Learning disability services ‘at worst damaging’, says CQC

Specialist health services for learning disabled people still need significant improvement, despite the intense focus regulators have given them in recent years.

That was the verdict of a follow-up audit of inpatient services published by the Care Quality Commission last month.

Inspections of 43 NHS and independent sector services from September 2008 to January 2009 found provision was “at best inconsistent and at worst damaging”, though the CQC said improvements had subsequently been made.

The critical findings come two years after the first national audit of provision by the Healthcare Commission found inpatient services were beset by poor leadership, physical environments and care planning.

This led to the introduction of performance indicators for NHS learning disability providers.

However, the 2008-9 audit, which included inspections of 10 services visited during the first audit, found widespread failings.

Most users were denied choice over whom they lived with and which staff supported them, despite the fact that most of the services were longer-term, rather than acute care, settings.

Most services did not provide person-centred plans or health action plans, and advocacy provision was found to have deteriorated overall since the first audit. However, there had been improvements in the involvement of users’ friends and family in services.

The CQC recommended that organisations considered appointing a learning disability champion to their boards to monitor quality.

Steve Shrubb, director of the NHS Confederation’s Mental Health Network, which represents many NHS learning disability providers, said organisations ought to involve more learning disabled people to help drive improvement.

He said this should involve trusts employing learning disabled people as advocates for other service users and in other posts.

David Congdon, head of campaigns and policy at Mencap, said the fact that most people lacked a choice over whom they lived with was “in breach of the principles of Valuing People Now”, the government’s key policy on learning disabilities, published 12 months ago.

He highlighted a passage in the CQC report in which it said it would seek to remind service managers and staff that learning disabled people were of equal value to others. The regulator said it would encourage providers to evaluate their services on the basis of whether staff and managers would themselves find provision acceptable.

Congdon added: “This is a powerful message. If the CQC keeps banging on about that we may start to see some real improvements.”