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Winterbourne View report calls for ban on physical restraint

The government should consider banning the use of certain forms of restraint on patients with learning disabilities, a review into failings surrounding the abuse of patients at Winterbourne View has recommended.

A serious case review by South Gloucestershire Council found there was extensive misuse of physical restraint by nurses and support workers at the hospital for patients with learning disabilities and autism.

The review report, published today, said despite stated policy being that physical restraint should be used as a last resort, that had not been the experience of patients at Winterbourne View.

Staff training there had been “skewed” towards the use of t-supine restraint, where staff use their body weight to hold a patient on the floor.

Report author Margaret Flynn, chair of Lancashire County Council’s Safeguarding Adults Board, called on the Department of Health, Department of Education and Care Quality Commission to consider banning the use of this type of restraint on patients with learning disabilities.

She said the issue should be treated with the seriousness “equivalent to that in banning of corporal punishment in children”.

The review report reveals a catalogue of abusive incidents dating back to when the hospital opened in 2007. One patient was reported to have lain on the floor in the restraint position when he saw support workers approaching, apparently to avoid being forced to the floor.

At one point the local police force asked the hospital’s management to install CCTV, following two incidents in which patients had teeth knocked out during incidents where they were being restrained by carers.

“Four forms of violence prevailed within the hospital – destruction of property, fighting between patients, the struggles associated with restraint, and self-harming,” the report said.

The review also found excessive use of chemical restraint, with many patients on anti-depressants and anti-psychotics but no diagnosis to support their use.

It said the hospital, which was supposed to be a learning disability nurse-led service when it opened, had become led by unregistered support workers, despite the presence of 13 professional nurses.

“It is not clear how the boundaries between the nurses and support workers were developed or maintained, or how the division between their responsibilities was determined…,” the report stated.

“It seems unlikely that the registered nurses were competent in delegating and supervising the unregistered healthcare assistants,” it said. “Research evidence suggests nurses’ education does not prepare students for the practicalities of this role.”

The report noted numerous occasions where patients tried to raise concerns but were ignored, even by members of their own family who trusted in the professionalism of staff.

It said whistleblower Terry Bryan had acted properly in approaching first his line manager, then the CQC and finally the media in a bid to get his concerns heard. The nurse had been working at the hospital for less than two months when he set out a long list of concerns in an email to his manager with the title “I’ve had enough”.

The scale of the abuse was finally exposed by an BBC’s Panorama following an undercover investigation last year.

Readers' comments (16)

  • how times have changed, Margaret Hayward got struck off for doing the same thing as this nurse. Both very brave but both treated very differently.

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  • Why the dramatic and untruthful headline ?

    It is a fact that some people with learning difficulties present very challenging behaviour Patterns. Facilities like Winterbourne emerged when the large hospitals which many people with learning difficulties were cared for were closed.

    The hospital closures resulted in many people being successfully integrated into the community.

    The small number of individuals who demonstrated very challenging behaviour were problematic for Social Services who simply had no local facility in which to care for these people.

    The individuals who found themselves accommodated in places like Winterbourne demonstrate, in most cases, extreme and unpredictable violence which can be directed toward fellow clients ,staff or the environment.

    Facilities such as provided by Winterbourne will, In my opinion, always be required.

    The failure of Winterbourne is a failure of MANAGEMENT. Management recruited the staff. failed to provide training or adequate supervision and refused to listen to legitimate concerns.

    It seem wrong to me that Management can create these situations and then walk away whilst muttering the magic words "lessons have been learnt"

    The police and the Crown Prosecution Service must find a means of placing these Managers in the dock , they are guilty of abuse by neglect.

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    How or why is what happened at Winterbourne even discussed in the same breath as Physical Intervention or Restraint.

    What them animals did to the Service Users in Winterbourne was torture and assault at it's worse. Every single staff member there should have been sacked.

    There is a time and place for Restrictive Physical Intervention, that is practiced in a trained for and professional manner, to keep staff & service users safe.

    Winterbourne and its cronies are a disgrace.

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  • The practices at Winerbourne had nothing to do with "restraint", and those of us who work in services realise that sometimes restraint is the only available course of action, to protect staff, other service users or the individual themselves.

    What happened at Winterbourne was abuse, and it should not be used as an excuse for questioning recognised means of restraint.

    These are totally seperate issues.

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  • according to the reports and Panorama video there were plenty of examples of physical restraint. however, it seems the techniques used were put into practice incorrectly or were not accepted techniques at all and were thus highly abusive and harmful.

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  • As a student learning disability nurse i believe yes there is a time and a place of physical intervention but where draws the line. I think it should be banned and should be not presented in our practice.

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  • Having worked in the mental health services, in my 30 year career, I came in contact with hundreds of 'aggressivel' bahaved patients during that time. 'Managing' such beh f aviour has always been a contentious issue. There were many occasions I had to physically patients who were a danger to other patients, staff, or even themselves. I had undertaken various 'courses' on managing such patients, but in the end, it the situation was down to my own personal assessment at the time which was the key factor whether I used restraint or not,
    I'm not an aggressive person by nature, but, I do have the capacity to act as if I| could protect myself, if the need arises. So, the strategy I used was based soley on NLP, mirrowing, matching, mis-matching the patient's behaviour. This enabled me to keep calm, and thus, stay in control of the situation. Unwittingly, it saved me from being seriously injured or harmed throghout my career, whilst, colleagues, who were less aware of NLP skills, wre frequently getting injured and harmed as a result of their threatening manner towards the patients concerned. All -in-all NHS staff need to be aware of their patients behaviour, and the factors which trigger their aggression.

