26 Nov 2014

Winterbourne View report: why has there not been more progress?

Today’s report on the care of people with learning disabilities in England is full of horrible words and phrases like “stakeholder”, “mandatory commissioning frameworks”, and “provider and workforce development”.  Aaaaggghhh –   just saw another one:  “system boundaries”.

Which is a pity because the report makes some very good points about why it has taken so long to do anything about care of people with learning disabilities and/or autism.

It’s not just that it is now nearly four years since the Winterbourne scandal and the horrible abuse of people with learning disabilities which was secretly filmed.

It’s not that the Government ignored it.  They didn’t.   They commissioned reports themselves.  In fact, look on the Department of Health’s website and you will see “Final report into the events at Winterbourne…”.

That was in December 2012 and there was an interim one in June that year.

In August 2012 an independent report said there needed to be a fundamental changes are needed in how care of vulnerable adults is commissioned and monitored.

Now this latest one by Sir Stephen Bubb, of the Association of Chief Executives of Voluntary Organsiations (ACEVO), has arrived.  It was commissioned by NHS England because not enough had happened.

For instance, a Concordat was signed by the Government and a number of other organisations pledging action. Specifically, that all current hospital placements would be reviewed and anybody inappropriate placed in hospital should be moved into the community as soon as possible.

The deadline was no later than June 2014.  NHS England’s figures show that between September 2013 and September 2014, 923 people were transferred out of inpatient care.

Marvellous?  Not.  Because the same data for the same period shows 1,306 people were admitted.

Why has there not been more progress?

The report says it’s not as if people haven’t tried before.  For decades, it says, people have described what good care looks like.  But , it hasn’t happened, the authors say, because it has been too hard to do the right thing and too easy to do the wrong thing and the people most eager to change the system – those with learning disabilities and/or autism and their families, have had too little power or support to do so.

Clinicians are asked to admit fewer people who present challenging behaviour to inpatient settings, and to discharge others, on the basis that they can be appropriately supported in the community   Many clinicians, the report says, would like to do that, and some manage it but often they do it in spite of the system not because of it.

And so it goes on.  Health and social care providers are asked to expand community capacity.  Frontline staff are asked to do things differently.  And some, the report repeats, manage to do this but, and again the report repeats, in spite of the system not because of it.

Sir Stephen’s conclusions are technically simple:  a big expansion of community provision, and more empowerment for the people it’s meant for, that is those with learning disabilities and/or autism and their families.

What is clear, though, is those very people often feel completely disempowered.  Their families have to fight and fight for the right services.  Still too many people are being sent to hospitals hundreds of miles away from home, they are kept there for too long because there is nowhere to move them, and they regress.

It, of course, is not as simple as saying all people with learning disabilities should be moved back into the community.  Some have severe problems that mean they could harm themselves or others.   So there need to be secure places of safety.

But it is a tragedy if they languish there for the wont of a place in the community when they are better.

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