Winterbourne-style hospital placements to end by 2014, says minister

No learning disabled person will be placed in Winterbourne View-style hospital services by June 2014, care services minister Norman Lamb pledged today as he published the government’s response to the abuse scandal.

Large-scale assessment and treatment units such as Winterbourne would no longer be used by the NHS to house people with learning disabilities and challenging behaviour, while people who need such inpatient services would receive them closer to home, in small units and for short periods.

The estimated 1200 people in assessment and treatment units in England would be reduced to about 300 under the plans, with community-based support commissioned for the estimated 3,400 people in NHS-funded inpatient learning disability or autism services, which includes assessment and treatment units.

The process will start with social workers and other professionals reviewing the care and support needs of the 3,400 inpatients by June 2013, agreeing care plans for each to provide community-based support.

“We have for too long tolerated people with learning disabilities being put into the wrong settings, living in hospitals completely inappropriately, being put under stresses so that their behaviour is inevitably affected, where we know that the correct model of care is completely different,” said Lamb.

Monitoring progress

Following the government’s interim report on Winterbourne, published in July, campaigners warned that its ambitions would not be delivered on because ministers were not prepared to pressure commissioners into stopping hospital placements and developing community solutions.

In response, the final report set out a number of mechanisms to support and track progress and hold NHS commissioners and councils to account. Lamb announced that:

• Health and social care leaders, including the NHS Commissioning Board, the Association of Directors of Adult Social Services and the Local Government Association, had signed up to a concordat to deliver on the government’s pledges.
• These organisations will set up a Joint Improvement Programme within three months, backed by £2m to £5m in DH funding, to support councils and clinical commissioning groups (CCGs) to transform provision in their areas. Directors of adult services and CCGs will have to provide assurance to the programme that they are making progress.
• By April 2013, the DH will develop targets to track progress, for example on the numbers of people in hospital, lengths of stay, incidents of restraint and numbers of safeguarding alerts.
• The DH and improvement programme will publish progress reports on how well localities are doing against targets.
• The DH’s Learning Disability Programme Board, chaired by Lamb, will monitor progress and challenge commissioners to improve where necessary.
• The DH will publish a progress report in December 2013 and, as soon after the deadline of June 2014 as possible.

Mencap chief executive Mark Goldring said the programme of monitoring gave him confidence that services and outcomes could change for the client group.

Reflecting on previous learning disability scandals, he said: “There have been reports in the past; there have been commitments after every scandal. What makes this report positive is that everyone has signed up in advance and everyone is accountable through appropriate mechanisms.”

Social work

The signatories to the concordat include the British Association of Social Workers and The College of Social Work, who have pledged to produce “key points guidance for social workers on good practice in working with people with learning disabilities who also have mental health conditions”.

Other key measures in the government’s report include:

• A presumption that care and support for the estimated 15,000 people with learning disabilities and challenging behaviour will be commissioned through pooled NHS and local government budgets.
• For the Care Quality Commission to inspect learning disability providers against a new model of care that specifies that services should be provided locally and by skilled workers, focus on improving quality of life and human rights and, in the case of inpatient services, be planning for people to return to the community.
• For the CQC to consider how it can use existing powers to hold corporate providers to account for failures of quality within their organisations, possibly by requiring an individual board member to be accountable to the regulator for quality.
• For the government to consider potential new criminal offences to hold corporate organisations to account for service failures, possibly including an offence of corporate neglect.
• For the DH to produce best practice guidance on positive behaviour support by the end of 2013 to ensure that restraint is only ever used as a last resort and never to punish or humiliate.

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