The documented concerns of a whistleblower made no difference in an unnoticing environment.

In all fairness, unqualified support staff can and do provide good quality care, with the right leadership and a good culture. Not that they got it from the owners, Castlebeck Ltd. They seemed happy to rake in the dosh from their remote headquarters in Darlington while an ethos of abuse, over-medication and excessive use of restraint ran rampart at Winterbourne View.

This may be worth remembering as the government applies the rhetoric of “any qualified provider” to the NHS. Castlebeck were regarded as a “qualified provider”. Whether they gave value for money is another matter entirely.