winterbourne view case study essay

Winterbourne View was a national disgrace, so why are institutions like this still open?

Visiting Professor in Social Care, Buckinghamshire New University

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Rhidian Hughes is Chief Executive of the Voluntary Organisations Disability Group which represents not-for-profit disability and care services

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The words Winterbourne View are etched into the public’s consciousness. They have come to symbolise everything that is wrong with care for people with learning disabilities, autism and complex mental health needs.

Now a new independent report , commissioned by the head of NHS England, suggests there has been an “absence of any tangible progress” since a previous review into the scandal. This despite a series of public commitments to transform care by moving people into community services that are better tailored to meeting their health and support needs.

Winterbourne View was a privately run assessment and treatment unit (ATU) that provided therapeutic interventions for people with complex needs and was directly commissioned by the NHS. In 2011, BBC Panorama exposed the appalling care and treatment of people there, showing them being bullied, bruised and assaulted. This came as a surprise to many who believed that these kinds of services no longer existed and that people had been transferred to community services after a closure programme of long-stay hospitals.

ATUs are today’s equivalent of what social psychologist Erving Goffman called “total institutions” – they routinely hold people many miles from their own homes and local communities and are run by both NHS and private providers. Of the 92 organisations involved, around half are directly run by the NHS.

Since Winterbourne View the clarion call across the sector could not be clearer: ATUs risk harbouring cultures and ways of working that are far removed from the ethics, values and cultures of modern, high-quality services focused on bespoke and personalised care. As Simon Stevens, head of the NHS, recently said: services need to be provided in a radically different way . This means that as ATUs are de-commissioned there needs to be a step up in community provision. Community services allow disabled people to live the kind of “ordinary life” that others usually take for granted. They are well placed to ensure support extends beyond simply meeting their personal needs, and more truly reflects their personal preferences, aspirations and choices.

The ongoing campaign for justice for Connor Sparrowhawk demonstrates how problems with ATUs were not just confined to Winterbourne View. In 2013 Sparrowhawk, 18, was admitted to Slade House ATU, run by Southern Health NHS Foundation Trust. Four months following his admission he drowned in the bath , a death that a report from the trust concluded was entirely preventable . While there is an ongoing campaign for accountability and changes in the law, as well as in the commissioning and regulation of these services, the sad fact is that this is just one of numerous campaigns.

What we know now

When news first broke about Winterbourne, no one knew how many people were placed in ATUs. It took time to create a learning disabilities census – Panorama aired in May 2011 but a census was only established in September 2014. The latest census shows there are 3,230 people living in ATUs (a figure markedly similar to the 3,250 in the previous census).

So what has been done since the Winterbourne scandal? Recent reports have made much noise but empty progress. In its latest report this month, NHS England and partners began by saying: “We have made progress, but much more needs to be done”. These are, sadly, well-rehearsed lines that have come to characterise a protracted policy response.

It seeks to disguise deeply entrenched ways of commissioning complex care and a lack of action. And since the Care Quality Commission’s oversight of health and social care commissioning was scrapped , the regulator has no power over this situation.

A first report by Stephen Bubb, chief executive of the Association of Chief Executives of Voluntary Organisations, (commissioned by Stevens) into ATUs last year described in strong terms the need to urgently close them.

His new report, Winterbourne View: Time is Running Out, describes a continuing lack of progress in closing ATUs and reluctance on the part of policy makers and commissioners to fully engage with community providers. The report recommends moving beyond the “walls of the state” to enable a positive shift of care to happen by providing bespoke, personalised care for people with learning disabilities.

Community care

Voluntary sector organisations have a strong track record of long-term investment and innovation in the disability sector by virtue of the the “social license” provided through their charitable aims. Bubb, in particular, is a keen advocate for third-sector providers to take a strong and active role in supporting the ATU closure programme.

We also know that the costs of community services are far cheaper than long-stay institutions . But community services cannot be built up overnight. The right housing needs to be purchased, or even built. The workforce needs to be recruited, trained and developed to ensure services are fit for purpose and sustainable in the long term.

In a report from the Voluntary Organisations Disability Group (VODG), we featured a story that showed that it is possible to do things more radically. Chris (23) left an ATU with high levels of support, which were gradually reduced from round-the-clock care provided by three members of staff and multiple daily physical interventions, down to two staff and eventually one during the day. These outcomes, achieved by supporting Chris in the community, saved commissioners around £130,000 a year. Good-quality community care such as this can help to make ATUs redundant.

There is now a requirement for those commissioning care to put the needs of people using services at the centre of the process and to enable them to make decisions about their own care, to trust and support those providers with a strong track record to move people out of ATUs and into community services – at scale and pace.

Commissioners must also make difficult decisions to close institutions, recognising the uncertainly of the impact it will have on those ATUs run both by the independent sector and the NHS, but in the knowledge that the right thing is being done for the right reasons. They will also need to take the long view and enable savings to be unlocked through collaborative partnerships between people using services, providers and local commissioners.

What went on at Winterbourne View was a national disgrace. So too has been the lack of progressive change since the problem was first exposed. Just as long-stay hospitals closed, we now need to be mindful that in closing ATUs we do not replace these institutions with other, equally oppressive, forms of care.

Day in, day out there are inspiring services providing excellent care. In doing so, providers win the opportunity to put their values into action and commissioners spend less money doing the right thing for the right reasons. These community services enrich the lives and well-being of many of the 191,000 people living with learning disabilities in the UK.

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Acting on the lessons of Winterbourne View Hospital

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• Margaret Flynn , chair 1 ,
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Because we’d failed them by our disregard

Panorama’s broadcast of Undercover Care: The Abuse Exposed during May 2011 made “real” the abusive treatment of patients with intellectual disabilities and adults with autism at a private hospital owned by Castlebeck Care (Teesdale) Ltd, which had become their “home.” The BBC’s undercover reporting enabled millions to watch the degradation and distress of patients as nurses and support workers exercised merciless power. Viewers witnessed the cruelties endured by patients and heard the shallow rationales of support workers and nurses as they encouraged each other to use considerable force. They covered patients’ heads, laid across patients’ chests, put their arms across patients’ throats, and generally immobilised patients with bodily weight and objects.

The Department of Health in England’s final report on the Winterbourne View scandal was recently published. 1 It recommended rapidly reducing the number of people with challenging behaviour in hospitals or in large scale residential care, particularly those away from their home area. It also recommended improving strategies to deliver integrated care so that individuals could stay at home or close to their homes.

The serious case review commissioned by South Gloucestershire’s Safeguarding Adults Board was published after the trial of 11 support workers and nurses. …

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CQC report on Winterbourne View confirms its owners failed to protect people from abuse

18 july 2011.

The Care Quality Commission has published details of the enforcement action it has taken against Castlebeck Care (Teesdale) Ltd which failed to protect the safety and welfare of patients at Winterbourne View. The effect of this action is that the assessment and treatment centre near Bristol has been closed.

Today CQC publishes the findings following an inspection of services provided at Winterbourne View. After considering a range of evidence inspectors conclude that the registered provider, Castlebeck Care (Teesdale) Ltd, had failed to ensure that people living at Winterbourne View were adequately protected from risk, including the risks of unsafe practices by its own staff.

