Labour calls for two-year deadline to end inappropriate learning disability hospital placements

Labour has called on the government to commit to ending inappropriate placements of people with learning disabilities in hospitals by July 2016.

In the wake of the Winterbourne View scandal, the government pledged to end inappropriate hospital placements by 1 June 2014. However, the latest official figures showed there were still more than 2,615 people living in hospitals as of 31 March, of whom 182 had a transfer date of before 1 June, meaning the target was missed.

The government-backed Winterbourne View Joint Improvement Programme, set up in 2012 to support commissioners to move more people out of hospitals into appropriate community placements, has also been hit by setbacks. Last week the programme’s director, Bill Mumford, stood down following two safeguarding incidents in services operated by MacIntyre, the learning disability provider of which he is the chief executive. A replacement for Mumford has still to be announced.

Liz Kendall, Labour’s shadow care minister, said the lack of progress on the Winterbourne View agenda was “a scandal”.

“The whole country was shocked by the serious abuse and appalling standards of care at Winterbourne View. Ministers promised to move people with learning disabilities out of assessment and treatment units [a form of hospital] and into the community. Labour warned at the time that without a detailed plan and clear deadlines, progress on achieving this would slip. Sure enough, three years on, there has been hardly any change,” she said.

In response, a Department of Health spokesperson said: “People with learning disabilities deserve the best possible care, in their own communities with the right support. Progress on moving people from in-patient settings has been too slow. We have asked NHS England to report back by the end of August to show how they will deliver the Winterbourne View commitments.”

In a statement, Mencap chief executive Jan Tregelles and Viven Coope, chief executive of The Challenging Behaviour Foundation, said action was needed in light of the “dismal failure” to meet June’s deadline.

“A new deadline is important but we really need to see the development of long-term and sustainable care in local communities to ensure people get the right support, in the right place, at the right time. What is imperative is that a clear plan is drawn up which engages everyone who has a role to play in not only moving people out of units but also preventing people being unnecessarily moved into them,” the statement said.

“Urgent action needs to be taken to bring together better informed clinical decision-making with the development, funding and monitoring of local support and services. Further delays in this programme are simply not acceptable.”

Speaking in Parliament last week, care minister Norman Lamb said NHS England expected 892 (35%) of the 2,615 people to be discharged within a year. Lamb also identified two key barriers to people moving out of hospitals.

“When someone transfers from the responsibility of NHS England to the local authority, the responsibility for the funding transfers to the local authority. That creates a disincentive for the local authority to take responsibility for that person, so the money has to flow with the individual.”

He added: “I have also mentioned that we have to address the question of clinical judgements. That is not to say that in individual cases clinician will not be making their best judgment about an individual’s need to stay in a particular setting, but surely the family need access to a second opinion to be able to challenge that judgment. I am conscious—I say no more than this—that the clinicians who are making the judgment are often employed by the organisation that is receiving payment for providing the bed to the individual.”

Labour’s call for a new deadline came after NHS England announced the establishment of a voluntary-sector led task group tasked with devising ‘co-commissioned’ solutions to cut the use of inappropriate hospital placements. The group will be chaired by Stephen Bubb, chief executive of charity leaders network ACEVO, and will report its findings in October 2014.

Writing on his blog, Bubb said the group planned to create “a national framework, locally delivered”.

“In essence this envisages the closure of most or all of the current inpatient facilities and the transfer of clients to appropriate community placements near their families. This will require investment in buildings, converting houses or building new. However social finance can cover this on the back of sensible commissioning i.e. 10 year contracts. With will, it is entirely doable,” he wrote.

Responding to NHS England’s announcement, some learning disability campaigners raised concerns that the project did not give sufficient priority to input from people with learning disabilities and their families. Questions were also raised over what role local authorities would play in the scheme.

In a statement, NHS England said that the programme will include “healthcare, charity and voluntary sectors, as well as people with learning disabilities and their families.” Asked about the absence of councils from this list, an NHS England spokesperson told Community Care local authorities would also be represented on the group and “are absolutely fundamental” to developing the framework.

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