From most urban centres in the UK Budock Hospital in Falmouth is a long way away. Even when you cross the river Tamar into Cornwall and think you must be nearly there, you’re not. Perhaps that’s why it took the Valuing People message so long to arrive.
This time last year all hell was about to break loose over Budock, which was at the centre of claims that people with learning disabilities had endured a catalogue of abuse and poor practice. A report by the Healthcare Commission and the Commission for Social Care Inspection also revealed conditions were no better in the local NHS-run Supported Living Service, which bore little resemblance to supported living schemes in other parts of the country and were, in fact, illegal unregistered care homes.
In short, the whole thing was a mess. But both local and national authorities had been aware of the problem well before the report was published last July and measures had already been set in train to put things right. A key part of that involved bringing in an external change team to support local managers and staff in both the NHS and the local authority with the task of hauling Cornwall’s outdated learning disability service into the 21st century.
The head of that team is Geoff Baines, a qualified social worker who was managing learning disability services in neighbouring Devon when he was asked to work with the change team, which was originally brought in for six months. But as the scale of the problem became clear the team was asked to stay on for an extra two years and Baines was appointed to the lead role last May.
Since then he has been overseeing a quiet revolution and, according to some observers, has made strides in cutting through red tape and transforming services so they are built around the needs of the individual, not the needs of the organisation. But he is the first to admit there is still a long way to go.
“We are talking about changing people’s lives in a way that will last for ever, so it can’t happen overnight. We have achieved a lot of milestones but this is just the start.”
Like every outsider who heard how people with learning disabilities had been treated in Cornwall, he was shocked by what he discovered. “People had lived in the hospitals for years and there were no concrete plans for them to move out at the time of the inspection. Staff at the hospitals and in the Supported Living Service had not taken Valuing People on board.
“I’d heard about things like it in previous inquiries but I’d never seen it for myself,” says Baines. “It’s clear that if things are left unattended and good practice is not in place, then this is the sort of thing that can happen.”
Baines’s immediate priority was to support people to move out of the four remaining long-stay institutions – Budock, Boslowick Road in Falmouth, West Heath Hospital, Bodmin and Tamarsk in Redruth. Another key focus was ensuring the adult protection system was made to work properly. A third task was to improve the Supported Living Service, which consisted of 46 small homes dotted over Cornwall, each with between two and five residents.
Baines says: “People had been living in them for 15 years or more. But for whatever reason they were unregistered care homes and so they were illegal. A big task has been to make these services legal and we are in the process of registering them with the CSCI and also asking people if they want to carry on living in them.
“We are working on a programme to help individuals choose new care providers but we’re having to take it one step at a time. Direct payments may be something people wish to have in future but first we need to create a system for the whole of adult social care. The key thing is that people have choice over their provider so they can hold them to account.”
Sixteen new service providers with good track records have been invited to set out their stalls to people with learning disabilities and their families. Some clients are keen to keep the staff they are used to as they move across to a new provider, others aren’t, but every one of the county’s 400 support staff will have to undergo a major training programme.
The change team has made the most impact with the 28 people from Budock Hospital and Boslowick Road who have now been moved out into a supported living scheme worthy of the name.
But improving the lives of the people in the group homes is proving harder. Most of the 168 people in question have high support needs. Some have families who are in denial and refuse to believe their relatives have been victims of abuse and poor practice.
Baines says: “The majority of families think their sons and daughters have been in supported living because that is what it is called. And it’s true there were some good places but there was also some very bad practice and some people with learning disabilities were unhappy.
“It’s been unsettling for the families and we are working with carers’ leaders to support a new carers’ network. We are trying to fully involve the people with learning disabilities and their families.”
Baines is keen to emphasise that he recognises the importance of building up local skills so when the change team and the myriad outside consultants finally pull out, the changes introduced will stick. “Efforts are focused on a sustainability plan to keep the changes going. That’s crucial to what we’re about.”
So how do others think he is doing? Reg Broad, chair of East Cornwall Mencap, who blew the whistle on the scandal in the first place, describes Baines as “a man you can do business with”.