The report concludes that there was a systemic failure to protect people or to investigate allegations of abuse. The provider had failed in its legal duty to notify the Care Quality Commission of serious incidents including injuries to patients or occasions when they had gone missing.

Inspectors said that staff did not appear to understand the needs of the people in their care, adults with learning disabilities, complex needs and challenging behaviour. People who had no background in care services had been recruited, references were not always checked and staff were not trained or supervised properly. Some staff were too ready to use methods of restraint without considering alternatives.

The review began immediately after CQC was informed that the BBC television programme Panorama had gathered evidence over several months including secret filming to show serious abuse of patients at the centre.

Inspectors who visited Winterbourne View considered taking urgent action to close the centre, but decided that it was in the best interests of the patients to allow NHS and local authority commissioners further time to find alternative placements.

CQC ensured that there would be an immediate stop on admissions and that extra staff would be brought in to protect patients until they could be moved.

When they were satisfied that those arrangements were in place, CQC took enforcement action to remove the registration of Winterbourne View, the legal process to close a location. The hospital closed in June.

The report which is published today finds that Castlebeck Care Ltd (Teesdale) was not compliant with 10 of the essential standards which the law requires providers must meet. CQC’s findings can be found below.

• The managers did not ensure that major incidents were reported to the Care Quality Commission as required.
• Planning and delivery of care did not meet people's individual needs.
• They did not have robust systems to assess and monitor the quality of services.
• They did not identify, and manage, risks relating to the health, welfare and safety of patients.
• They had not responded to or considered complaints and views of people about the service.
• Investigations into the conduct of staff were not robust and had not safeguarded people.
• They did not take reasonable steps to identify the possibility of abuse and prevent it before it occurred.
• They did not respond appropriately to allegations of abuse.
• They did not have arrangements in place to protect the people against unlawful or excessive use of restraint.
• They did not operate effective recruitment procedures or take appropriate steps in relation to persons who were not fit to work in care settings.
• They failed in their responsibilities to provide appropriate training and supervision to staff.

Amanda Sherlock, CQC’s Director of Operations said: “This report is a damning indictment of the regime at Winterbourne View and its systemic failings to protect the vulnerable people in its care.

“It is now clear that the problems at Winterbourne View were far worse than were initially indicated by the whistleblower. He has stated that he was not aware of the level of abuse until he saw the footage from the secret filming.

“We now know that the provider had effectively misled us by not keeping us informed about incidents as required by the law. Had we been told about all these things, we could have taken action earlier. We will now consider whether it would be appropriate to take further legal action.

“CQC has already acknowledged that we would have acted earlier if the evidence from the television report had been made available to us.

“However it is incorrect that CQC had failed to act on warnings by the whistleblower. Our internal investigation has confirmed that while we were aware of those concerns, our inspector believed they were being dealt with through the local safeguarding process involving a number of agencies. We should have contacted the whistleblower directly – and this will be one of the issues which will be addressed by the independently-led serious case review.

“Immediately we were aware of the extent of the problem, we took the action which is detailed in this report. Although Winterbourne View is now closed, we will continue to monitor Castlebeck's other services closely.

“The most important outcome of all this is that the people who had been living at Winterbourne View are no longer subject to this culture of abuse.

”Our plans for a programme of random, unannounced inspections of hospitals providing care for people with learning disabilities are well underway and we will report back in due course."

Over the last four months CQC has reviewed and inspected all the services provided by Castlebeck Care (Teesdale) Ltd at its 24 locations. We will publish the results of this review, including reports on all locations, at the end of July. Where we have identified concerns, measures are in place to address the problems and to ensure the safety of people using services.

For further information please contact the CQC press office on 0207 448 9401 or out of hours on 07917 232 143.

Notes to editors

Below is CQC’s response to the abuse at Winterbourne View hospital.

• A review of all Castlebeck services. Full details of the inspection of 23 locations will be published later this summer.
• A review of learning disability services involving the inspection of 150 services for people with learning disabilities which have the same or similar characteristics as Winterbourne View.
• An internal management review. The first stage of CQC’s internal management review of our actions in relation to Winterbourne View is complete. The final report will make recommendations relating to how CQC ensures that safeguarding alerts and whistle blowing information are handled.
• A serious case review: CQC's internal report will feed into a serious case review being led by an independent chair, Margaret Flynn, which will examine the role of all the responsible agencies.

Read the report

Review of compliance: Winterbourne View - July 2011

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We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.

We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find to help people choose care.

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Winterbourne View ‘a case study in institutional abuse’

Serious case review diagnoses widespread failings of management, regulation, safeguarding and commissioning and calls for end to use of hospital placements for adults with learning disabilities and autism..

