The latest plan to end inappropriate learning disability hospital placements post-Winterbourne View has been revealed, following commissioners’ failure to meet a government target to do so.
About 2,600 people with learning disabilities or autism and additional mental health needs remain in inpatient settings despite the government’s 2012 commitment to end inappropriate such placements by June this year – its key response to the Winterbourne scandal.
Today’s report, Winterbourne View – Time for Change, commissioned by NHS England from a steering group, is designed to address that failure through a further plan to transform care. It said community-based alternatives to inpatient care should be boosted through the creation of a mandatory commissioning framework requiring local authorities and NHS clinical commissioning groups to pool health, social care and housing budgets. A social investment fund, backed by £30m of government or NHS England funding, should also be set up to leverage up to £200m capital investment in community services.
The report also called on the government to create a ‘charter of rights’ for people with learning disabilities and their families to underpin all commissioning decisions, including rights to personal health budgets and to challenge admissions in inpatient care.
The commissioning framework should also be accompanied by a closure programme of ‘inappropriate’ inpatient units drawn up by NHS England, it added.
NHS England’s chief nursing officer, Jane Cummings, said it was “committed to playing a full and active in the implementation of the recommendations”, and called on other agencies, such as local government leaders, to do the same.
In a foreword to the report, steering group chair Stephen Bubb, chief executive of the Association of Chief Executives of Voluntary Organisations, said: “Over the past few years people with learning disabilities and/or autism have heard much talk but seen too little action, and this forms the backdrop to our recommendations and our desire to see urgent action taken now to make a reality of the Winterbourne pledge. They deserve better and this report provides recommendations on that essential road map for change.”
However, leading commentators on learning disability care, gave the report a mixed response, saying there was a lack of detail about how its objectives could be implemented.
Rob Greig, chief executive of the National Development Team for inclusion (NDTi) and a former government learning disabilities director, said: “There are good headline ideas but each headline idea begs so many questions about how it will happen. We would have hoped it would have some more concrete statements. There are no ideas in this report other than the social capital finance issue that people haven’t being saying for years. They could have used these months to work out how to deliver these ideas.”
“The question is what’s now going to happen? If NHS England turn around this side of this Christmas, some specific actions to implement the ideas in the report then that could be construed to be some progress,” he said.
Chris Hatton, a learning disability academic at the University of Lancaster, raised similar concerns. He said the report contained some strong general messages but left a “lot of questions” about how some proposals would work in practice.
“Why are some welcome new proposed new rights to challenge not accompanied by a comprehensive strategy for putting people with learning disabilities really in charge of commissioning decisions and a comprehensive programme of legally enforceable rights for people and their families?,” said Hatton.
Other issues raised by Hatton are that the recommended drive to integrate commissioning could be undermined by the fact that health and social care commissioners have a “less than glorious track record” with learning disabilities. He also said the report makes reference to ‘inappropriate’ inpatient services but doesn’t say which inpatient services, if any, are necessary.
Cummings said she understood why people with learning disabilities and their families were angry at the failure of past post-Winterbourne policy but said the plan set out a vision for ‘radical’ change.
“The only answer I can give to that is that I’m committed to making a difference. I’ve met with many families of people with learning disabilities. I know and understand their frustration and I’m absolutely committed, as are the board of NHS England, to making a difference,” she said.
On the issue of how that report’s recommendations would be turned into action, Cummings said: “We will in the new year certainly have a much more detailed response to what we’re going to do and by when. We’ll do that in collaboration with the other people who are required to act in the report.”