Sector looks on with dismay at lack of progress on transforming care post-Winterbourne

One year on from the government's commitment to end inappropriate hospital placements for learning disabled people, optimism has turned to pessimism

Twelve months ago care and support minister Norman Lamb vowed to end inappropriate placements of people with learning disabilities in mental health hospitals by June 2014, as part of the government’s response to the Winterbourne View scandal. In future, stays in hospital would be restricted to short spells in local, small-scale units that provided assessment and treatment to deal with breakdowns in health and support: community-based support, close to home would be the norm.

Lamb’s words were backed up by action. He gave the Local Government Association and NHS England £2.86m to set up a programme – the Winterbourne View Joint Improvement Programme (WVJIP) – to help local commissioners transform care in line with the vision. He set tough timescales for commissioners to review the care needs of learning disabled inpatients and develop personalised care plans to help move all those who could do so back to their home communities by next June. And 51 organisations – representing health and social care commissioners and providers, leading charities and professional bodies – signed up to delivering the vision. Optimism was in the air.

From optimism to pessimism 

But 12 months on, that optimism has turned to pessimism.

On Wednesday, Rob Greig, the person who led the implementation of the landmark 2001 Valuing People white paper as the Department of Health’s learning disabilities director from 2001 to 2008, wrote the following in a blog post for the Think Local Act Personal partnership:

The post Winterbourne View agenda has had a seriously disappointing year, with the nationally led programme involving a lot of talk but little evidence of real action.”

This is a damning indictment on the past year from a leading voice in learning disability care. Speaking to me earlier today, Greig said that the WVJIP had spent insufficient time working alongside commissioners to help guide them in reshaping services, which was the only way to achieve real change.

Greig’s comments were followed by news that the WVJIP’s director, Chris Bull, had left the programme, with his number two, Ian Winter, due to follow suit next week. A spokesperson for the programme said that Bull was working part-time and it was felt the programme needed a full-time head, and that Winter was coming to the end of his contract. Though both had made “valuable contributions to the programme in its initial phase”, the spokesperson added: “As the focus of the programme changes, the opportunity has been taken to review the structure of the team in order to ensure that it reflects the requirements of the next stage.” This suggests that, at some level, it had been decided that a change in leadership was required. That change has now happened with the appointment, today, of Bill Mumford, as programme director, today. Mumford, chief executive of learning disability provider MacIntyre, has been seconded to lead the programme for 18 months.

How far we have to go

If the government and local areas don’t stop dithering, we will miss this unique opportunity. In so doing, they continue to fail not only people with a learning disability, but everyone who saw or heard about what happened at Winterbourne View and demanded change.”  Vivien Cooper and Jan Tregelles, chief executives of The Challenging Behaviour Foundation and Mencap 

The scale of the challenge facing him was made clear today. A census of inpatient provision by the Health and Social Care Information Centre found that there were 3,250 people with learning disabilities in units as of September – virtually the same figure as when the last census was carried out in March 2010. Sixty per cent of this group had been on hospital wards for over a year. Though the Winterbourne transformation programme was only launched in December 2012, ending inappropriate hospital provision for people with learning disabilities had been government policy for over a decade and numbers had come down from 2006 to 2010.

This lack of progress was described as a “national disgrace” by respected commentator and former Department of Health (DH) personalisation lead Martin Routledge, now operations manager at In Control. Specialist charities Mencap and the Challenging Behaviour Foundation said the “distressingly slow” progress was undermining the confidence of families of people in inpatient units that the government process would improve their loved-ones’ lives.

Government verdict

Alongside the census, the DH delivered its own verdict on progress to date. Unsurprisingly its one year on report was less bleak than sector leaders’ comments. For instance, it found that most of the 75 commitments in the concordat have been delivered or are on track. However, a foreword from Lamb illustrated the scale of the challenge ahead. It listed a number of achievements from the programme to date but all of these were either procedural (for example, the establishment of a new inspection framework for learning disability services coming into force next year), related to information gathering (the census) or largely irrelevant (the publication of legislation to put adult safeguarding boards on a statutory footing from April 2015).