“He’s a good listener and he acts on what he hears. It’s a case of so far so good. They are doing really well and they’ve closed down the worst bits, which were those two long-stay hospitals.”
Broad says the way the former patients have been supported in moving into their own homes is “fantastic”. “If they can carry that through to those people in the Supported Living Service we will be delighted. The question is will they have enough money to do it?”
Carol Tozer, director of adult care for Cornwall, insists there will be enough cash.
“On the local authority side we are putting in an extra £4.2m and Cornwall Partnership NHS Trust has come up with £5.2m for all learning disability services. We’re talking about a significant investment to support real change. We don’t just want to be good enough, we want much more than that.”
It’s a point echoed by Baines: “At the start we learned a lot from the In Control pilots but now we are gaining experience ourselves in giving people a real choice and direct control over their lives.
“We’ve come a long way with supporting people with learning disabilities to choose from a range of providers and we don’t know anyone else in the country working in the same way and on this scale in such close partnership with people and their families.
“What we’re doing is the foundation work. But the culture is changing and I believe Cornwall could end up as a beacon of good practice. The aim is not just to make Cornwall as good as elsewhere. The ambition is to be the very best.”
What the july 2006 report said
The Healthcare Commission/CSCI report was scathing about the quality of care for people with learning disabilities in Cornwall. Among the comments were:
“Investigators found evidence of institutional abuse, including some staff hitting, pushing and dragging people. Some staff were also reported to have withheld food and given people cold showers
“The investigation team also found an over-reliance on medication to control behaviour, as well as illegal and prolonged use of restraint. One person spent 16 hours a day tied to their bed or wheelchair for what staff wrongly believed was for that person’s own protection.”
● Cornwall moves long-stay hospital residents into new NHS-run, “cutting edge” Supported Living Service in the community.
● Cornwall Partnership NHS Trust awarded the highest rating of three stars by the Healthcare Commission.
● East Cornwall Mencap submits formal complaint over “financial, psychological, emotional and institutional abuse and neglect” of people with learning disabilities in Budock Hospital and the Supported Living Service.
● The Healthcare Commission loses patience with the slow progress of local procedures and launches a formal investigation of its own with the Commission for Social Care Inspection.
● Change team brought in for six months to support NHS and council staff in improving the care of people with learning disabilities.
● Change team involvement extended for further two years.
● Healthcare Commission and CSCI publish damning report criticising “significant failures” and “widespread institutional abuse”.
● Recommendation that Cornwall Partnership NHS Trust is placed on special measures.
● £1.8m Supporting People grant to be withdrawn over next two years because it has been used for mini-institutions.
● Budock and Boslowick Road Hospitals are closed. Residents move into their own homes.
● West Heath and Tamarisk treatment centres due to close.
● Target date for the 168 people with learning disabilities in the Supported Living Service to have had chance to choose new providers.
Views from Cornwall
‘Things are already starting to change for the better’
● “I still say adult social care in Cornwall is underfunded.” Reg Broad, East Cornwall Mencap
● “I was so shocked by what I saw down there when I went in with the inspectors. I’m going back again in two months to help people speak up for themselves. But from
what I hear things are already starting to change for the better.” Karen Flood, co-chair, National Forum of People with Learning Difficulties
● “There has been no question of shifting the blame to health. We are all in it together.” Carol Tozer, director of adult social care
● “It will take a long time for us to trust health and social care after what happened. We have the right to say no to abuse and protect our friends with complex needs.” Anthony Dunn, Cornwall People First
● “We now ensure our adult protection committee meetings are attended by officers at chief executive, director or board level. That’s a big change. I know in many parts of the country they have more junior people but that doesn’t give it sufficient clout.” Carol Tozer, director of adult social care
● “It’s important people going in to do short-term contract work leave the scaffolding in place so things don’t collapse once they leave. It’s no good parachuting in, doing some work then just naffing off.” Temporary consultant, Cornwall
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This article appeared in the 28 June issue under the headline “Cornwall: has the tide turned?