The document discusses strategies to support people with learning disabilities who exhibit challenging behaviors. It notes the failures at Winterbourne View and aims to develop positive approaches. Participants share feelings about Winterbourne View and discuss legislation, accountability, positive behavior support plans, and developing person-centered risk assessments. The goal is to find better ways to support people in their communities to avoid situations like Winterbourne View.

1. WINTERBOURNE
There Must
be
Another Way…….
But What Is It ?
Network Name
Lancaster & Preston Community LD Teams

2. Who We Are
We are Amanda Tiley and Alison Riley.
We are Community Learning Disability Nurses
based in Preston and Lancaster respectively.
We work with people who challenge services and
may be subject to being sectioned under the
Mental Health Act.
We liaise with all members of the multidisciplinary
team, including police, solicitors, social workers,
commissioners, psychiatrists etc.
Network Name
Lancaster & Preston Community LD Teams

3. Aims of the Workshop
To raise awareness of Positive Behavioural
Supports.
To work collaboratively in a multi-professional
forum in order to develop strategies to minimise
the risk of abuse of vulnerable adults.
To generate action plans to put into practice within
the workplace.
Network Name
Lancaster & Preston Community LD Teams

4. Exercise
When you hear the words
“Winterbourne View”
what does it mean to you?
Network Name
Lancaster & Preston Community LD Teams

5. These are some of the thoughts my
colleagues and I felt…..
• Safeguarding • Torture
• Restraint • Guidance
• Abuse • Lack of
• Lack of care supervision
• Sadness • Anger
• Despair • Threat
• Evil
Network Name
Lancaster & Preston Community LD Teams

6. Winterbourne View Review Concordat or
Agreement Programme of Action
• After the Panorama Programme was aired, an inquiry
took place identifying what went wrong and why.
• Recommendations were made – not only to front
line staff and service providers but also to
community teams, commissioners, social workers,
housing and CQC.
Network Name
Lancaster & Preston Community LD Teams

7. Simon Tovey was at Winterbourne
view because the care home he’d
lived in for 16 years needed extra
staff to cope with his behaviour.
They asked the council for an extra
£600 a week.
The council and other agencies decided he needed
assessing and moved him out of area.
Assessment was supposed to take 6 months, but Simon was
away for 3 years.
He ended up at Winterbourne View.
Network Name
Lancaster & Preston Community LD Teams

8. Winterbourne One Year On
Since the inquiry, Simon has moved back to
the care home near his family that he did
not want to leave in the first place.
It costs £1,400 a week less than it did for him to stay at
Winterbourne View.
His mother, Ann Earley says:
‘All this could have been resolved in his current home. He
need never have had those three years of hell.”
Network Name
Lancaster & Preston Community LD Teams

9. What led us to Winterbourne
and the Mental Health Act as
an answer?
Working with people who challenge services when distressed
may cause risk of serious harm, not only to the person
themselves, but members of the public and staff teams
supporting them. Physical intervention, restrictive practices and
the use of the Mental Health Act have historically been used to
reduce the risk of harm, sometimes disproportionately.
When developing care plans for these people, we have to
consider risk, duty of care and proportionate responses.
Network Name
Lancaster & Preston Community LD Teams

10. So what is the other way?
• Today we will be discussing: positive
behavioural supports, legislation and guidance
around the protection of vulnerable adults.
• As a group we will be working together to look
at ways forward to avoid the possibility of
these scenes occurring again.
Network Name
Lancaster CommunityCommunity LD Teams
& Preston LD Team

11. As a group
• What can we change?
• Keeping it Local - are the Mental Health Act
and Out of Area Placements the only way to
support people who challenge the service?
• Leadership - who is in charge?
• Accountability - what is the line of
accountability? Supervision, training, support,
burn out, competency?
Network Name
Lancaster & Preston Community LD Teams

