A step-by-step guide to helping people with learning disabilities leave hospital placements

By Bev Ashman, Practice Development Co-ordinator, United Response

The 2011 Winterbourne View scandal was a stark reminder to all those working in social care that commissioning out-of-area and emergency placements can damage the quality of care received by adults with learning disabilities and autism. It reinforced the need for high-quality care provided in community settings, as outlined by the late Professor Jim Mansell, and it led to a commitment from government and sector alike to bring an end to all inappropriate placements.

Three years on, however, and despite much effort to the contrary, many people with a learning disability or autism remain in inpatient care for long periods of time, often without a clear discharge plan in place.

Bureaucracy

Complex bureaucracy, uncertainty over accountability, and traditional mistrust between organisations whose cultures and operational processes differ, all slow down the process of moving people on, as does fear of failure and concerns about crossing established professional boundaries.

Some progress has been made, but not across the whole sector; that will only happen if all organisations openly share their learning.

United Response has a track record of successfully supporting people with high levels of challenging behaviour to move from institutional settings into their own homes in the local community. Like others, and for many of the reasons described above, we have sometimes got it wrong, and this drove us to develop a checklist of the elements and processes that are essential for a placement to work well.

Eight steps

The Transforming Care: New Referral Checklist, which has been created with input from family members, people we support, staff and other professionals, maps out, in sequential steps, the eight phases needed to successfully move someone back to their community.

The aim of the checklist is to provide everyone involved in creating services for people whose behaviour challenges with an agreed route they can use to drive the move forward successfully and in partnership. By working through the checklist, stakeholders are encouraged to address early on in the process key issues, such as who will fund and deliver the various components of the project, and by when.

The importance of information gathering is highlighted in the second stage of the checklist, which lists all the different sources and approaches that should be considered in order create a service that reflects all the needs and wants of the individual, as opposed to just their most obvious care and support requirements.

Recruiting the right staff

Recruiting new staff and developing the skills of existing staff is addressed in phases three to five, and needs to happen in advance of the new service being created, to give everyone involved the opportunity to get to know each other, and for staff to be able to successfully and confidently support the person to move into their new living environment.

Creating the appropriate living environment takes place in the sixth phase, where the physical aspects as well as the location of the individual’s new home need to be considered. Are there stairs in the property for example, and is it close to family members and transport links?

Phase seven addresses the legal issues that stakeholders must consider and agree before the placement can go ahead, and finally phase eight lists eleven requirements which must be in place before the individual can make the move to their new home. This includes a front-line manager and staff being, support from external professionals and emergency plans all being in place.

Sharing learning 

By publishing our checklist on our website we hope that our learning can be shared across the sector.

Bill Mumford, the director of the Winterbourne View Joint Improvement Programme, recently stated that what was most needed to drive forward the reshaping of services was “behaviour change”, with local areas working together to achieve it.

We hope that like us, others will recognise that need to change, and will share their own learning. It is only by doing so that we will see people whose behaviour challenges living the rich and meaningful lives they deserve.