Joanna, Jon and Ben: a Serious Case Review
The CBF has issued a statement about the Serious Case Review made by Norfolk Safeguarding Adults Board, about Joanna, Jon and Ben who died in Cawston Park private hospital.
St John’s House, a hospital for people with a learning disability and autistic people, in Suffolk will close following an unannounced CQC inspection in July 2021.
The July inspection of St John’s House in Palgrave, Suffolk, by the Care Quality Commission (CQC), followed a previous inspection that rated the mental health hospital inadequate and placed it in special measures due to concerns around patient safety, incident management, staffing and the use of restraint. In the latest inspection, inspectors found that insufficient progress had been made regarding patient safety, staffing, risk management and adherence to patient care and risk needs. It has been announced today (17th September 2021) that St John’s House will now close.
The CQC said: “Our latest inspection of St John’s House found an unacceptable service where insufficient improvements had been made to protect patients from harm and abuse and the number of safety incidents remained high.”
The CQC first placed St John’s House into special measures in December 2020 and it remained in special measures following an inspection in April this year.
It is unclear why commissioners have continued to fund places for individuals in a service which has been in special measures providing unsafe care for at least 9 months. Restrictive interventions have been used without sufficient training, and abuse and safeguarding allegations have not been reported to the local authority.
The CQC statement notes ‘The provider is working to find alternative care services for the patients’. We are concerned that a failing provider is responsible for moving individuals to new settings. All the individuals at St John’s House and their families should have access to good quality independent advocacy and legal advice regarding their rights. Who is taking responsibility for ensuring this happens?
The closure follows a number of scandals over recent weeks:
Today’s scandal comes as we continue to wait for the publication of the cross-government “Building the Right Support action plan”, over 10 years after the Winterbourne Hospital scandal resulted in a promise to “transform care”. The action plan due to be published this month (September), will need to include new clear accountable steps and timescales to deliver the right support at the right time to children and adults with learning disabilities and autistic people in their local community. Current systems and processes are not effective in delivering appropriate support and protecting individuals with learning disabilities and autistic people from harm.
The report on St John’s House has been published on CQC’s website.
If you have been affected by any of the issues raised in this statement, you can call the Family Support Service on 0300 666 0126
Or email us at support@thecbf.org.uk
We are open at the following times:
Monday – Thursday: 9am – 5pm
Friday: 9am – 3pm
We offer information about challenging behaviour to anyone who provides support to a child, young person or adult with a severe learning disability. We can also signpost you to other specialist organisations and sources of information.
Please note we are a small support service so you may not be able to get support straight away. We will support families with urgent concerns as a priority.
Please consult the following information section on our website, for information sheets and signposting:
What to do when things go wrong
The CBF has issued a statement about the Serious Case Review made by Norfolk Safeguarding Adults Board, about Joanna, Jon and Ben who died in Cawston Park private hospital.
A group of families with relatives who were at Winterbourne View have published their family stories reflecting on the last ten years since the Winterbourne View scandal. Read ‘Tea, smiles and empty promises.’