‘Worrying’ rise in ‘inadequate’ inpatient care for people with autism and learning disabilities

Care Quality Commission findings follow longstanding concerns over the treatment of people with learning disabilities or autism in hospital

Image of laptop and magnifying glass (credit: Paweł Michałowski / Adobe Stock)
(credit: Paweł Michałowski / Adobe Stock)

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.

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.

6 Responses to ‘Worrying’ rise in ‘inadequate’ inpatient care for people with autism and learning disabilities

  1. James October 19, 2020 at 11:11 am #

    If most of these placements are funded by LA’s, then a social worker of some description must have been involved. Perhaps if placements were properly reviewed and social workers did not op out of the lives of people once they complete their assessment, we wouldn’t need “professional visitor” status. Instead of grandstanding, BASW needs to own the inadequacies of social work services for people with a learning disability and autism. If BASW is as representative of social workers as it never tires of telling us, some of the social workers placing people into horrible environments and who are complicit in their neglect and abuse abrogation of responsibility, must be their members. When are they going to accept responsibility for these failures? Stop relying on the CQC and do your jobs to ensure safe and respectful services.

  2. Chris Sterry October 19, 2020 at 3:52 pm #

    Much of hospital care follows the ‘medical’ model, which is generally not good for many patients and certainly not for patients with Learning Disabilities and Autism.

    All care should be modeled on a model based on ‘patient-centred; care, rather than ‘institutional’ care, that is care based on the needs of each individual and not the system that is in force currently.

    Patients views and choices should be obtained as early as possible, at admission would be ideal.

    This could be more expensive, but it is what is needed.

    I realise the article is referring to private hospitals in the field of mental health, but this is also relevant to General Hospitals dealing with the variety of medical issues.

  3. John Burton October 19, 2020 at 4:40 pm #

    When will it be understood that CQC has colluded in the continuance of these dreadful private hospitals for people with autism and learning disabilities? After abuse is exposed (not by CQC) inspectors are sent out to all the places that have been given a good rating, and lo and behold they find that they are not so good after all, in fact they are awful, so the ratings go down. We are then presented with a report that tells us that such places have got worse. They didn’t get worse – they were bad all along, it’s just that CQC don’t want to be found out again and pretend that they have “discovered” poor practice. A rotten regulator is worse than no regulator at all, and we’ve got a permanently rotten regulator. They are worse than inadequate, they are a major part of the health and social care problem.

  4. Sterling October 21, 2020 at 8:31 am #

    It’s not just about the CQC being useless and colluding with providers. Social workers need to accept their part. We all know how awful some of the placements are but we put people into these places because apparently we can’t find alternatives. Yes we are forced to make decisions we know are not in the best interest of people but we somehow find our voice when it impacts on us personally. The systems of care are rotten but we are part of this too. I am afraid we have lost the morality of honesty in social work so as are many others I too am leaving the ‘profession’. Morrisons here I come and all the happy for it.

  5. Sheena Felton October 21, 2020 at 10:48 pm #

    As I have said elsewhere on Community Care recently the same concerns apply to institutions labelled ‘Residential Care’.

  6. Julia Smitheers October 22, 2020 at 8:39 am #

    Cygnet Health Care which run Yew Trees Hospital received £434million from the public purse. Its learning difficulties and autism units are entirely funded by the NHS and Local Authorities. In the current financial year it paid out £50million in dividends. Yet ADASS still bleats on behalf of these companies for the ‘Government’, you and me in the real world, to buy them PPE, pay their staff when they are off sick or isolating, increase subsidies, all without any accountability from them. I along with many working in adult social care, believe ADASS is not on the side of vulnerable residents or staff and is not fit for purpose. I suggest that in any review of social care, ADASS is abolished. I am sure private owners and hedge funds can find them a role somewhere as recompense for their cheerleading.