The Winterbourne View scandal provides “a case study in institutional abuse”, which went unchallenged because of substantial failings by managers, commissioners, regulators and safeguarding agencies. That was the damning verdict of a serious case review into the scandal, published today, which called for hospital placements for people with learning disabilities and autism to be radically reduced and to be subjected to much greater levels of scrutiny. The review, by adult protection expert Margaret Flynn, reserved its harshest criticisms for Castlebeck Ltd, which ran the hospital near Bristol, but said the company’s failings went largely unchecked by the Care Quality Commission, NHS commissioners, police and South Gloucestershire Council, in its safeguarding capacity. “The apparatus of oversight across sectors was unequal to the task of uncovering the fact and extent of abuses and crimes at the hospital,” it said.   SCR recommendations  Commissioners should ensure people with learning disabilities and autism receive community support and only receive in-patient care when absolutely necessary;  Commissioners should ensure they have up-to-date knowledge of hospital services including serious incidents and safeguarding investigations;  All registered care providers should advise staff in their contracts to whom they should whistleblow and the response they should receive from their employer;  Commissioners should ensure all hospital patients with learning disabilities and autism have unimpeded access to effective complaints procedures;  The government should consider banning the use of the “t-supine restraint” of patients in assessment and treatment units, in which they are lain on the ground and staff use their body weight to restrain them;  Hospitals for adults with learning disabilities and autism should be regarded as “high-risk services” and subject to more frequent and thorough inspections and safeguarding investigations.;   Conditions for abuse The SCR was triggered by last May’s BBC Panorama programme that screened undercover footage of patients being abused and humiliated with apparent impunity by a group of support workers. Eleven former staff are facing jail for the abuse . The review found that many of the conditions under which the abuse occurred were present from 2008, including the use of restraint by untrained staff, a lack of professional input or patient advocacy and the limited ways in which staff worked with patients. It found that “professional standards and codes of practice had no bearing on patient care” as Winterbourne View became largely “led” by its biggest staff group, the unregulated support workers, despite the presence of a team of 13 learning disability nurses. Training was “skewed towards restraint practices with nothing about working with patients”. The review was scathing about the Castlebeck’s management of Winterbourne, saying there was “little evidence of senior executive oversight” and a lack of professional leadership from the registered manager. The hospital went without a registered manager for two periods during 2008-11, of seven and 18 months. The company failed to respond adequately to “unprofessional behaviour” by staff, written complaints by patients, escalating self-harm and the “continued and harmful use of restraints” – of which there were 379 incidences recorded in 2010 and 129 in the first three months of 2011. This approach culminated in its failure to take action when charge nurse Terry Bryan blew the whistle on poor practice at the hospital in an email to managers in October 2010. Commissioners found wanting Despite being set up as an assessment, treatment and rehabilitation centre for people with learning disabilities and autism, the review said Winterbourne “strayed far” from this purpose, for which commissioners as well as Castlebeck were to blame. Primary care trusts placing people at Castlebeck did not set performance targets for the company or effectively check the progress of patients despite being charged an average of £3,500 a week for places. Reviews were “ineffective and did not bring to light either concerns about the quality of assessment and treatment or detail of abusive practices. Commissioners failed, with council partners, to develop the family support and prevention services that would have removed the need to place people at Winterbourne. Strategic health authorities also did not effectively performance manage PCTs in their commissioning of placements for this client group. Safeguarding staff failed to spot pattern The response of safeguarding agencies to incidents was “ineffective”, with evidence that South Gloucestershire Council’s safeguarding practice was more effective in other cases than in relation to Winterbourne View. Forty safeguarding alerts were made concerning Winterbourne View patients from October 2007-April 2011: 27 allegations of staff to patient assaults, 10 allegations of patient to patient assaults and three family-related alerts. But in only 19 cases were service users who were the subject of alerts seen by the police or social workers with the other 21 largely left to Castlebeck to investigate. The review found that social workers and other safeguarding staff treated these as discrete incidents and failed to identify a pattern of concern at the hospital; they also relied too much on Winterbourne’s management to honestly report the facts concerning referrals, but this did not happen. Inadequacy of light-touch regulation The review also concluded that institutions such as Winterbourne were “ill-suited” to the “light-touch” regulatory model employed by the CQC, which was “over-reliant on self-assessment” and did not specify how providers should meet prescribed outcomes for service users. The SCR said “closed establishments” such as Winterbourne would benefit from a more prescriptive approach, which specified best practice in terms of inputs and processes, such as staffing and models of care, as well as outcomes. “Such services require more than the standard approach to inspection and regulation,” it said. “They require frequent, more thorough, unannounced inspections, more probing criminal investigations and exacting safeguarding investigations.” Reactions In response, Castlebeck said it was “committed to learn the lessons from the serious case review” and was “working hard to ensure its model of care was fit for the future”. The CQC has published its own management review into its role in the Winterbourne View case, including its failure to respond to whistleblower Terry Bryan’s reports of ill-treatment of service users at the hospital. Chief executive David Behan promised to “respond fully” to the SCR’s recommendations for the regulator. South Gloucestershire Safeguarding Adults Board chair Peter Murphy – who is also the council’s director of adult social services – said the board fully accepted the findings and was “determined to ensure that events such as this never occur again in South Gloucestershire”. Mithran Samuel is Community Care’s adults’ editor. Related articles Background to Winterbourne View case

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Winterbourne View

Journal of Learning Disabilities and Offending Behaviour

ISSN : 2042-0927

Article publication date: 8 June 2012

Dale, C. (2012), "Winterbourne View", Journal of Learning Disabilities and Offending Behaviour , Vol. 3 No. 2. https://doi.org/10.1108/jldob.2012.55403baa.001

Emerald Group Publishing Limited

Copyright © 2012, Emerald Group Publishing Limited

Article Type: Editorial From: Journal of Learning Disabilities and Offending Behaviour, Volume 3, Issue 2

The damning verdict of the serious case review (Flynn, 2012) into the Winterbourne View scandal was that it was “a case study in institutional abuse”, which went unchallenged because of substantial failings by managers, commissioners, regulators and safeguarding agencies.

The review called for hospital placements for people with learning disabilities (LD) and autism to be radically reduced and to be subjected to much greater levels of scrutiny.

The finding that “The apparatus of oversight across sectors was unequal to the task of uncovering the fact and extent of abuses and crimes at the hospital”, comes as no surprise and somewhat states the obvious.

The findings give an uncomfortable resonance on the myriad of similar scandals which preceded it: the use of restraint by untrained staff; a lack of professional input or patient advocacy; the limited ways in which staff worked with patients; the service being led by its biggest staff group, the unregulated support workers; training skewed towards restraint practices with nothing about working with patients.

The finding that primary care trusts (PCT) placing people at Castlebeck did not set performance targets or effectively check the progress of patients is not unique to Castlebeck but commonplace across the sector. PCT’s neither had the resources or skills to perform this function in the main and it is naïve of the reviewers to believe that this was unique in this situation.

The sad truth is that the recommendations are obvious and only what the services and regulators should have been doing anyway. The real problem here is that there is little that provides confidence that this will prevent a re-occurrence of problems in the future.

Safeguarding

The Care Quality Commission (CQC) has identified a significant issue about concerns about the lack of understanding of the operation of the Mental Capacity Act in LD services.

A recent report by the CQC (2012) recommends that the NHS needs better training and more awareness of when and how to apply the Mental Capacity Act – Deprivation of Liberty Safeguards for patients. As “managing authorities” under the Deprivation of Liberty Safeguards, hospitals must apply to their PCT, and notify the CQC if they think that a patient needs to be deprived of their liberty for treatment or care which they can establish is in their best interests. CQC points out in the report however that there is a significant under-reporting by hospitals of notifications that they are required to make.

The CQC report highlights:

The value of a system of safeguards.

A large variation in practice across the country.

Low levels of training of staff.

Lack of clarity about when the safeguards might be needed.

CQC plan to improve their approach to monitoring the safeguards by:

Embedding the safeguards as a routine and major part of inspectors’ practice.

Improving information on managing authorities’ applications and authorisations for the safeguards.

Developing the ability to monitor the overall safeguards system and managing authorities.

Many services have developed good practice on the use of the safeguards, especially in involving people and their families in the decision-making process, but some were confused as to when restraints or restrictions on a person amounted to a deprivation of liberty. However, between a third and a quarter of care homes had not provided their staff with training on the safeguards, and in some cases only the manager had received training.

One of the key issues here is that the Mental Capacity Act is a complex legal framework and staff simply do not understand it. The root cause of the problem may not simply lie with training staff but in the Act itself which staff avoid using if possible because of its complexity and feel more comfortable with the Mental Health Act and its familiarity and straightforward approach.

It is interesting to note that the projected use of the Mental Capacity Act calculated by the government in advance of the legislation becoming law was far in excess of what has turned out in practice. Conversely the Community Treatment Order (CTO) enacted by the 2007 amendments to the Mental Health Act has far exceeded expectations of its use in practice. When exploring with clinician’s the reasons why this should be the response is that they find the Mental Capacity Act cumbersome and complex to use whilst the CTO is clear and simple to operate.

The Queen’s Speech

The Queen’s Speech (HM the Queen, May 2012) included a draft bill to modernise adult care and support in England, setting out what support people could expect from government and what action the government would take to help people plan, prepare and make informed choices about their care.