More tellingly, he said, repeatedly, that the pace of progress will need to be accelerated if the June 2014 target is to be met. He also pointed out that there is still doubt over the number of people whom the Winterbourne programme should be seeking to help.

Question marks remain over patient numbers

Of the 3,250 people identified by the census, most of the 585 in high or medium-secure settings are likely to be ineligible on the grounds of being placed in hospitals for reasons of public protection. But do all of the 2,665 others on general wards or in low-secure settings count? And are these 2,665, broadly, commensurate with the 2,621 people with learning disabilities identified, separately, by NHS commissioners as being placed in hospital settings?

In his foreword Lamb said that these figures needed to be reconciled. But with less than six months to go until the June deadline, how realistic is it to do this and also deliver changes to people’s care and lives?

Some of the other findings in the census are also concerning. Of the 3,250 patients, providers could not provide a valid home postcode for 910 of them –  a key gap given the ambition of people receiving services as close to home as possible. While the researchers were able to find postcodes for most of the 910 by using their unique NHS number, this raises significant questions about the extent to which some providers – and commissioners – are geared towards supporting people to return home.

The future

The next six months should see faster progress. For one thing, the WVJIP has spent only £400,000 of its £2.86m so far and is due to use the coming period sending improvement advisers into local areas to provide tailored support to commissioners in reshaping services. This is the sort of support that Greig thinks is crucial to delivering real change and, in his blog for TLAP, he said he could see evidence that the programme was starting to make an impact. Greig himself is optimistic that progress will be made, particularly given the appointment of Mumford to lead the programme.

Mumford is incredibly well-respected across social care for his strong commitment to personalisation, service user involvement and workforce development, and his appointment has been widely welcomed. Lamb said: Bill Mumford will provide strong leadership at a critical time to drive this work forward and I welcome his appointment.”

At the same time an enhanced quality assurance programme, under the auspices of NHS England, is sending social workers and nurses to review the cases of a sample of patients, including those formerly placed at Winterbourne View, to assess how well they are being supported to return to the community. This should also accelerate progress, as should the introduction of key performance indicators for commissioners from April 2014 to help hold them to account for progress in transforming care.

All of this is coming rather too late to come close to meeting the June 2014 target. But that would not be a tragedy if, six months from now, true progress is being made in helping the people concerned return to living a normal life, in a home they can call their own, alongside family and friends. Let us hope that health and social care leaders – and government – rise to this challenge, or a significant opportunity to bring some good from one of social care’s darkest hours will have been lost.

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One Response to Sector looks on with dismay at lack of progress on transforming care post-Winterbourne

  1. Martin Routledge December 13, 2013 at 4:59 pm #

    When I spoke of a national disgrace today I was referring to one that has been years in the making for which many of us must take some responsibility. It is notable though that progress was made in the 2006-10 period and it is no coincidence that this was when the Valuing People Team had a targeted and supported programme to drive change, building on the success in getting people out of long stay hospitals. Keeping a “priority” while removing the team delivering it was never going to work. We must look forward though. The June 2014 target is never going to be met and it would be a mistake in my view to insist on it as this could have unfortunate, unintended consequences. In Control and partners have just started working with a collaborative in one region and it is clear that there are many who really want values-driven and rapid action to better support people with complex needs. They have asked for help with this. There are some quite significant system inhibitors though – health commissioners are going to be have to prepared to transfer the cash currently used in the assessment units for better local use. Some providers of the current services are going to have to stop seeing people as sources of revenue. Staggeringly I heard informally recently of one very senior provider manager planning to expand their “business” in this area. The minister and new programme director are going to need to have an early sit down and come up with a new plan – building on the good things that have happened, with some challenging but realistic targets and timescales and then both provide support to and put pressure on the key system managers – programme managing them through.