People with learning difficulties are being put into independent
sector hospitals rather than being cared for in the community
because commissioners have failed to develop adequate services,
critics have warned, writes Maria
Community Care minister Stephen Ladyman has accused authorities
of “flying in the face” of the Valuing People
white paper by “reinventing” the long-stay hospital
“by the back door.”
The number of registered independent beds currently stands
around 1,000 with around 900 actual patients, according to a
Healthcare Commission survey published in July.
Contrary to expectations, the closure of long-stay hospitals has
not borne out the promise of more community services as local
authorities and NHS chiefs look for an “easy” way out,
A question of money?
John Dixon, chair of the disabilities committee for the
Association for Social Services Directors said there was “no
excuse” for a return to institutional care, but highlighted a
lack of investment in service planning.
He said money from the closure of long-stay hospitals had not
been effectively redirected.
A recent government Learning Disabilities Taskforce report
highlighted that of the £4bn spent annually on learning
difficulties services, only 0.43 per cent was directly related to
implementing the Valuing People white paper
Too much of the budget is being spent in areas which “bear
no relation to a modern learning disabilities service,”
rather than improvements in housing, support and access to
healthcare, the report said.
Part of the budget is being “wasted” in independent
sector hospital places, which campaigners say are not
Learning disabilities charity Turning Point highlighted that
there was “extensive” research to show that long-stay
hospitals have “poorer outcomes”.
A spokesman said: “Independent sector hospitals are
drawing resources away from support living, leaving no impetus to
develop community care.”
ADSS spokesman Dixon added: “Hospital places of this kind
are simply more expensive than community-based care. There is
enough evidence to show that people with complex needs can be
placed in self-managed care in the community, with direct or
indirect payments, and this costs significantly less.”
He said the financial solutions “lay in the hands”
Passing the buck?
Local authorities have also been criticised for using
independent sector hospitals to “pass the buck” for
people with very complex, “borderline” mental health
Dixon said: “There is a grey area between severe learning
difficulties and mental health which is being exploited. People
with complex needs are being put in hospital, when they could be
cared for in the community.”
People with learning difficulties who are currently in
independent sector hospitals are usually formally detained under a
section of the Mental Health Act and often have
“forensic,” or mental health needs, according to the
Department of Health.
Mencap said local authorities are “filling a gap” in
services by dealing with people with complex needs in this way.
Head of external relations David Congdon said: “When
social services find it difficult to place a client with complex
needs, health services have to pick up the pieces. The only places
available are often health facilities of a psychiatric
He also raised concern that some people with learning
difficulties may be placed on a section in hospitals as a way of
passing on responsibility for them.
Congdon said: “We don’t want to see large-scale
institutions holding people on a long-term basis. There is a range
of facilities in the community, and appropriate services must be
Confidence in the community?
Carers or service users who have been used to long-stay hospital
care may lack confidence in the idea of community-based provision,
making independent sector hospitals a “safe” option,
according to Dixon.
He said: “We need to work with carers, particularly older
parents who feel unable to cope that we will be able to provide
safe care in the community.”
Turning Point added: “The message should be a hospital is
not a home, not matter how good the care is.”