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In 2004/2005 local partnership boards requested West Midlands South and Birmingham & The Black Country Strategic Health Authorities (SHAs) to review and report back on the circumstances of adults with a learning disability placed out of area. There are currently 623 known adults with learning disability living out of area at an annual cost to commissioning services of £35 million. In 1993 the Mansell Report predicted major problems and potential consequences relating to future planning of services for people with learning disabilities and complex needs. Twelve years on this has become a reality, as more people are living in highercost services away from their original district and families. There is no evidence from this review that out‐of‐area services are any worse or any better than local services. The review does not set out to make a direct comparison of out‐of‐area placements and services provided locally, nor does it reflect on the number of people being imported into the West Midlands. With lack of monitoring and reviewing of placements, many people have been left solely to the care of provider organisations. Commissioners of services are becoming reliant on the Commission for Social Care Inspection (CSCI) to raise any concerns with them. This review calls for specific action to be taken now to reverse this trend of increasing out‐of‐area placements and to make more cost‐effective local solutions.

Being placed in out‐of‐area services can be one of the most significant forms of transition experienced by people with learning disabilities. The paper reviews the extent of such provision, identifies who is most at risk of being placed out of area, briefly explores the effects of such placement and concludes with a discussion of possible strategic solutions.

The closure of long‐stay National Health Service (NHS) hospitals has seen the placement of people with learning disabilities who offend or have offending‐type behaviours placed ‘out of area’ many miles from local services. This move of people out of area has made it difficult in many localities to develop local services and to monitor the quality of care for this group. This paper describes the start of an exercise to examine potential local care pathways for those who present with offending behaviours and to look at differences between the out of area group, and another receiving treatment locally. Within the two groups we found no significant differences regarding rates of psychiatric disorder, quality of life or levels of unmet need. The main difference was that the out of area group was largely characterised by a range of aggressive and challenging behaviour, necessitating the additional structure and securities provided by out of area placements.

The Howard Shuttering Contractors case throws considerable light on the importance which the tribunals attach to warnings before dismissing an employee. In this case the tribunal took great pains to interpret the intention of the parties to the different site agreements, and it came to the conclusion that the agreed procedure was not followed. One other matter, which must be particularly noted by employers, is that where a final warning is required, this final warning must be “a warning”, and not the actual dismissal. So that where, for example, three warnings are to be given, the third must be a “warning”. It is after the employee has misconducted himself thereafter that the employer may dismiss.

There is little published literature about the number of home visits provided to patients within forensic intellectual disability units, and there is no published data on variables that affect home visits. There is a need for a baseline audit that can formulate standards for future practice. The paper aims to discuss these issues.

This paper describes the home visit programme within a forensic intellectual disability service, and a baseline audit of the programme. The audit measured the number of home visits, any factors that adversely affect home visits, and the extent of family contact. The authors propose audit standards for evaluation of good practice in this area.

The audit involved 63 patients over a one-year period. In total, 81 per cent of patients had some form of family contact and 54 per cent of patients at least one home visit. However, 19 per cent of patients had no contact with their family due to a variety of reasons. There were no significant differences in the number of home visits between men and women, patients on civil vs criminal sections or those treated “within area” or “out of area”. Patients in rehabilitation wards had significantly more visits than those in low or medium secure.

Conventional wisdom is that reduced family contact is the direct result of patients being placed “out of area”. The results of this audit suggest that, at least in this group, the reasons may be much more nuanced and that the current definition of “out of area” has to be improved to incorporate the actual distance between the patient’s current family home and the service. Audit standards have been proposed to monitor family contact and home visits. Future work should focus on the relationship between family contact and treatment outcomes.

This mainly exploratory study was a one‐point‐in‐time survey of the situation in one English county. This study involved a survey of all social care homes in the county, followed by measures of quality of life/service for a random sample of 30 people identified by the survey, interviews with home managers, service users, family carers and care managers, and focus groups with members of four community learning disability teams. The total number of people placed from out‐of‐area was estimated to be close to 2,000 (1,500 were placed by the local authority within the county). The main reason for such placements was lack of good local services, but cost also seemed important. For many of those who had been in long‐stay hospital, locality appeared not to be important. Effects varied, but at least a third of people were experiencing very poor service quality and quality of life. Family carers generally felt their relative was happy, but fear of losing the placement was a strong theme. Distance was a major difficulty for both family and care manager involvement. For local community learning disability teams, the main problems included increased workload, reduced provision for local residents, difficulty in dealing with placing authority and the poor quality of the homes. Challenges for public agencies include provision of better local services, management of the cost incentives, especially for London Boroughs, and a system where funding follows the person wherever they chose to live.

This article describes one of the issues that arose from my research into the Longcare abuse scandal: how local authorities place learning‐disabled adults in out‐of‐area settings far from their original homes, and then fail to visit them regularly to check on their welfare. It describes the failings of three local and health authorities in the Longcare case, and then reveals that the problem was not confined to those authorities that placed adults at the Longcare homes. It also suggests that placing vulnerable adults in out‐of‐area homes puts them at a greater risk of abuse. The article concludes that, ten years on from the exposure of the Longcare regime, many local authorities are still placing vulnerable adults in out‐of‐area homes and failing to visit them. It calls for a national audit of out‐of‐area placements and for measures to be introduced to allow learning‐disabled adults to live in placements closer to their families and friends… and care managers.

Key components of the logistics mix are described in an effort to create an understanding of the total logistics concept. Chapters include an introduction to logistics; the strategic role of logistics, customer service levels, channel relationships, facilities location, transport, inventory management, materials handling, interface with production, purchasing and materials management, estimating demand, order processing, systems performance, leadership and team building, business resource management.

Describes a study to measure the quality of service provided by food‐poisoning surveillance agencies in England and Wales in terms of the requirements of a representative consumer ‐ the egg producing industry ‐ adopting “egg associated” outbreak investigation reports as the reference output. Defines and makes use of four primary performance indicators: accessibility of information; completeness of evidence supplied in food‐poisoning outbreak investigation reports as to the sources of infection in “egg‐associated” outbreaks; timeliness of information published; and utility of information and advice aimed at preventing or controlling food poisoning. Finds that quality expectations in each parameter measured are not met. Examines reasons why surveillance agencies have not delivered the quality demanded. Makes use of detailed case studies to illustrate inadequacies of current practice. Attributes failure to deliver “accessibility” to a lack of recognition on the status or nature of “consumers”, combined with a self‐maintenance motivation of the part of the surveillance agencies. Finds that failures to deliver “completeness” and “utility” may result from the same defects which give rise to the lack of “accessibility” in that, failing to recognize the consumers of a public service for what they are, the agencies feel no need to provide them with the data they require. The research indicates that self‐maintenance by scientific epidemiologists may introduce biases which when combined with a politically inspired need to transfer responsibility for food‐poisoning outbreaks, skew the conduct of investigations and their conclusions. Contends that this is compounded by serious and multiple inadequacies in the conduct of investigations, arising at least in part from the lack of training and relative inexperience of investigators, the whole conditioned by interdisciplinary rivalry between the professional groups staffing the different agencies. Finds that in addition failures to exploit or develop epidemiological technologies has affected the ability of investigators to resolve the uncertainties identified. Makes recommendations directed at improving the performance of the surveillance agencies which, if adopted will substantially enhance food poisoning control efforts.