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Winterbourne View report calls for ban on physical restraint

  • 16 Comments

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.

  • 16 Comments

Readers' comments (16)

  • 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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  • David Dickinson

    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 gold...you 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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