Bleak prospects for reforming Winterbourne-style provision

The prospects for reducing the use of outmoded learning disability hospitals such as Winterbourne View are bleak because of a lack of incentives to change from providers, commissioners and the regulator.

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The prospects for reducing the use of outmoded learning disability hospitals such as Winterbourne View are bleak because of a lack of incentives to change from providers, commissioners and the regulator.

That was the warning in a report from the National Development Team for Inclusion (NDTi), based on a Department of Health-funded project on reforming private sector hospital provision in line with government policy.

The report said the services were generally out of step with personalisation policy and good practice because they congregated people in large numbers, offered little chance for service users to engage with the community and were remote from their homes and connections.

However, providers were reluctant to change and few engaged with the NDTi project.

The main reason for providers’ aversion to change was a reluctance, in economically difficult times, to risk closing off a source of income “in favour of a (largely untried) alternative approach that may take a couple of years to show a comparable financial return”.

However, it also found commissioners were reluctant to become involved in driving change, with no external pressure on them to do so.

Part of the trouble, the report said, was the multiplicity of commissioners with which the hospitals worked. With one of the hospitals profiled having 16 commissioners, the report concluded it was too difficult for one commissioning authority to have enough interest to engage in a change process.

Regulation was also a problem, it found, with the Care Quality Commission’s role not being to enforce national policy but to “review standards within a service design out of line with policy”.

The study was completed before BBC Panorama exposed alleged abuse at Winterbourne View, a learning disability hospital in Bristol run by Castlebeck that has since closed after legal action by the CQC. Co-author Rob Greig, chief executive of NDTi, said the scandal could increase the potential and desire for change within privately run learning disabilities hospitals.

“What Winterbourne View might do is encourage commissioners to get their act together and commission services that are more in line with policy and good practice,” he told Community Care. “That way, they won’t even commission services like those at Winterbourne View.”

Greig said the high-profile nature of the case could also lead government to instigate a programme of change that would help commissioners achieve this goal.

There is already evidence that the Panorama investigation has moved commissioners to take more interest in practice. Earlier this week Community Care reported that commissioners are visiting hospitals more frequently.

And last week, after a crackdown by  the CQC, Castlebeck agreed to close a second learning disability hospital, Arden Vale, after the regulator initiated legal action due to safeguarding failings.

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