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  • NLP- what next, reading bumps on patients craniums. Pure hocus-pocus.
    Restraint is needed, but it has to be proportionate, and having worked with people with LD and challenging behaviour it sometimes takes a considerable amount of restraint to control a situation safely.
    This sound like one of those places that employs a load of men who are thick in t'arm and thick in t'head purely for their physical prowess.

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  • The CQC are obsessed with paperwork and not patients. They seem to judge a patients care on the quality of the paperwork. I don't think they even look at patients themselves. The patient could be dead in their bed but if the paperwork was up to date the care would be deemed 'excellent'

    I think this is how apalling patient treatment is missed.

    The general condition of patients both physically and mentally needs to be assessed not just the paperwork.

    I believe documentation has reached such a ridiculous level that it is done in preference to patient care so as not to fail CQC inspections.

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  • Having worked within the LB/MH/CB field foe the last 20years and a LD nurse, I do believe there is a time and place for the use of physical intervention but only as the last resort. We have come a long way when people were "decked" for looking at someone in the wrong way.
    Having been injured by a service user and off work for 2.5 years because the service didnt provide adequate training I know first hand the need for this intervention.
    What happened in this "hospital" was pure evil and about control not about caring. Good for the nurse who whistleblew. I know its not nice but worth it in the end - at least the servise users will get a life they deserve now.

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  • What seems to have been missed out here is that the appalling treatment these poor patients endured was for some of the staffs entertainment.It was showing off in front of their pals. Management should totally hang their heads in shame for allowing this to go on and on. Well done to the whistleblower.

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  • Very poor, mis-leading and sensationalist headline, Nursing Times. Do better.

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  • Mikey Rich | 14-Aug-2012 10:54 am

    try asking the author what her original title was. NT change them in an attempt to make them more sensationalist just as they do in the tabloids. this practice seems inappropriate and unnecessary for a professional journal.

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  • NT Editors, please could we use headlines which are appropriate to the main points in the articles. if those given by the authors were retained they would be most suitable in most cases. a professional journal does not need sensationalist headlines like a tabloid or newspaper sold on stands. professionals will read those articles on issues which interest them!

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  • Edward Freshwater

    I concur with my colleagues who are concerned about the sensationalist headline to this article.

    "Report highlights systemic failure in Care Home scandal" would have been better and more accurate.

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  • dikod1

    As a Rampton trained restraint instructor (thanks Graham Simpson, inspired training - 1987!) and a committed positive practice vegan ex hippy and commissioner of two former challenging behaviour services where I personally trained the staff who had a whole day as part of their regular team every third Thursday studying a range of relevent subjects including positive practice to restraint and moreover the mindsets which precipitate them, I can say without a second thought that yes, in the old days of rugby scrum restraints and smelly glass syringes with blunt needles that things did improve greatly initially with C&R. BUT, like all things, abuse creeps in and in no time abusive applications were killing service users who were being literally crushed whilst practitioners relaxed chatting to each other with full weight applied and no one checking, i.e. NOT CARING. The mindset being, "you're beaten, feel it". Thus it continued as us v them with practitioners over confident and often inclined to bring matters quickly under control increasingly without barely a second thought and too late for alternative strategies that anyway were argued out by the most restraint inclined team members, typically the most dominant, thus it was down to values based leadership which focussed upon service users human needs rather than our amygdala driven self-belief that we had to prevail in theatrical shows of lightening (over)reaction or risk loosing some kind of collectivelly percieved battle. Written intervention strategies were increasingly seen as the irrelevent offerings of the office bound ex grammer school brigade increasingly grappling with risk obsessed compliance inspectors whose guidance-absent and self-preservation shift contributions increasingly excited little more than contempt. Enter Winterbourne. The best device that I came to realise was the most effective in controlling challenging behaviour was a good sound system with 15" base speakers, plenty of sing-a-long rock & roll and the habit of smiling and finding alternative behaviours far more of a gas than the disruptive ones. However, when the inevitable event of necessary restraint occured the urgency was to replace automatic irritated communication responses with calming silence intersperced with low-key "nooo...noo... noo.." sounds and waiting for the inevitable pause then timely engaging with a third party in re-booted fun discourse discreetly observing for the subjects indication of interest then turning the attention idly back on them and imperceptably releasing as a single lazy action..but ready for seamless reapplication but not with threats of consequential repetition etc. The management of challenging behaviour involves the subjects permanently improved moodstate preferably without the use of confusing case focussing psychotropic medication. And crucialy, a day programme coordinated by someone who loves life..they are worth their weight in know who you are and a psychiatrist into anti-psychiatry. A careful incentive scheme that avoids all temptation to resort to punishing declarations of disapproval. The secret..ah..these poor unfortunate people often only know disapproval and not the experience of being loved..unconditionally. Give it a go, it can be the best job in the world..and they pay you!

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