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Man with learning disability awarded compensation following allegations of ill-treatment and excessive restraint at NHS Assessment & Treatment Unit

Lawyers for a 45 year old man with Autistic Spectrum Disorder and epilepsy have reached an out-of-court settlement on behalf their client following alleged failures in his care at an NHS Assessment & Treatment Unit.

Posted on 07 August 2018

The man, known only as James to protect his identity, is non-verbal with very limited communication skills.

In 2007, aged 34, James was admitted to Chebsey Close, an Assessment & Treatment Unit run by North Staffordshire Combined Healthcare NHS Trust, for short term rehabilitation lasting between 12 and 18 months whilst a more appropriate placement was found for him in the community.

However, due to ongoing issues in securing his discharge, James remained at Chebsey Close for nearly six years.

During this time, he was subjected to repeated physical restraints, including incidents where it is alleged he was held face-down in a prone position on the ground. James was also subjected to unwelcome physical behaviour by other service-users, an issue which members of staff were aware of and which James found highly distressing.

In 2010, due to their concerns about the unavailability of lead clinicians working in the service, James’s parents submitted a Freedom of Information Request to the Care Quality Commission and discovered that other patients in James’s unit had been subjected to verbal and physical abuse by members of staff.

This included an incident where a patient had been kneed in the groin by a member of staff and another where a staff member had ‘rolled up’ a patient in a rug.

Due to the nature of his learning disabilities, James is both self-referential and hypervigilant, and is also unable to predict outcomes. As such, any aggressive behaviour in his vicinity - even if not directed specifically at him – would have been perceived by him as a direct threat, causing him to live in a constant state of fear.

It was through the civil action that James’s parents also discovered that James had continued to suffer from epileptic seizures whilst he was at Chebsey and they were very concerned about the apparent lack of follow up action that had been taken in response, including ensuring that James was supervised during bath times.

Although there was no clear evidence that James had come to any additional harm as a result of this, his parents, who have worked with the Challenging Behaviour Foundation and applaud the achievements of the ‘Justice for LB’ campaign, were concerned this could have had catastrophic results and were very distressed to learn this.

The unit was eventually closed down following a number of critical reports by the CQC regarding the quality and safety of care.

James’ lawyers, Alison Millar and Kate Whiting from the Abuse Team at Leigh Day, brought a case on James’ behalf alleging negligence, assault and breach of his human rights.

The team obtained supportive evidence from an expert psychologist and an advisor on learning disabilities, who was of the view that James had suffered negligent treatment at Chebsey Close and had also been subjected to excessive and disproportionate physical restraint.

In addition to the direct physical injuries that James was alleged to have suffered during these restraints, his family were also very concerned to learn that James had often self-isolated in his bedroom and had suffered from repeated bouts of vomiting, which they believe may have been caused by his severe levels of anxiety.

The Defendant made no admissions of liability in the claim but agreed to make an award of damages to James, which his family intend to use for specialist therapeutic support for him, including input from a speech and language therapist to help James develop ways of communicating his needs to his current staff team.

James is now living in a supported living placement in the community and, whilst it is still taking time for him to fully recover from his previous experiences, his family report that he is making good progress and has not required any form of physical intervention for a number of years.

Of their experiences as James’ family, his parents said: “At 19 years of age James had no idea how to hurt anyone. In the first 14 years in adult social care, he was then placed in what we have always felt to be inappropriate, inadequate and consequently poor-quality services which had no hope of meeting his needs. In all those services, we were concerned that he was suffering significant neglect and abuse and therefore had to remove him.

“James was admitted to the Chebsey service to identify his needs; enable him to learn skills that would reduce his need to exhibit challenging behaviour; and enable the commissioning of an appropriate bespoke service.

“However, it seems clear to us that his experiences at Chebsey damaged him greatly and made it more difficult for him to adjust to his current service. The extensively delayed discharge was, in our view, undoubtedly damaging to him. “We understand that the Chebsey service had on site support from a psychiatrist, psychologists, occupational therapists, a speech and language therapist, learning disability nurses and nurse managers yet, in our view, it achieved little if anything.

“It is astonishing to reflect that his current, initially unskilled team have much improved James’ quality of life. They have demonstrated that his challenging behaviour is a legitimate response to unmet needs. Not having to live in a frightening, oppressive environment is clearly a massive relief to him.

“The litigation process was not easy, particularly because James cannot speak and was unable to give evidence directly. There is also a general lack of clarity around how people like James should be supported. However, we were very pleased to reach a resolution for James and hope his case will help people to recognise the suffering endured by people like him, whose needs and human rights are so readily ignored.”

Viv Cooper OBE, the founder of the Challenging Behaviour Foundation, added:
“It is clear that James and his family have been badly let down by the system that is meant to be there to provide care and support, and that this has had and continues to have a significant and long term impact. It is difficult to imagine the constant fear that James endured, subjected to regular and repeated physical restraints as well as unwelcome physical behaviour without the means to ask for help or escape. How would we feel if we were in that situation? How would we cope or react?
"How James has been treated has only been exposed due to the determination of his family – without which it would have remained out of sight and unchallenged. A system that protects itself rather than the people it is meant to serve is dangerous. Closed defensive cultures that are not only allowed to develop but are perpetuated must be exposed and people held to account, but the mechanisms to do so are complicated and slow. The legal system that should be there to protect us all has also proved difficult to negotiate for James. It is too easy to blame the victim if he has a learning disability, and he is not able to provide a witness account. His family feel he has been portrayed as “a monster” when in fact he is a gentle person who showed no form of aggressive behaviour until he entered adult services.  They wanted accountability, they wanted the intrinsic failings of the system to be recognised and hopefully addressed, they wanted to generate a response that would prevent it happening to others, they wanted the truth – instead,  although there were no admissions of liability, financial damages were paid to James, and so because of the way the system works, it didn’t get to court.
"James will always need high levels of support but he has already proved that he can live successfully in the community when this is provided within the right environment. He will also need significant time and understanding for his post -traumatic stress to try and undo the damage that has been done to him. It will take time for him to no longer live in fear and he is able to trust the people around him to do him no harm. I applaud his parents for their long and painful battle to expose this injustice, which takes its toll on all involved, and I admire James for his resilience and beginning to live again. This legal case will hopefully will send a strong message that abusive practices will not be tolerated and they will be exposed.”