This week it was announced that the commitment to move people with learning disabilities inappropriately placed in assessment and treatment units had been missed. Much more now needs to be done to ensure necessary change does happen.
Three years ago, the nation was shocked and appalled when the BBC’s Panorama programme broadcast its exposé of abuse of people with learning disabilities at the Winterbourne View assessment and treatment unit near Bristol.
Since then, numerous reports, enquiries, and strategies have been published and vast amounts of column inches written on the fallout from the scandal – much of that material saying how the sector needs to change, and that units like Winterbourne View should be largely closed.
But since then, has much changed? Not really, seems to be the answer.
This was put into sharp focus by the passing on June 1 of the government’s self-imposed deadline, originally set out in December 2012 in its final response to the Winterbourne View scandal, to move all people inappropriately placed in assessment and treatment-style units back into the community.
Sadly – and frustratingly – the commitment was nowhere close to being met. Of course, we already knew this, having seen the latest NHS figures, published last month: as at March 31, of 2,615 patients in assessment and treatment-style units, only 256 had a transfer date, of which 182 were before June 1. These figures also showed that more people were admitted than went home in the past quarter.
This is a failure of government, the NHS, local authorities and service providers. Despite many fine words about the positive sentiment in the sector to make the necessary changes, progress is still painfully slow. Those on the ground, trying to get people out of these units and back into the community, report how difficult the process is, with the barriers and bureaucratic systems preventing a return home, still as strong as ever. It also seems that the medical model of care is often still more influential than the social model.
But now that these commitments have been missed, what are the consequences for those who were supposed to be responsible for delivering them? As far as I can tell, there aren’t any, apart from a telling-off from Care Services Minister Norman Lamb in the press.
For me, this is part of the problem – there isn’t enough threat of a stick for commissioners, service providers etc to be forced to make the changes. Admittedly, putting the facilities in place to ensure people with learning disabilities and behaviour that challenges is far from easy, but as numerous examples from around the country show, it is by no means impossible.
In response to the failure, the Board of NHS England has been tasked with creating a new and more robust corporate plan that will accelerate the process of people leaving hospital, but, given the abject failure of the commitment outlined 18 months ago, I’m sceptical about whether this will have the desired effect.
Meanwhile, the work of the Winterbourne View Joint Improvement Programme continues. In a blog on its website, its head, Bill Mumford, has outlined the challenges for the programme. Mumford, one of the most respected figures in the sector, has been in charge of the Winterbourne View JIP for about 6 months, and he reports that there are positives in what is being achieved, and that is important to recognise.
But the Winterbourne View JIP has only one year to run. I can’t see it achieving all it wants to in that time. And what will come after this? Will the programme be extended, or will it just disappear with the responsibility for carrying on the work left to heads of services, commissioners etc? I hope it isn’t the latter because that hasn’t worked so far.
All of that will be after the next general election, of course, so the political landscape may have changed by then. Hopefully in all that will inevitably follow, this agenda doesn’t slip through the cracks. Perhaps some, more cynical, people in charge may be thinking that if they stall long enough on this agenda, it might go away, and they won’t have to do anything. Perhaps not, I don’t know.
But, as it stands, while there has been some progress, it is nowhere near enough and tragedies are still unfolding in assessment and treatment units, such as the death of Connor Sparrowhawk last year. While another abuse scandal on the scale of Winterbourne View hasn’t emerged – yet – regulatory reports still show services failing to meet even the minimum standards. That’s just not acceptable.
Perhaps the most frustrating aspect of this is that we know what good care and support look like and have done for many years: the late Professor Jim Mansell spelt this out more than 20 years ago in his eponymous report. There are numerous examples of how such care can, and does, work across the country.
Alongside providing more incentives, greater pressure should be applied to those in charge of commissioning and delivering services to ensure that they do make the changes necessary to guarantee that as many people as possible move out of assessment and treatment units, and into the community, where all the evidence shows they have better life outcomes.
If that doesn’t happen, the status quo will continue. In all likelihood there will then be another scandal, and the whole process will start again. Meanwhile, the people who are stuck in assessment and treatment units will continue to be unable to fulfil their potential, or lead the life they want to. That is the biggest frustration of all.