Adult Protection research suggests there is still much to do in response to events at Winterbourne View

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The events at Winterbourne View assessment and treatment service, where the BBC Panorama programme uncovered systematic abuse of people with learning disabilities, has led to a serious case review written by Margaret Flynn and Vic Citarella.

The review concluded that the services provided at Winterbourne View were not based on an understanding of the needs of the local population and 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.

DH response

The Department of Health has published its response to the case review which promises strengthening the accountability of boards and senior managers, detailed reviews of people placed in hospital inappropriately and the development of local joint plans to ensure high quality care and support. The concordat to support action has been signed by over 50 partners. However, there remain a number of concerns about progress.

RCPsych guidance

Agreeing what constitutes a hospital placement for example and what constitutes inappropriate placement raises some difficulties. The Royal College of Psychiatrists was asked to produce guidance on the number of hospital beds required and drawing on data from their representatives in England suggested that there had already been a significant drop in the number of available beds, from 33,000 in 1987/88 to 3,954 today. They suggest the need to clarify different categories of beds and their functions; to move away from a narrow focus on assessment and treatment beds.

Special edition of the Journal of Adult Protection

The DH plans to produce a progress report in December, but a special edition of the Journal of Adult Protection, given over to an exploration of progress in this area, paints a bleak picture.

Firstly Margaret Flynn and Vic Citarella reflect on the findings of the Serious Case Review they chaired, and suggest that the practices at the hospital and those of the commissioning agencies and oversight bodies still show a gulf between professionals, professionals and their organisations and also leadership shortcomings.

Jo Plomin, the producer of BBC Panorama reflects on how the abuse at Winterbourne View persisted, despite attempts to alert regulatory bodies and health professionals and sets out lessons for those professionals responsible for adult protection. The author sets out concerns however that these appear to have permeated only to some areas and professionals.

a new criminal sanction for “corporate neglect”

A new criminal sanction called “corporate neglect” may make it easier to hold corporate bodies responsible for future abuse and neglect

Sheree Louise Green then goes on to outline measures that can be taken, using existing legislation and provision to change the day-to-day experience of people with learning disabilities who are placed in hospitals, awaiting the development of more local provision as well as those who may be remaining longer in in-patient care. She suggests that commissioners could include such measures to promote the safety and protection of such adults at little or no additional cost.

Finally, Paul Burstow (MP) sets out how he believes that corporate bodies could be held criminally responsible for abuse and neglect in hospitals and care homes if it can be shown that they facilitate this abuse or neglect to take place by their actions. He sets out the current framework of national and international law that might enable the Government to create a new criminal sanction for “corporate neglect”  by amending the existing Health and Social Care Act 2008.

Taken together, the articles show the extent of the problem and the inertia that exists within the system, but also sets out some clear vision for change.

The Mencap Out of Sight report

The Out of Sight report by Mencap and the Challenging Behaviour Foundation focuses on stopping the neglect and abuse of people with learning disabilities

Margaret Flynn warns against making the assumption that the two year life of the Department of Health’s joint programme board will be sufficient to do everything required to bring about a transformation in care. The joint Challenging Behaviour Foundation and Mencap report ‘Out of Sight’ urges us all to ensure that this issue is never far from our minds and our actions. Even two years after the Panorama programme, there are still people who were patients at Winterbourne View patients who are still in out of county placements. The dangers of this approach were outlined in the first Mansell report in 1992 and remain as relevant today as then.


Flynn M & Citarella V, Winterbourne View Hospital: a glimpse of the legacy, in Journal of Adult Protection, 15, 4, 173 – 181.

Plomin J, The abuse of vulnerable adults at Winterbourne View Hospital: the lessons to be learned, in Journal of Adult Protection, 15 4, 182 – 191.

Green S,  An unnoticing environment: deficiencies and remedies – services for adults with learning disabilities, in Journal of Adult Protection, 15 4, 192 – 202.

Burstow P  Care and corporate neglect: the case for action, in Journal of Adult Protection, 15, 4, 203 – 214.

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John Northfield

After qualifying as a social worker, John worked in community learning disability teams before getting involved in a number of long-stay hospital closure programmes, working to develop individual plans for people moving into their own homes. He worked for BILD, helping to develop the Quality Network and was editorial lead for the NHS electronic library learning disabilities specialist collection. This led him to found the Learning Disabilities Elf site with Andre Tomlin as a way of making the evidence accessible to practitioners in health and social care. Most recently he has worked as part of Mencap's national quality team and also been involved in a number of national website developments, including the General Medical Council's learning disabilities site.

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