The government must initiate the closure of Winterbourne View-style learning disability hospitals by instructing the NHS to start decommissioning them, Paul Burstow has said.
The call, which goes beyond the government’s current position, came in an interview with Community Care three weeks after Burstow lost his job as care services minister after more than two years in post.
Burstow also called on ministers to commission a thorough probe into the level of funding going into social care to ensure the sector is not short-changed in the next government spending review, expected next year. In a wide-ranging interview, he also said he would pursue his interest in social care from the backbenches, developing policy in areas including the role of social workers in community development.
Winterbourne View response
Burstow said the final report of the Department of Health’s review into the abuse at Winterbourne View, due this autumn, should tell NHS commissioners to start decommissioning assessment and treatment units for people with learning disabilities and challenging behaviours, such as Winterbourne. [Listen to Burstow on the government’s response to Winterbourne View]
The DH’s interim report into Winterbourne, published under Burstow’s watch in June, said the client group should receive personalised, community-based services, and not be placed long-term in assessment and treatment units. However, sector leaders warned that the government’s goals would not be achieved without it instructing the NHS to change commissioning practice – a position Burstow has now reached.
“There has to be a clear determination to start closing these places, otherwise nothing will actually change,” he said.
Social care funding
Burstow spent his time in office stoutly defending the government’s 2010 spending review, which led to estimated budget reductions for councils with social services responsibilities of 4.7% in 2011-12 and 3.3% in 2012-13, in cash terms.
However, with the government due to produce a second spending review next year, to cover 2015 and beyond, he warned ministers that insufficient funding for social care would have dire consequences by shunting costs on to the NHS.
He said the government needed to carry out a review of the long-term costs of social care, recognising its interdependency with the NHS and the impact of preventative interventions in limiting costs. [Listen to Burstow on social care funding]
He said this could create the “space to have a grown-up debate about what the taxpayer is going to put into the system”.
Such a review would look at the overall level of funding for social care, rather than the balance between the state and the individual, as had been examined by the government-commissioned Dilnot review, which reported last year.
Since leaving office, Burstow has been outspoken in his criticisms of the Treasury for allegedly blocking agreement to implement Dilnot’s proposals to cap long-term care costs for individuals, a charge the Treasury has rejected.
He told Community Care his proudest achievement in office was to publish the care White Paper and draft Care and Support Bill, whose reforms he said would have “implications for 20-30 years”. These include putting adult safeguarding on a statutory footing, introducing new duties on council to fund preventive services and promote a diverse market in high-quality care, and setting a national minimum threshold for support.
However, Burstow said the reforms would only be “historic” if a cap along the lines proposed by Dilnot were part of them, though he said that he was hopeful that his successor, Norman Lamb, might be able to achieve this. [Listen to Burstow on prospects for the Dilnot reforms]
On the safeguarding reforms, he said he had initiated, while in post, a consultation into whether social workers should have powers to enter homes where they suspect abuse but cannot speak to the alleged victim, because he feared there would otherwise be a “gap in the law”.
“I was concerned we were leaving a gap in the [draft Care and Support Bill] and that’s why we’re having the consultation, to establish whether or not there is a consensus about where you draw the line in terms of those powers of entry.”
However, the area is controversial among social workers pitting those who say such a power is a necessary last resort to protect people coerced into staying silent about the abuse they are facing, against those who fear the power would be used in a heavy-handed manner.
Social work role
Before the publication of the White Paper, Burstow had promised to set out a strong role for social workers in shifting the care system from crisis response to the promotion of well-being, through community-based practice that helped people build on their strengths.
However, while community development, and social workers’ role within it, was mentioned in the White Paper, Burstow said this idea needed to be fleshed out further, and that this would be something he would be looking at from the backbenches.
“The White Paper begins to mark out some new territory about what are described as asset-based approaches to social care, not looking just at what people can’t do but the social fabric within which they live their lives. I think there’s more work to do in that area; it’s an area that I would mark out as one in which I would want to do more so it becomes an integral part of social work practice and care and support.”
He stressed that being outside government would enable him to help develop policy on social care in a way that had been difficult to do within Whitehall.
“There’s a funny thing about being inside government; you’re implementing, you’re firming up on the detail of policy that you’ve already got,” he said. “It’s actually harder to think completely outside the box and develop entirely new policy from scratch.”
“My passion for these issues has been there for 15 years at least and therefore I can’t just walk away and turn my back on the things I care about. I can now use what I’ve learned from being on the inside to help make better policy and set some of the agenda in this area, along with others, over the next few years.”
Learn the lessons from Winterbourne View and improve your safeguarding practice by attending Community Care’s conference on safeguarding adults in care homes and other residential settings, on 4 December.