Southern Health set to lose £5m learning disability contract after ‘significant concerns’ over care

An NHS Trust criticised for the quality of care at its learning disability inpatient units is set to lose a £5.5m contract to deliver specialist services in Oxfordshire.

A review by Oxfordshire county council’s adult social care director and local NHS commissioners has concluded that Southern Health’s contract to run specialist inpatient services and community teams in Oxfordshire should not be renewed when it expires on December 31. The review said regulators and commissioners had raised “quality and performance concerns” about the inpatient services.

“There has also been significant public concern, alongside concern from people with learning disabilities and their families, about current provision, and especially about inpatient services,” the report said.

A new model of care

The Oxfordshire review concluded that the specialist services model was “out-of-date” and recommended that services should be integrated into mainstream health provision. The review puts forward proposals to redesign care, which it calls ‘The Big Plan’. This includes proposals for a specialist co-ordinating team for people with health needs related to their learning disability and inpatient beds commissioned as part of a mental health contract being negotiated with Oxford Health NHS Foundation Trust.

Southern Health acknowledged the concerns raised about its services in the review and said it was committed to making necessary improvements.

Oxfordshire council’s cabinet will vote on the review’s recommendations next week.

Series of concerns

The review follows a series of concerns about Southern Health-run learning disability services in Oxfordshire.

In June 2013, 18-year-old Connor Sparrowhawk, who had autism, a learning disability and epilepsy, died while a patient at Slade House, one of the trust’s inpatient units. Connor was found unconscious in the bath following an epileptic seizure. He died the same day in hospital. An independent investigation found that Connnor’s death was preventable.

Slade House’s inpatient unit was closed in November 2013 following a damning Care Quality Commission inspection report. In an inspection report published in March 2014 the care regulator found significant management and care failings at a learning disability care home – the 4 Piggy Lane service – that was run by the trust.

Last month, a CQC inspection of the trust revealed that some Southern Health staff felt the trust had not been ‘as open and honest as it could have been’ in its response to Connor’s death. The CQC also found that the uncertainty among staff over whether Southern Health would retain the Oxfordshire contract had also damaged morale. The trust’s learning disability inpatient services were rated as ‘requiring improvement’. Its community learning disability services were rated as ‘good’.

Connor’s mother, Sara Ryan, has documented her interactions with Southern Health since her son’s death via her ‘mydaftlife’ blog. A grassroots movement, the Justice for LB campaign (LB refers to ‘Laughing Boy’ – Connor’s nickname), has also raised awareness of developments via social media.

The Oxfordshire review said that any new services required under the recommended model of care will have been implemented ahead of the expiry of the Southern Health contract. The changes potentially involve TUPE transfers of staff and this will be taken into account, it said.

Southern Health response

In a statement, a Southern Health spokesperson said the trust ‘shared the vision’ of the Big Plan proposals but raised questions over the ‘ambitious’ timetable set out for delivering the new model.

“We also support the Big Plan’s intentions for people with learning disabilities to access health and social care through non-specialist health services where this is safe and appropriate. However it is widely acknowledged that people with a learning disability have greater health needs than the general population and that mainstream services have struggled over many years to redress the inequalities in health outcomes for people with a learning disability,” the statement said.

“We believe there is a disparity between the vision of the Big Plan and how prepared and ready mainstream services are to support people with learning disabilities and to sustain that service. The existing arrangements for education and professional training in learning disabilities is limited and we feel that although there is certainly potential to make changes, the short timescale the cabinet has been presented with is very ambitious in which to achieve such a significant shift in culture and models of care.”

The statement added: “We acknowledge the concerns that have been raised as part of the cabinet document. We have been working closely with our commissioners, partners, staff, service users and their families and have already made substantial improvements. We will of course continue to address any concerns and make necessary improvements.

“It is also important to recognise the high levels of very good practice from within our services, as has been highlighted recently in a report from the Care Quality Commission following a comprehensive inspection of all Southern Health services in October 2014. We remain committed to providing safe and high quality services to people with learning disabilities in Oxfordshire, and we will continue to work with our commissioners and partners to ensure that our service users receive the support that’s right for them, whatever the future of services looks like.”