12. Associated Legislation
• CARE IN THE COMMUNITY ACT (1990)OUTLINED - PLANS FOR HOSPITAL
TO COMMUNITY TRANSFER
• THE HUMAN RIGHTS ACT (1998)
• THE CARE STANDARDS ACT (2000) -RECOGNISED ABUSE IN CARE HOMES
LEADING TO CSCI INSPECTIONS
• THE CARE STANDARDS ACT (2000) - RECOGNISED ABUSE IN CARE HOMES
LEADING TO CSCI INSPECTIONS
• MENTAL CAPACITY ACT (2005) – AND DOLS PUTS BEST INTERESTS IN
STATUTE LAW
• SAFEGUARDING VULNERABLE GROUPS ACT 2006
• MENTAL CAPACITY CODE OF CONDUCT(2007) - PROVIDES FRAMEWORK TO
DETERMINE MENTAL CAPACITY
• THE EQUALITY ACT 2010 PREVENTS DISCRIMINATION AGAINST A PERSON
BECAUSE OF PROTECTED CHARACTERISTICS
• WINTERBOURNE ENQUIRY 2012
Network Name
Lancaster & Preston Community LD Teams

13. What is positive behaviour
support?
• Positive Behavioural support approaches have become established as
the preferred approach when working with people with learning
disabilities who exhibit behaviours described as challenging.
• The strengths and successes of positive behavioural support
approaches provide the reason for the increasing support for their use.
They are fundamentally rooted in person centred values, aiming to
enhance community presence, increasing personal skills and
competence and placing emphasis on respect for the individual being
supported. They also use quality of life improvements for the person,
both as an intervention and as an outcome measure.
(BILD)
Network Name
Lancaster CommunityCommunity LD Teams
Lancaster & PrestonLD Team

14. Staff responses to behaviours
that challenge services.
As reported at previous sessions of PBS for
managers training.
 They are attention seeking
 It’s a slippery slope, what if it gets out of control
 They know exactly what they are doing
 They are doing it to wind us up
 They have already had (biscuit/brew…..)
 You are giving in to them
 I don’t get paid enough to be attacked at work
 Why do people respond in this way?
Network Name
Lancaster CommunityCommunity LD Teams
Lancaster & PrestonLD Team

15. This
“Person”
could save
your life
Please Don’t Discriminate
Network Name
Lancaster CommunityCommunity LD Teams
Lancaster & PrestonLD Team

16. GROUP EXERCISE
To reduce the potential for Challenging
Behaviour what needs to be in the care plan?
Network Name
Lancaster & Preston Community LD Teams

17. Gold Standard Care Plan
Is this the WAY????
Or have we forgotten
something???
Network Name
Lancaster CommunityCommunity LD Teams
Lancaster & PrestonLD Team

18. What is involved in a PBS Plan?
• Personal Information
• Health Action Plan
• Person Centred Plan
• Mental Capacity Assessment/Consent
• Communication Passport
• Person Centred Risk Assessment
• High Density of Preferred Activities
Network Name
Lancaster & Preston Community LD Teams

19. What is involved in a PBS Plan?
• Functional Assessment (including Support
Plan)
• Sensory Assessment
• Medication
• Primary and Secondary Prevention Strategies
• Reinforcement Inventory
• Motivational Assessment
Network Name
Lancaster & Preston Community LD Teams

20. Risk Assessments
• Human rights joint risk assessment and
management plan (hr-jramp)
• How can we develop person centred risk
assessments that keep people safe and happy
(as opposed to safe and unhappy or happy
and unsafe)
• How can we work together for a
solution
Network Name
Lancaster & Preston Community LD Teams

21. What do we need in order to improve?
• More community based enhanced services
- environments tailored to individual needs.
• More specialised skilled services to deal with
these behaviours.
• Using the Mental Capacity Act as opposed to
the Mental Health Act as a legal framework.
• Meaningful life.
• Keep it local.
Network Name
Lancaster & Preston Community LD Teams

22. Any questions?
Network Name
Lancaster CommunityCommunity LD Teams
Lancaster & PrestonLD Team