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Government failing those in learning disability care – report

The government has failed to keep its pledge to move all people with learning disabilities and/or autism who are in inappropriate institutional care into community care by June this year, according to a new report.

The pledge was made following the Winterbourne View scandal, which exposed abuse at a Bristol care home in 2011.

The report ‘Winterbourne View - Time for Change’, commissioned by NHS England and produced by ACEVO, the Association of Chief Executives of Voluntary Organisations , shows that not only has there been a failure to achieve the movement, there are still more people being admitted to such institutions than are being discharged – causing “anger and frustration”.

NHS England’s quarterly data collections have revealed that between 30 September 2013 and 30 September 2014, 923 people were transferred out of inpatient care. But numbers admitted have been consistently higher than numbers transferred out – with 1,306 individuals admitted over the same period.

Sir Stephen Bubb, chief executive of ACEVO and author of the report, has made a series of recommendations for the NHS, local government, regulators and the government. These include a robust NHS commissioning framework to support people with learning disabilities and autism move out of hospitals and into the community.

For instance, it was stated that the government should draw up a Charter of Rights for people with learning disabilities and/or autism and their families, and it should underpin all commissioning. In order to force the pace on commissioning, it has also been suggested that the government and NHS England should require all local commissioners to follow a mandatory commissioning framework.

Other recommendations include giving people with learning disabilities and their families a ‘right to challenge’ decisions and the right to request a personal budget; a requirement for local decision-makers to follow a mandatory framework that sets out who is responsible for which services and how they will be held to account, and a planned closure programme of inappropriate institutional in-patient facilities supporting patient choice.

Sir Stephen said: “The Winterbourne View scandal shocked the nation. People are still angry and frustrated that more people with learning disabilities are being placed in institutional care than moved into the community.

“We urge immediate action, to close all Winterbourne-style institutions and ramp up community provision. We need a new Charter of Rights to empower people with learning disabilities and their families, and give them the right to challenge the system.”

On receiving the report, Simon Stevens, chief executive of NHS England, stated that radical changes are needed in NHS and social care, so that people with learning disabilities and their families increasingly take control of how the services they want and need are provided.

The report has also recommended that Health Education England, Skills for Care, Skills for Health and partners should develop a national workforce ‘Academy’ for this field, building on work that has already started.

Chief executive of the NHS Confederation's Mental Health Network, Stephen Dalton, said: “The scale of transformation recommended by this report will need serious consideration in terms of the financial cost of the ambition and workforce implications. The community infrastructure and staff required to allow people, currently in residential settings, to live more independently simply isn’t in place right now – but it can be developed.”

It has been suggested that a ‘Life in the Community’ Social Investment Fund should be established to facilitate transitions out of inpatient settings and build capacity in community-based services.

The Investment Fund, seeded with £30m from NHS England and/or government, could leverage some £200m from other investors to make investment more easily accessible to expand community-based services, according to the report authors.

Care and support minister Norman Lamb MP said: “It is unacceptable for people with learning disabilities and autism to be left in institutions if they can live in their own home or in the community.

“I am going to consult on changing the law to speed up delivery of the Winterbourne View commitments – to see people living in the community wherever possible and able to challenge decisions about their care.”

But Liz Kendall MP, Labour’s shadow care minister, stated that the failure is a “total disgrace”.

She added: “People with learning disabilities and their families don’t want yet another review, they want action. Ministers should now set a clear, two year deadline for moving people out of hospital and into the community.

“Without clear deadlines for action, more fundamental ways of empowering service users, and much stronger lines of accountability this review risks gathering dust alongside all the others.”

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