The main benefits of the draft Bill would be:

Modernising care and support law to ensure local authorities fit their service around the needs, outcomes and experience of people, rather than expecting them to adapt to what is available locally.

Putting people in control of their care and giving them greater choice, building on progress with personal budgets.

Consolidating the existing law by replacing provisions in at least a dozen Acts with a single statute, supported by new regulations and statutory guidance.

Simplifying the system and processes, to provide the freedom and flexibility needed by local authorities and social workers to allow them to innovate and achieve better results for people.

Giving people a better understanding of what is on offer, to help them plan for the future and ensure they know where to go for help when they need it.

These proposals if fully embraced by local services hold the potential to make significant differences in people’s lives and provide the prospect for the challenging group of LD offenders who frequently possess unique and/or idiosyncratic needs to get tailored support.

In this issue

This issue of the journal includes an insightful contribution from The Netherlands from Hendrien Kaal and her colleagues. Their study sought to discover what differences there are in personal characteristics and functioning between juvenile offenders with IQ<70, IQ 70-85, and IQ>85, in order to be able to better fit supervision and treatment to their needs.

A total of 1,363 case files of serious juvenile offenders were scored using an instrument that encompasses over 70 characteristics relevant in risk-assessment and for measuring problem behaviour.

The analyses showed that the behavioural and mental health problems and background characteristics of juvenile offenders of various IQ-levels (IQ<70, IQ 70-85, and IQ>85) are in many respects very similar. However, differences were found in, for example, social skills and relationships, and the needs inherent with having an intellectual disability have important implications for the way treatment is offered.

Brendan M. O’Mahony provides one of the first published papers to examine the interaction between an intermediary, a vulnerable defendant and barristers and the judge in the courtroom. It highlights the complexities of the language that is still used by lawyers in the courtroom and the difficulties that this causes for the vulnerable defendant. Additionally, this paper looks at a transcript of a police suspect interview and reveals the difficulties that the police caution presents to a vulnerable police suspect. It also reveals that whilst a lawyer and an appropriate adult were present during the police interview, complex language was still used and inadequately explained.

Dr Stephen J. Macdonald’s article describes his study into how social barriers might result in people with specific learning difficulties coming in contact with the criminal justice system (CJS) in the UK. This study applies the social model of disability to conceptualise a statistical relationship between socio-economic status and key life events for people with specific learning difficulties (i.e. diagnosis, educational achievements, and employment).

The study collected quantitative and qualitative data on the life experiences of 77 people with specific learning difficulties. This paper analyses the quantitative data and discovered statistically significant relationships concerning socio-economic status, specific learning difficulties and crime.

Recently, very few studies have used the social model of disability to understand pathways into offending for people with learning difficulties. To my knowledge, this is the first study to apply a quantitative analysis to the concept of disabling barriers and criminality.

Fola Esan and his colleagues describe the experience of a secure LD service in participating in the national shared pathway pilot project in secure services.

Some background drivers to the project are explored as well as the experience of service users and staff who were involved in the pilot project. The authors feel that the shared pathway will lead to considerable changes in practice and have implications for resources. Also, the shared pathway may be useful in ensuring evidence-based outcomes are routinely used by clinicians in secure services in collaboration. Recommendations on service wide implementation of the shared pathway are made.

Nicola McNamara describes her work as a speech and language therapist (SLT) in the North West Forensic Support Service who takes referrals for individuals over 16 who have a LD and who are, or are at risk of becoming, involved with the CJS.

Nicola describes how initially the number of referrals to the SLT was quite low, despite research suggesting the need within this client group is high. In an attempt to identify those individuals who may benefit from input, a communication screening tool was introduced which examined data from two to six month periods – pre and post the introduction of the communication screen. The results of this analysis and implications for practice are discussed as well as recommendations made for future service development.

Care Quality Commission (2012), The Operation of the Deprivation of Liberty Safeguards in England, 2010/11 , Care Quality Commission, London, March

Flynn, M. (2012), A Serious Case Review – Winterbourne View Hospital. South Gloucestershire Safeguarding Adults Board , South Gloucestershire Council, Bristol

HM the Queen (2012), Queens Speech in the UK Parliament , Her Majesty the Queen, London, 10 May

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Winterbourne View Case Study

Castlebeck is a large company employing 2,100 people providing care for 580 service users at 56 locations nationwide. One of these locations is Winterbourne View, a privately owned 24 bed facility that treats people with autism and learning difficulties. An urgent investigation was conducted after a BBC panorama reporter went undercover at the facility as an untrained support worker. The footage captured showed some of the hospitals most vulnerable patients being subjected to serious abuse. The staff at Winterbourne was caught on film whilst teasing and taunting patient.

Essay Example on Winterbourne Care Home Case Study

They were also caught hitting and kicking and pinning down patients. One patient was dragged into a cold shower fully clothed then put outside in the cold. Certain members of staff were seen as ring leaders however other members of staff sat back and watched or pretended that nothing was going wrong. A former Winterbourne nurse Terry Bryan tried to raise his concerns both with Castlebeck and CQC. The owners of winterbourne, health regulators, local health services and the police were all criticised for failing to act on a number of warning signs of increased institutional abuse by the staff.

The professional standards and codes of practice had no bearing on patient care as Winterbourne View became largely “led” by its biggest staff group, the unregulated support workers, despite the presence of a team of 13 learning disability nurses. Training was skewed towards restraint practices with nothing about working with patients and a clinical psychologist who viewed the footage said basic techniques for dealing with people with challenging behaviour were ignored.

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Police confirmed that three men aged 42, 30 and 25 and a woman aged 24 was arrested as part of the investigation. There were also 13 employees suspended.

One of the care homes patients who was being subjected to terrible abuse told her parents but they refused to believe her saying that it would never be allowed to happen. In a statement the CQC said following an internal review it recognised that there were indications of problems that should have led them to take action sooner. The care services minister Mr Burstow confirmed with CQC that they should undertake a series of unannounced inspections of services for people with learning difficulties. Castlebeck have launched an internal investigation into their whistle blowing procedures and are reviewing the records of 580 patients.

The vulnerable patients from the documentary have been removed to safety. A statement from the chief executive of Castlebeck said he was utterly ashamed by what had happened and sent unreserved apologizes to both the service users and their families. Gloustershire council said it takes all allegations of abuse seriously and as soon as the SAB (safe guarding adults board) were made aware of the allegations at winterbourne the correct and appropriate action was taken in line with established protocol and procedures.

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Winterbourne View Case Study

The Winterbourne View case study remains a stark reminder of the failures within the healthcare system, particularly concerning the treatment of individuals with learning disabilities. Situated in Bristol, England, Winterbourne View was a private hospital operated by Castlebeck Care. It gained notoriety in 2011 when an undercover BBC Panorama investigation exposed systematic abuse and neglect of residents by staff members. The revelations sparked outrage and led to widespread condemnation of the facility's practices, as well as a broader scrutiny of the care provided to vulnerable individuals in similar institutions.

