This week’s interim report by the Department of Health on Winterbourne View and residential care for people with learning disabilities contains some heartening words on why the system needs to be changed, but Dan Parton isn't sure the actions it outlines go far enough to ensure that it happens:
The DH’s report contained little that many involved in the sector didn’t already know about residential care for people with learning disabilities. For example, that people with learning disabilities are staying for too long in in-patient services for assessment and treatment has been widely spoken of for some years. So while government acknowledgement of this problem is welcome, it is long overdue.
The DH rightly said that all parts of the system – commissioners, providers, individual staff, the regulators and government – have a duty to drive up standards. That change is needed to drive up standards is indisputable. As the Care Quality Commission (CQC)’s report on its 145 inspections of learning disability residential facilities found, almost half failed to meet essential standards. At the risk of repeating myself from past blogs, these are standards providers are required to meet by law. Not any aspirational standard, but the basics.
For failings to be on such a scale says that there is something fundamentally wrong with the system. But these are not statistics, these are people. It makes you wonder what sorts of lives they are living in these facilities; they’re certainly not the personalised ones that government policy says they should be leading, and crucially not the ones they want to lead as individuals. This should never be lost sight of. So it is a disappointment then that, while the 14 national actions the DH set out in its report to improve care and support for people with learning disabilities are well-intentioned without doubt, I am unsure as to how much impact they will have on the ground.
For example, it talks of how the DH will work with the NHS Commissioning Board on how best to embed Quality of Health Principles into the systems, which will set out the expectations of service users in relation to their experience. But there are already standards in place that providers are supposed to adhere to and, as the CQC report shows, some don’t. The report also talks of setting up a voluntary accreditation scheme for providers.
Again, all providers have to be registered with the CQC, but that hasn’t stopped services failing. I don’t see how a voluntary scheme would improve the situation. Instead, practical actions are needed to address the systemic failures, and it has to be driven by central government for local implementation. The Mansell reports of 1993 and 2009 – quoted in the DH report – pointed the way that services should develop, with an emphasis on services within the local community.
Nothing has changed. The DH’s focus should be on ensuring this vision is realised. The Government’s final report on Winterbourne View is expected later in the year. Hopefully that will contain more robust actions with a clear implementation plan that will deliver the change that is necessary if another scandal is to be avoided.