When Monopsony Met Monopoly

Some blogs I would like to write about the Serious Case Review of Winterbourne View Hospital:

1. The institution was a hospital and not a care home
2. The hospital was a CQC registered and regulated service with a statement of purpose concerning the assessment and treatment of people with learning disability, mental health needs, autism and behaviour which challenges services – and sometimes families
3. The service was one that was bought for individuals – by 14 NHS Primary Care Trusts
4. Care management and contract monitoring were not effective either through the care programme approach or through linking payment to service delivered.
5. Strategic Health Authorities had responsibility for the performance of NHS Primary Care Trusts
6. The professional and managerial leadership of the hospital should have derived from a Registered Manager and a Medical Director with Castlebeck company oversight from a responsible individual
7. The responsible individual has not been called to account
8. A GP was responsible for the health care of the patients on a day to day basis and for prescribing medication
9. There were troubling incidents which merited a large scale investigation procedure by the adult safeguarding and the police – notwithstanding the belated reaction to the whistleblower
10. The support worker-led culture at the hospital of ‘its them or us’ was abusive and corrosive. It is one that nurse managers chose to ignore and one where all other professionals failed to pick up the warning signs
11. There is a debate to be had about the possibilities of prophylactic technology
12. Physical and chemical restraints are indicative of regime failure in treatment terms as well as those of control
13. Closed institutions require proactive inspection, care management and challenge to their very closed nature through rights to advocacy and visiting
14. The very existence of Winterbourne View Hospital, and how it was used, ran counter to government policy and local commissioning intentions
15. Finally, the regulator should have a much stronger role wherever ‘monopsony meets monopoly’. This is an inherently dangerous market scenario.