At the heart of the Winterbourne View scandal was the mistreatment of residents, who were subjected to physical assaults, emotional abuse, and inappropriate restraint techniques. The Panorama documentary revealed shocking footage of staff members taunting, restraining, and assaulting residents, highlighting a culture of cruelty and disregard for human dignity within the institution. Moreover, the investigation uncovered a pattern of institutional failings, including inadequate staff training, poor management oversight, and a failure to respond to complaints effectively.

The aftermath of the Winterbourne View scandal prompted significant changes within the healthcare system, particularly in the regulation and oversight of care facilities for individuals with learning disabilities. The government launched inquiries into the incident, resulting in the publication of the Winterbourne View Joint Improvement Programme, which outlined recommendations for improving care quality and safeguarding vulnerable individuals. Additionally, regulatory bodies such as the Care Quality Commission (CQC) implemented stricter monitoring and inspection protocols for similar care facilities, aiming to prevent similar abuses from occurring in the future.

Despite the reforms and increased awareness brought about by the Winterbourne View case, challenges remain in ensuring the safety and well-being of individuals with learning disabilities in care settings. Issues such as staff shortages, inadequate training, and insufficient funding continue to pose significant obstacles to delivering high-quality care. Furthermore, the Winterbourne View scandal underscored broader societal attitudes towards people with disabilities, highlighting the need for greater inclusion, respect, and advocacy for their rights.

In conclusion, the Winterbourne View case study serves as a cautionary tale of the consequences of neglect and abuse within healthcare institutions. It prompted much-needed reforms and scrutiny of the care provided to individuals with learning disabilities, leading to improvements in regulation and oversight. However, the incident also revealed systemic shortcomings that persist in the healthcare system, emphasizing the ongoing need for vigilance, accountability, and advocacy to ensure the rights and dignity of all individuals are protected.

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Winterbourne View Care Home Failures

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• Article 3 (prohibition of torture)
• Article 5 (right to liberty and security)
• Article 8 (right to your private and family life)
• Article 10 (freedom of expression)
• Article 14 (prohibition of discrimination)
• Mental Health Act 2014
• Offences against the person act 1861 (ABH section 47)
• Report incidents
• Act on incidents that were reported

• Wayne Rogers, 32,   jailed for two years
• Alison Dove, 25, jailed for 20 months
• Graham Doyle, 26, jailed for 20 months
• Nurse Sookalingum Appoo, 59, jailed for six months
• Nurse Kelvin Fore, 33,   also jailed for six months
• Holly Laura Draper , 24, jailed for 12 months;
• Daniel Brake, 27, six month jail sentence suspended for two years and ordered to carry out 200 hours of unpaid work;
• Charlotte Cotterall , 22, was given a four-month jail term suspended for two years. Cotterell was ordered to do 150 hours of unpaid work
• Michael   Ezneagu, 29, was given a six month jail sentence suspended for two years and ordered to carry out 200 hours of unpaid work;
• Neil Ferguson, 28, was given a six month jail term was suspended for two years and ordered to carry out 200 hours of unpaid work;
• Jason Gardiner, 43, was given a four month jail term was suspended for two years and ordered to carry out 200 hours of unpaid work.

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• BBC news Winterbourne view: careworkers jailed for abuse [online] https://www.bbc.co.uk/news/uk-england-bristol-20092894  26 oct 2012

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Winterbourne View Essay Example

• Pages: 8 (1932 words)
• Published: August 1, 2016
• Type: Essay

Winterbourne View was a private independently run hospital by Castlebeck Care (Teesdale) Ltd. Opening in December 2006 the hospital was a 24 bed unit providing treatment, care and support for adults with autism, learning disabilities and challenging behaviour. The hospital had 2 floors each with 12 beds, the ground floor contained the offices, kitchen, laundry and meetings rooms. The second floor was a 12 bed unit providing support to rehabilitate service users towards independent living. The third floor again was a 12 bed unit providing more intensive treatment for service users with more complex needs.

The hospital provided commissioners, service users and their families with a ‘statement of purpose’ of what would be provided. This boasted a quality service providing high quality specialist healthcare, treatment and support, based on the needs of the individual to achieve their full potentia

l. Through the recruitment, development and retention of well trained and dedicated staff, including registered nurses and psychiatrists. Each service user benefitting from appropriately registered staff and a multi-disciplinary team approach.

It came into the spotlight following the BBC programme Panorama secretly filming within the hospital, and raised much concern about the abuse that was taking place. Terry Bryan a senior nurse working at Winterbourne View reported his concerns firstly to management at the hospital and then to The Care Quality Commission (CQC). His concerns of abuse were not listened to in both cases, and decided to approach the BBC.

BBC Panorama Undercover Care The abuse Exposed

Aired 31st May 2011, Panorama’s programme exposed the disturbing levels of abuse taking place. An undercover reporter Jo Casey gained employment as a support

worker and secretly filmed within the hospital for 5 weeks. Before he went undercover the BBC sent Jo on a private training course on ways to best care for people with learning disabilities. Following this he fully understood restraint should be a last resort, and all other attempts should be made before using such methods.

Whilst filming there were several incidents of extreme abuse witnessed, a service user was doused with water fully clothed, left outside on a cold March day and left shivering on the ground. This person was then taken to their bedroom had a vase of water poured over them whilst lying on the floor screaming, which was a gift from their parents. The patient was then taken to the bathroom for a second shower fully clothed, where workers poured mouthwash over them.

On another occasion a worker repeatedly poked a client in the eye. The same client was later pushed to the floor by a different worker and told to ‘suffocate on your own fat’. Another service user was repeatedly bullied by staff, this person was slapped, held down for no reason and threatened to have their head put down the toilet. He witnessed most of the staff were using physical restraint as a first resort, and little evidence of other techniques being used.

Jo witnessed the services users experiencing abuse practically daily, mostly taking place on the 3rd floor of the hospital. He found the level of activity and engagement with the service users was very poor. He felt an air of boredom within the staff and service users, days consisted of watching television in the lounge

or service users sleeping in their rooms. One activity that took place whilst secretly filming was a member of staff reading from a general knowledge textbook.

Jo found the experience difficult, saying what he witnessed horrific and struggled not to intervene and stop abuse happening. He knew he needed to get the abuse on film to expose the abuse and protect vulnerable people in the future. The programme sparked serious concerns about the whistle blowing and safeguarding procedures in place to prevent abuse taking place failing. As well as the role of the CQC to inspect services and ensure standards are being met, once notified by the BBC CQC began an immediate inspection of Winterbourne View. The Department Of Health, Care Service Minister Paul Burstow, called for urgent reviews of services for adults with learning disabilities. By 10th June 2011 Avon and Somerset Police had arrested a total of 11 employees.

An Adult Protection Expert Margaret Flynn was appointed to chair the serious case review, commissioned by South Gloucestershire Safeguarding Adults Board. Margaret Flynn is leading the examination into what lessons are to be learnt from the agencies failures to protect vulnerable adults from abuse. She had chaired an investigation of the murder of disabled man Steve Hoskin in 2006, which made far reaching recommendations to reform adult protection, including raising awareness and tightening up multi-agency working. She is also the chair for Lancashire Safeguarding Adults Board and joint editor of the Journal of Adult Protection.

