Open Forum

Whether run by the NHS or by councils, learning difficulty services will not improve until clients choose their services.

Two days before the Healthcare Commission unveiled the appalling conditions in Orchard Hill I had a call from the mother of Joy. “I have to thank you so much,” she said. “Joy was with us over the Christmas break: she was a real delight. So different from how things used to be.”

Joy is 33 and severely autistic. Before she came to live in my small residential home, she was living in residential care in Devon. When I visited her I was told that she was “trouble” and “difficult”. Like schoolchildren, residents’ behaviour was rewarded with stars.

Joy now has a home that she likes, with people she likes. She can, within the limits of her disability, make decisions about her life.

This is not so for Helen. She is 34, has a learning difficulty, lives with her parents and wants very much to live with us. But there is one problem: her borough not only will not pay the fairly modest fees (which I have twice reduced at its request). They want to house Helen under a supported living scheme which will cost them nothing but where she will receive none of the attention and stimulation she needs. After months of fruitless representations, she and her parents are making a snail’s progress through the council’s complaints procedures.

So, too, is Christine, another would-be resident, and her parents (who also allege a cover up by the same council of abuse in the home where she was formerly placed).

So much for choice and “valuing people”. But, of course, there’s the good news: in the wake of the Orchard Hill scandal, the government is considering shifting all learning difficulty services to local authorities. I have worked for an NHS learning disability trust. I know their severe shortcomings and I doubt that Helen and Christine would notice the slightest difference in who commissions until “choice” is something other than words on the lips of politicians and directors of adult services.