The government’s NHS reforms could make abuse cases like the Winterbourne View scandal more likely, experts have warned.
GPs, who would take over commissioning healthcare for people with learning disabilities under the Health and Social Care Bill, may lack the expertise to do so, it has been claimed.
Earlier this week, BBC’s Panorama exposed a pattern of abuse at Winterbourne View, a private hospital in Bristol for people with learning disabilities, complex needs and challenging behaviour. The case has resulted in four arrests and the suspension of 13 staff.
“The issue for me is that all the people at Winterbourne were funded by primary care trusts,” said Denise Platt, former chair of the Commission for Social Care Inspection, the Care Quality Commission’s predecessor. “You have to ask the question, linked to the NHS reforms, if you have GPs purchasing this care, does it leave the way open to more Winterbournes?”
Keith Smith, chief executive of the British Institute of Learning Disabilities, did not believe that GPs had the specialist knowledge and expertise to commission services for people with learning disabilities and challenging behaviour.
“Getting the commissioning right for this small group of people is a very specialist requirement,” said Smith, whose organisation advises on supporting people with challenging behaviour.
“Within the context of budget cuts, we are losing commissioners with expertise in this area because they are being made redundant.”
However, David Stout, chair of the NHS Confederation’s PCT Network, said it would make little difference. “There are challenges for commissioners about how they get specialist experts’ input and the NHS reforms are not going to change that,” he said.
There were also widespread calls, backed by Smith and Platt, for commissioners to cease placing learning disabled people in hospitals such as Winterbourne View, as opposed to smaller homes.
“It’s not appropriate to commission this style of care. By and large, it’s an outmoded approach for [a group of] people who have been mishandled in the past,” said Jane Livingstone, chief executive of the Association for Real Change (ARC), which represents learning disability providers. She would think twice about accepting an application for membership from an organisation that provided large, institutionalised forms of care.
This view has been endorsed by several charities and the head of the NHS Confederation’s Mental Health Network, Steve Shrubb, whose organisation represents NHS providers of learning disability care.
Mencap chief executive Mark Goldring said large institutions removed people with learning disabilities from the support networks of their community who might otherwise spot abuse.
“You do need to ensure that people are advocated for and their voices are properly heard,” said Andy Tusk, director of autism services at Ambitious about Autism.
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