Winterbourne View has been one of the most public and worst abuse cases in many years, the procedures in place to prevent this failed. The senior

nurse Terry Bryan reported concerns to the management of Winterbourne View, which were ignored. He later reported these to the CQC and again these were not acknowledged and action not taken. There is clear evidence of safeguarding concerns reported to South Gloucester Council Safeguarding Adults Board and shows policies and procedures were ineffective. The first safeguarding concern raised was in 2008, and continued up until 2011 and were not fully investigated by the governing bodies responsible.

The Care Quality Commissions Actions

CQC began an immediate investigation, admissions into Winterbourne View were stopped, and alternative placements sought for patients. Extra staff were brought in to ensure patients were protected until they could be moved. Once these actions were finalised Winetbourne View had its registration removed and closed by CQC in June 2011. A statement published by CQC in July 2011 which detailed the enforcement actions taken above, it details the failures of Castlebeck Care to meet 10 essential standards required by law and misled CQC by not reporting incidents to them as required by law. CQC acknowledged action should have been taken sooner, had they been aware of incidents action would have been taken sooner.

CQC also explained action would have happened sooner had evidence from the TV programme had been available sooner. CQC responded to the concerns raised by Terry Bryan stating it was incorrect they had failed to act on his warnings. CQC explain they had been made aware by the whistle-blower, however the inspector assumed these were being dealt with by local safeguarding procedures. CQC acknowledge Terry Bryans complaint should have been contacted directly, and will be addressed by an

independent serious case review. CQC released its review of compliance report in July 2011. It details the failings in the 10 essential standards Winterbourne View (Castlebeck Care LTD) were responsible to meet by law. There were serious and massive failings which were widespread across the service and company.

The standards not met being and findings by CQC – Outcome 4 – People should get safe and appropriate care that meets their needs and supports their rights. PAGE 6 Care plans were poor, lacking information and were not person centred. Records lacked understanding of the complex needs of the clients, planning and delivery of the care and treatment provided did not ensure their safety and welfare. Incidents and accidents were not followed up, prompt medical attention and wound management were lacking. Interventions and support to prevent and manage self-harm and suicide were also poor.

The service did not ensure users were protected from care and treatment that was inappropriate or unsafe. Care, treatment and risk plans were often out of date, not reviewed and contained poor use of language and little information. They showed little respect or understanding for the service users and that staff were using a controlling approach. Records for one service user showed persistent self-harm and suicide, plans to monitor this were lacking details on methods, and safety measures were not put in place. Plans for this person did not include supportive action to prevent harm or wound management following harm. There was reactive action of administering first aid, however only 9 of 53 staff had been trained in emergency first aid.

The care plan dated 29/05/2009 stated the person

had an objective of learning relaxation techniques and good night time routine, this contained no details of what these were or the benefits for person. Another person’s records were checked, self-harm was often reported to staff by the service user. Again plans were lacking details of preventative or risk minimising measures. There were also no wound management plans in place, despite the person’s records showing repetitive harm using the same methods. An incident report dated 20/09/2012 detailed a service user who was on frequent observations had self-harmed causing serious injury to themselves. Medical treatment had not been sought until the next day, the person required 19 stiches.

The risk assessment was not reviewed, and accident report was completed 10 days later, and both contained conflicting information. An incident dated 03/03/2011 staff recorded and person’s behaviour as not being helpful, was on the floor and not moving. The situation was handled by a further 2 staff applying physical restraint, and staff document the behaviour became more problematic. More staff members joined to manage the person, all using restraint totalling 7 members of staff who were de-escalating the situation.

Outcome 7 – People should be protected from abuse and staff should respect their human rights. PAGE 6 -7 There were not suitable and effective arrangements to identify and prevent abuse. Allegations or risks of abuse were not managed or responded to appropriately, therefore service did not protect people using the service from abuse. Records checked show staff were willing to use restraint rather than de-escalation techniques. They also show how management were lacking in effectively reviewing this, other serious incidents and completing necessary reports and

ensuring actions to prevent and improve standards were implemented.

Winterbourne View was visited by Mental Health Act Commissioner between 18/06/2009 and 25/09/2010, reviewing the safety and vulnerability of service users. They observed a service users arm was in plaster, the commissioner was told by the person the injury had happened when restrained on 23/07/2010. The commissioner reported that all necessary action was taken immediately to deal with the incident, but the service user was not offered any legal or advocacy services.

The commissioner checked the mini root cause analysis completed by the manager and deputy manager following the incident, the quality was poor and showed a lack of recommendations or lessons to be learnt. The commissioner requested the independent review report, which should have been carried out following such an incident. This was not provided, and was requested again by CQC on 19/05/2011, the report was dated 20/05/2011. CQC reviewed all the documentation for the above incident.

The incident report had not been dated, three statements from employees were dated 22/07/2010, an accident report dated 223/07/2010, a female body map dated 29/07/2010 and the mini root cause analysis dated 29/07/2010. This showed clear inconsistencies with how incidents were dealt with, the mini root cause analysis did not identify these and no lessons were learnt. It was reported to the health and safety executive as required by reporting of injuries, diseases, and dangerous occurrences (RIDDOR) regulations.

The manager stated the incident happened 29/07/2010, six days after the incident, it also conflicted with the details in statements from staff on location of the incident. The notification CQC received was very limited in detail

and stated ‘was being restrained on the floor’. Another incident dated 14/10/2010, detailed the service user was removed during the incident. The service user continued to fight, spit, scream, scratch, bit and pull hair. The staff restrained the person with a pillowcase over there mouth for 20 minutes, and involved 6 members of staff. CQC also noted in the daily notes of a service user on 24/02/2011, they were restrained under a duvet for 15 minutes.

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Winterbourne View

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Winterbourne View was a private independently run hospital by Castlebeck Care (Teesdale) Ltd. Opening in December 2006 the hospital was a 24 bed unit providing treatment, care and support for adults with autism, learning disabilities and challenging behaviour. The hospital had 2 floors each with 12 beds, the ground floor contained the offices, kitchen, laundry and meetings rooms. The second floor was a 12 bed unit providing support to rehabilitate service users towards independent living. The third floor again was a 12 bed unit providing more intensive treatment for service users with more complex needs.

The hospital provided commissioners, service users and their families with a ‘statement of purpose’ of what would be provided. This boasted a quality service providing high quality specialist healthcare, treatment and support, based on the needs of the individual to achieve their full potential. Through the recruitment, development and retention of well trained and dedicated staff, including registered nurses and psychiatrists. Each service user benefitting from appropriately registered staff and a multi-disciplinary team approach.

It came into the spotlight following the BBC programme Panorama secretly filming within the hospital, and raised much concern about the abuse that was taking place. Terry Bryan a senior nurse working at Winterbourne View reported his concerns firstly to management at the hospital and then to The Care Quality Commission (CQC). His concerns of abuse were not listened to in both cases, and decided to approach the BBC.

