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Bob Gates: ‘Address the appalling lack of direction for learning disability nurses’


Bob Gates on why we may see another Winterbourne View scandal

I am not convinced that much has moved on for people with learning disabilities since the Winterbourne View scandal. What is problematic and worrying is that the latest BBC Panorama investigation into the abuse inflicted upon residents of Winterbourne View Hospital now appears not to be isolated. 

When one places this into the context of the recent Care Quality Commission inspections of 145 unannounced inspections carried out and reported on this year then things are less than reassuring. It should be remembered that they only looked at the care and welfare of people who use services, and whether people were safe from abuse. 

The CQC found that nearly half the hospitals and care homes inspected did not meet the required standards. Their inspections concluded that some assessment and treatment services admitted people for disproportionately long spells of time, and that discharge arrangements took too long to arrange. Their report also stated that there were lessons that need to be learnt about the use of restraint. They advocated an urgent need to reduce its use, together with training in the appropriate techniques for restraint when it is unavoidable. 

“Paradoxically this growth in independent sector provision has occurred as a result of previous adverse reports on standards of care for people with learning disabilities in the NHS, and it has been driven by central government policy” 

They also identified that many of the failings identified by this report are the result of care not being centred on the individual. The CQC reported that too often people are fitted into services rather than services being tailored to people’s individual needs. They also found that “independent healthcare services” (33% compliant) were twice as likely to fail to meet the standards as “NHS providers” (68% compliant). Paradoxically this growth in independent sector provision has occurred as a result of previous adverse reports on standards of care for people with learning disabilities in the NHS, and it has been driven by central government policy. 

As I have previously argued, such appalling atrocities can and must never be excused but they should be understood within the context in which some of the qualified nurses now work within the independent sector. 

And as I have repeatedly reported – a context characterised by them working in isolated settings, with little peer support, little or no clinical supervision, and very often no access to continuing professional development and no clear career structure. It is not uncommon in such settings to find nurses overseeing large numbers of unqualified support workers who have little or no formal training. 

The qualified learning disability nurses who work in settings, such as Winterbourne, need support, development and modernising, and I fear that without this we may still yet see another scandal surface. 

The appalling lack of direction, attention and support to this workforce may yet still result in Winterbourne, as a name, becoming synonymous as the starting point for a long list of scandals that were so characteristic of residential services for people with learning disabilities in the 1960s. 

In order for learning disability nursing to develop and thrive, not only in settings such as Winterbourne, but also in the many other contexts in which they work, they need to be promoted and supported by the Departments of Health, The Royal College of Nursing and the Nursing and Midwifery Council. Although this process has now begun with the recently published UK-wide review of learning disability nursing, led by the DH in Scotland - I repeat what I have said before – I hope that this not a case of “too little and too late”. 

Bob Gates is professor of and academic and professional lead for learning disabilities at the University of West London


Readers' comments (2)

  • time to bring back specialist nurse training courses.

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  • "Winterbourne View" is starting to become a lazy blanket term for any Learning Disability service that is deficient in any area of practice. No service is perfect, and carefull consideration of the evidence of malpractice needs to be made before a service is equated with the criminal abuse and violence against vulnerable people that occurred in Bristol.

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