There has been a “worrying” increase in the proportion of ‘inadequate’ inpatient services for people with autism and learning disabilities, primarily in the independent sector, the Care Quality Commission (CQC) has found.
In its annual report on the state of health and social care, the regulator said it continued to find “more poor care” in inpatient wards for people with a learning disability and/or autistic people.
The overall proportion of services rated inadequate sharply increased to 13% in 2019-20, from 4% in 2018-19. Almost all of this rise happened in independent services, where the proportion of ‘inadequate’ services rose from 5% to 22%. In contrast, NHS services rated as inadequate remained at 3% of the total.
The findings follow longstanding concerns over the treatment of people with learning disabilities or autism in hospital – highlighted recently by the abuse of patients by staff at Cygnet Health Care’s Yew Trees hospital in Essex – and the inappropriateness of such placements for longer-term care.
However, repeated targets to substantially reduce the number of people with learning disabilities or autism in hospital have been missed. The current measure is to reduce numbers to half of 2015 levels (around 2,600) on a like-for-like basis by 2023-24.
System “failing people”
Samantha Clark, chief executive of Learning Disability England (LDE), which represents people with learning disabilities, their carers and self-advocacy groups, said she and LDE’s co-chairs were not surprised by the findings.
“LDE members and partners have been saying for some time this is a system that is failing people and indeed as our co-chairs said recently, people are still being traumatised for life by the very places that are meant to help them,” Clark said.
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She said too many of the services are not designed or delivered in ways that help, which keeps being demonstrated.
“Closed cultures with staff teams that are not well trained or supported must stop being commissioned and mental health support for people with learning disabilities and autistic people must be changed radically, working with people with lived experience and their families,” she added.
Maris Stratulis, British Association of Social Workers (BASW) England national director, echoed LDE’s concerns about “closed cultures” that have developed as a result of the lockdown and ongoing restrictions of movement.
She said this is “extremely concerning” given the Yew Trees case.
BASW has launched a campaign for social workers to be given ‘professional visitor’ status, which it said would ensure visits to care settings were taking place, in order to ensure situations with poor quality care can be identified and the appropriate action taken.
“This simply must not continue”
Jane Harris, director of external affairs at the National Autistic Society, said the “damning report” shows a worrying increase in the number of hospitals found to be poor quality.
“This simply cannot continue,” she said.
“Autism is not a mental health condition, it’s wrong that hundreds of autistic children and adults are living in mental health hospitals, often inappropriately, many miles away from home and unable to see family and friends.”
Harris added: “But without the right mental health and social care support in the community, too many autistic people really struggle, eventually hitting complete crisis and facing being put in a hospital that doesn’t meet their needs.
“The government must put this right by investing in mental health and social care support for autistic people, and crucially reviewing the Mental Health Act so that autistic people aren’t inappropriately sectioned. Only this will end this vicious cycle.”
Not a case of a few “bad apples”
Meanwhile, Chris Hatton, professor of social care at Manchester Metropolitan University, said whether this was the result of more rigorous recent inspections by the CQC, or the further deterioration of inpatient services in the independent sector, it was clear that “this was not a case of a few bad apples” but rather, a “feature of the inpatient system”.
“This will not change while units rated as inadequate by the CQC stay open, commissioners continue to put people into them, and ways to support people to live fulfilling lives so these are a path not taken fall short,” he said.
He said it was a particular concern that companies with inadequate-rated services were “at the heart of new NHS-led provider collaboratives which will have more control over the purse-strings for mental health services”. The collaboratives have been set up to manage budgets for specialised care, and NHS England’s target is for them to be responsible for all such care for people with learning disabilities and autism over the next five years.
Immediate reform needed
The report said that the quality of adult social care remained largely static in 2019-20, with 80% of services rated good, 15% rated needs improvement and 1% rated inadequate – no change from figures reported for 2018-19. The proportion of services rated outstanding rose from 4% in 2018-19 to 5%.
In the report, the CQC pressed the need for immediate and urgent reform of the social care sector, saying the need for this had been “thrown into stark relief” by the pandemic.
The sector, already fragile, faced significant challenges around timely access to personal protective equipment (PPE), testing and staffing – and co-ordinated support was less readily available than it was for the NHS, the regulator said.
“The legacy of Covid-19 must be the recognition that issues around funding, staffing and operational support need to be tackled now – not at some point in the future.
“Alongside this, there needs to be a new deal for the care workforce, which develops clear career progression, secures the right skills for the sector, better recognises and values staff, invests in their training and supports appropriate professionalisation,” the report said.