BBC Panorama Undercover Care The abuse Exposed

Aired 31st May 2011, Panorama’s programme exposed the disturbing levels of abuse taking place. An undercover reporter Jo Casey gained employment as a support worker and secretly filmed within the hospital for 5 weeks. Before he went undercover the BBC sent Jo on a private training course on ways to best care for people with learning disabilities. Following this he fully understood restraint should be a last resort, and all other attempts should be made before using such methods.

Whilst filming there were several incidents of extreme abuse witnessed, a service user was doused with water fully clothed, left outside on a cold March day and left shivering on the ground. This person was then taken to their bedroom had a vase of water poured over them whilst lying on the floor screaming, which was a gift from their parents. The patient was then taken to the bathroom for a second shower fully clothed, where workers poured mouthwash over them.

On another occasion a worker repeatedly poked a client in the eye. The same client was later pushed to the floor by a different worker and told to ‘suffocate on your own fat’. Another service user was repeatedly bullied by staff, this person was slapped, held down for no reason and threatened to have their head put down the toilet. He witnessed most of the staff were using physical restraint as a first resort, and little evidence of other techniques being used.

Jo witnessed the services users experiencing abuse practically daily, mostly taking place on the 3rd floor of the hospital. He found the level of activity and engagement with the service users was very poor. He felt an air of boredom within the staff and service users, days consisted of watching television in the lounge or service users sleeping in their rooms. One activity that took place whilst secretly filming was a member of staff reading from a general knowledge textbook.

Jo found the experience difficult, saying what he witnessed horrific and struggled not to intervene and stop abuse happening. He knew he needed to get the abuse on film to expose the abuse and protect vulnerable people in the future. The programme sparked serious concerns about the whistle blowing and safeguarding procedures in place to prevent abuse taking place failing. As well as the role of the CQC to inspect services and ensure standards are being met, once notified by the BBC CQC began an immediate inspection of Winterbourne View. The Department Of Health, Care Service Minister Paul Burstow, called for urgent reviews of services for adults with learning disabilities. By 10th June 2011 Avon and Somerset Police had arrested a total of 11 employees.

An Adult Protection Expert Margaret Flynn was appointed to chair the serious case review, commissioned by South Gloucestershire Safeguarding Adults Board. Margaret Flynn is leading the examination into what lessons are to be learnt from the agencies failures to protect vulnerable adults from abuse. She had chaired an investigation of the murder of disabled man Steve Hoskin in 2006, which made far reaching recommendations to reform adult protection, including raising awareness and tightening up multi-agency working. She is also the chair for Lancashire Safeguarding Adults Board and joint editor of the Journal of Adult Protection.

Winterbourne View has been one of the most public and worst abuse cases in many years, the procedures in place to prevent this failed. The senior nurse Terry Bryan reported concerns to the management of Winterbourne View, which were ignored. He later reported these to the CQC and again these were not acknowledged and action not taken. There is clear evidence of safeguarding concerns reported to South Gloucester Council Safeguarding Adults Board and shows policies and procedures were ineffective. The first safeguarding concern raised was in 2008, and continued up until 2011 and were not fully investigated by the governing bodies responsible.

The Care Quality Commissions Actions

CQC began an immediate investigation, admissions into Winterbourne View were stopped, and alternative placements sought for patients. Extra staff were brought in to ensure patients were protected until they could be moved. Once these actions were finalised Winetbourne View had its registration removed and closed by CQC in June 2011. A statement published by CQC in July 2011 which detailed the enforcement actions taken above, it details the failures of Castlebeck Care to meet 10 essential standards required by law and misled CQC by not reporting incidents to them as required by law. CQC acknowledged action should have been taken sooner, had they been aware of incidents action would have been taken sooner.

CQC also explained action would have happened sooner had evidence from the TV programme had been available sooner. CQC responded to the concerns raised by Terry Bryan stating it was incorrect they had failed to act on his warnings. CQC explain they had been made aware by the whistle-blower, however the inspector assumed these were being dealt with by local safeguarding procedures. CQC acknowledge Terry Bryans complaint should have been contacted directly, and will be addressed by an independent serious case review. CQC released its review of compliance report in July 2011. It details the failings in the 10 essential standards Winterbourne View (Castlebeck Care LTD) were responsible to meet by law. There were serious and massive failings which were widespread across the service and company.

The standards not met being and findings by CQC – Outcome 4 – People should get safe and appropriate care that meets their needs and supports their rights. PAGE 6 Care plans were poor, lacking information and were not person centred. Records lacked understanding of the complex needs of the clients, planning and delivery of the care and treatment provided did not ensure their safety and welfare. Incidents and accidents were not followed up, prompt medical attention and wound management were lacking. Interventions and support to prevent and manage self-harm and suicide were also poor.

The service did not ensure users were protected from care and treatment that was inappropriate or unsafe. Care, treatment and risk plans were often out of date, not reviewed and contained poor use of language and little information. They showed little respect or understanding for the service users and that staff were using a controlling approach. Records for one service user showed persistent self-harm and suicide, plans to monitor this were lacking details on methods, and safety measures were not put in place. Plans for this person did not include supportive action to prevent harm or wound management following harm. There was reactive action of administering first aid, however only 9 of 53 staff had been trained in emergency first aid.

The care plan dated 29/05/2009 stated the person had an objective of learning relaxation techniques and good night time routine, this contained no details of what these were or the benefits for person. Another person’s records were checked, self-harm was often reported to staff by the service user. Again plans were lacking details of preventative or risk minimising measures. There were also no wound management plans in place, despite the person’s records showing repetitive harm using the same methods. An incident report dated 20/09/2012 detailed a service user who was on frequent observations had self-harmed causing serious injury to themselves. Medical treatment had not been sought until the next day, the person required 19 stiches.

The risk assessment was not reviewed, and accident report was completed 10 days later, and both contained conflicting information. An incident dated 03/03/2011 staff recorded and person’s behaviour as not being helpful, was on the floor and not moving. The situation was handled by a further 2 staff applying physical restraint, and staff document the behaviour became more problematic. More staff members joined to manage the person, all using restraint totalling 7 members of staff who were de-escalating the situation.

Outcome 7 – People should be protected from abuse and staff should respect their human rights. PAGE 6 -7 There were not suitable and effective arrangements to identify and prevent abuse. Allegations or risks of abuse were not managed or responded to appropriately, therefore service did not protect people using the service from abuse. Records checked show staff were willing to use restraint rather than de-escalation techniques. They also show how management were lacking in effectively reviewing this, other serious incidents and completing necessary reports and ensuring actions to prevent and improve standards were implemented.

Winterbourne View was visited by Mental Health Act Commissioner between 18/06/2009 and 25/09/2010, reviewing the safety and vulnerability of service users. They observed a service users arm was in plaster, the commissioner was told by the person the injury had happened when restrained on 23/07/2010. The commissioner reported that all necessary action was taken immediately to deal with the incident, but the service user was not offered any legal or advocacy services.

The commissioner checked the mini root cause analysis completed by the manager and deputy manager following the incident, the quality was poor and showed a lack of recommendations or lessons to be learnt. The commissioner requested the independent review report, which should have been carried out following such an incident. This was not provided, and was requested again by CQC on 19/05/2011, the report was dated 20/05/2011. CQC reviewed all the documentation for the above incident.

