The government’s ambitions to end Winterbourne View-style hospital care for people with learning disabilities will fail because of a lack of mechanisms to drive change. That was the warning from learning disability leaders, after the Department of Health produced the interim report of its review into the failings exposed by last year’s abuse scandal at the Bristol hospital.
The DH found too many people with learning disabilities and challenging behaviour were placed in assessment and treatment units such as Winterbourne View and were staying there too long, in a model of care that "has no place in the 21st century". Instead, people should be offered local personalised supportand only placed in hospitals for short periods, when absolutely necessary, and where units are of high quality.
However, while backing the government's ambitions, sector leaders slammed a lack of action to bring about change for the estimated 15,000 people in England with learning disabilities or autism and behaviour that challenges, an estimated 1200 of whom are placed in hospitals.
"A number of new pieces of national advice and guidance are proposed but there is an extremely disappointing lack of action that will really help local people to change how they commission and provide services," said Rob Greig, chief executive of the National Development Team for Inclusion and former DH national director for learning disabilities. “Past progress has been achieved through a combination of clear national targets, active practical support for local change, and robust monitoring. In this report, the national targets and robust monitoring are unclear and the active, practical support for local change is missing."
"The government’s proposals on local action will not be enough to create the systemic change needed," said Viv Cooper and Mark Goldring, chief executives of the Challenging Behaviour Foundation and Mencap respectively. "We are looking for a direct commitment from government to put in place a strong, practical action plan with clear targets when it publishes its final review." Goldring is among those who has advised the DH on its Winterbourne review.
Greig, Mencap and the foundation were among 86 signatories to a letter last year to the prime minister, in response to the Winterbourne View scandal, which called for:-
- Commissioners to be prevented from purchasing hospital placements for people with learning disabilities and challenging behaviour on the basis that they provide "poor outcomes, often at very high cost".
- A two-year programme of support for commissioners to develop local community-based alternatives to hospitals, improve care planning to prevent such placements and provide person-centred reviews for people currently placed in hospitals.
However, today's DH report stops short of such actions. Among 14 national actions to achieve its ambitions, the DH said it would:-
- Develop a clear description of the essential components of a model service for this client group by March 2013.
- Develop guidance on what service users should expect from services to inform health and social care commissioners' contracts with providers.
- Discuss with providers for this client group the development of a voluntary accreditation scheme.
Despite the criticisms, care services minister Paul Burstow said: “Our national actions will mean that people have access to good care, closer to home. They will make sure those who provide care, commission care and care staff know exactly what part they must play and what standards are expected of them.”
Today's paper will be followed by a final report from the Winterbourne review later this year, following the conclusion of criminal proceedings and the publication of the serious case review into the scandal. Burstow said the final report would set out "firm actions at a national level" to ensure people receive personalised care, and would be followed by a further report a year later "to make sure real progress is being made".
However, localising provision for people with learning disabilities and challenging behaviour could mean that their specific needs were not met because of a loss of specialisation, said Professor Chris Thompson, director of public affairs at independent provider Priory Group.
"You are talking about relatively few people for any given area," he said. "I'm not sure how much you can localise provision without losing specialistation but I'm sure it's more complicated than the debate has been set out today."Mithran Samuel is Community Care's adults' editor.
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