Private learning disability hospitals perform far worse than NHS

Private learning disability hospitals do far worse than NHS counterparts in meeting care standards, including in areas such as tackling abuse and using restraint, the Care Quality Commission has found.

Its inspection of 145 services for people with learning disabilities and challenging behaviours, provoked by last year’s abuse scandal at private assessment and treatment unit Winterbourne View, found 68% of NHS providers were compliant with standards on safeguarding and care and welfare compared with 33% of independent healthcare providers.

The gap in performance covered all areas of service investigated by the CQC, found further analysis of the regulator’s findings conducted by Improving Health and Lives (IHAL), a Department of Health-funded body that researches health outcomes for people with learning disabilities.

Performance gap between NHS and independent sector

IHAL found that:-

• NHS assessment and treatment and secure units were three times as likely to be compliant with CQC standards on using restraint than independent services.
• NHS units were 4.69 times as likely to be compliant with CQC standards on responding to allegations of abuse than independent providers.
• Independent assessment and treatment units were significantly more likely to have had service users resident for over three years than NHS services. Units are designed to be for short-term placements.

“For every comparison made, units operated by NHS trusts were more likely to be compliant than services operated by independent healthcare providers,” said the IHAL report. “These differences in probability of compliance are highly unlikely to be accounted for by random error or chance fluctuation.”

The gap in performance “raises important questions about the patterns of commissioning behaviour and practices”, said the CQC in its own review of its inspection programme.

Findings queried

However, the findings were questioned by Professor Chris Thompson, director of public affairs at independent provider Priory Group, which provides a number of learning disabilities services under the Craegmoor banner. Thompson said 90% of Craegmoor’s learning disability services met the CQC’s standard on care and welfare, compared with 60% nationally, and 94% met the standard on safeguarding, compared with 66% nationally. This showed that the “generality that independent providers are more likely to fail than NHS providers” was “too broad in its assertion”.

Thompson said the comparison between NHS and independent services was not “like-for-like” as the latter were more likely to provide longer-term or secure placements. While this explained some of the difference in performance, he said other explanations could include that some independent providers were small-scale and lacked the infrastructure to quality assure services and deliver training to staff to work with this client group. He also said he was “not convinced” that the CQC inspected private and NHS providers consistently.

Other CQC findings

The CQC found that just 48% of sites were compliant with both safeguarding and care and welfare outcomes across all 145 services inspected, which included 32 residential care homes. The regulator identified particular failings in relation to care planning, the use of restraint and “unacceptably long” lengths of stay in assessment and treatment or secure units of up to 17 years.

“All too often, inspection teams found that people using services were at risk of being restrained inappropriately because staff often did not understand what actions count as a restraint, and when restraint happened there was inadequate review of these [incidents], putting people at risk of harm and abuse,” said CQC chair Jo Williams.

The CQC said commissioners “urgently” needed to review care plans for people in assessment and treatment services to ensure people could be moved on into more appropriate accommodation. Councils and NHS commissioners also needed to invest in community-based alternatives to hospital provision for people with learning disabilities and challenging behaviour.

The regulator also called on providers to take urgent action to reduce the use of restraint, provide training for staff in appropriate use of restraint and improve monitoring of the practice. Knowledge of the deprivation of liberty safeguards also needed to improve, it said.

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