The incident report had not been dated, three statements from employees were dated 22/07/2010, an accident report dated 223/07/2010, a female body map dated 29/07/2010 and the mini root cause analysis dated 29/07/2010. This showed clear inconsistencies with how incidents were dealt with, the mini root cause analysis did not identify these and no lessons were learnt. It was reported to the health and safety executive as required by reporting of injuries, diseases, and dangerous occurrences (RIDDOR) regulations.

The manager stated the incident happened 29/07/2010, six days after the incident, it also conflicted with the details in statements from staff on location of the incident. The notification CQC received was very limited in detail and stated ‘was being restrained on the floor’. Another incident dated 14/10/2010, detailed the service user was removed during the incident. The service user continued to fight, spit, scream, scratch, bit and pull hair. The staff restrained the person with a pillowcase over there mouth for 20 minutes, and involved 6 members of staff. CQC also noted in the daily notes of a service user on 24/02/2011, they were restrained under a duvet for 15 minutes.

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JSmol Viewer

Examining the response to covid-19 in logistics and supply chain processes: insights from a state-of-the-art literature review and case study analysis.

1. Introduction

• RQ1 (scientific): How have researchers studied the impact of COVID-19 on logistics and supply chain processes? Which industrial sectors were mostly studied and why? Which additional topics can be related to COVID-19 and logistics/supply chain?
• RQ2 (practical): What effects of COVID-19 on logistics and supply chain processes were experienced by companies?

2. Materials and Methods

2.1. systematic literature review, 2.1.1. sample creation, 2.1.2. descriptive analyses, 2.1.3. paper classification.

• Macro theme: sustainability, resilience, risk, information technology, economics, performance, planning and food security. This classification represents paper’s core topic.
• Industrial sector: aerospace, agri-food, apparel, automotive, construction, e-commerce, electronic, energy, fast-moving consumer goods, food, healthcare, logistics, manufacturing and service.
• Data collection method: questionnaire/interview, third-party sources or case study. This classification represents the method used by the authors to collect the data useful to their study.
• Research method: statistical, decision-making, simulation, empirical, literature review or economic. This category describes the tool used by the authors to conduct the study and reach the related goals.
• Specific method, e.g., descriptive statistics, structural equation modeling (SEM), multi-criteria decision making (MCDM), etc.; this feature describes more accurately the type of work carried out by the authors and the tools used.
• Country: it reflects the geographical area in which the study was carried out, in terms, for instance, of the country in which a sample of people has been interviewed or where empirical data were collected, or where the simulation was set. This method of classification, although more elaborated, was preferred over traditional approaches, in which the country of the study is defined based merely on the affiliation of the first author of the paper, because the exact knowledge of the country in which the study was carried out is, for sure, a more representative source of information about the research. This is true in general, but it is even more important for this subject matter, as the management of the COVID-19 pandemic was made on a country or regional basis, with significant differences from country to country; knowing the exact location of the study helps in better interpreting the research outcomes. Possible entries in this field also include “multiple countries” and “not specified”, with the obvious meanings of the terms.

2.1.4. Cross-Analyses

2.1.5. interrelated aspects, 2.2. case study, 2.2.1. data collection.

• Economic data: some key economic data were retrieved from the company’s balance sheet, from 2019 up to the latest available document, which refers to 2022.
• Organizational data: these data describe changes in the operational, decision-making and business structure of the company in terms, e.g., of number of employees hired, number of drivers, etc.
• The related data were collected and elaborated between July and September 2023.

2.2.2. Survey Phase

2.2.3. analysis and summary, 3. results—systematic literature review, 3.1. descriptive statistics, 3.2. common classification fields, 3.2.1. macro theme, 3.2.2. industrial sector, 3.2.3. data collection method, 3.2.4. research method, 3.2.5. country, 3.3. cross-analyses, 3.3.1. macro theme vs. industrial sector, 3.3.2. research method vs. macro theme, 3.4. interrelated aspects, 4. results—case study, 4.1. company overview, 4.2. pre-covid-19 period, 4.3. covid-19 period, 4.4. post-covid-19 period, 4.5. analysis and summary.

• Strengths : at present, Company A benefits from a robust network of relationships with customers and suppliers (e.g., drivers), which was leveraged during the pandemic period to provide a rapid response to the increased request by the consumers. The company has also leveraged the usage of digital technologies, which made logistics activities more efficient and, again, allowed the company to respond to consumer demand in the pandemic period.
• Weaknesses : Company A has suffered from low economic results, in particular in the post-COVID-19 period, mainly due to the high production costs. Efforts must be made by the company to reduce expenses. At the same time, however, the service level, in terms of delivery lead time or on-time delivery, should be safeguarded.
• Opportunities : the growth of e-commerce, experienced in the COVID-19 period but expected to last over time, creates opportunities for increasing the volume of items handled by Company A. Indeed, the survey phase demonstrated that the company’s consumers have shifted towards the usage of online sales; hence, the company could consider investing in this area to increase its market share. By leveraging the e-commerce logistics and diversifying service, expansions could also be possible at an international level. Even if the company has already embraced the implementation of digital technologies, some emerging technologies (e.g., drones or advanced traceability systems) could also be introduced for further improving the logistics efficiency. Finally, sustainability is another opportunity to be leveraged, because of the current push towards the adoption of environmental-friendly logistics solutions. Examples of those solutions include a reduction in CO 2 emissions, and the usage of electric vehicles or zero-impact materials.
• Threats : the growth of e-commerce can be seen as an opportunity, but because many logistics companies have already entered this field, the sector is characterized by very high competition, which could limit the market share of Company A; this could instead be seen as a threat needing to be properly managed. Another threat comes from the increased cost of fuel, which, for sure, for a logistics company plays an important role in determining the cost of the transport activities (also, having previously observed that the company suffered from a limited revenue in recent years). This factor could further push towards the adoption of environmentally friendly transport modes (e.g., electric vehicles), which have been previously mentioned as an opportunity for leveraging in the logistics sector.

5. Conclusions

5.1. answer to the research questions, 5.2. scientific and practical implications, 5.3. suggestions for future research directions, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

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Monferdini, L.; Bottani, E. Examining the Response to COVID-19 in Logistics and Supply Chain Processes: Insights from a State-of-the-Art Literature Review and Case Study Analysis. Appl. Sci. 2024 , 14 , 5317. https://doi.org/10.3390/app14125317

Monferdini L, Bottani E. Examining the Response to COVID-19 in Logistics and Supply Chain Processes: Insights from a State-of-the-Art Literature Review and Case Study Analysis. Applied Sciences . 2024; 14(12):5317. https://doi.org/10.3390/app14125317

Monferdini, Laura, and Eleonora Bottani. 2024. "Examining the Response to COVID-19 in Logistics and Supply Chain Processes: Insights from a State-of-the-Art Literature Review and Case Study Analysis" Applied Sciences 14, no. 12: 5317. https://doi.org/10.3390/app14125317

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