Sir Stephen Bubb’s report on the future of institutional care for people with learning disabilities doesn’t tell us much we didn’t know before – and there are doubts it will bring the change that everyone wants.
Reading through the report ‘Winterbourne View – Time For Change’ I got a sense that I’d heard this somewhere before: largely because I have, several times over recent years.
I thought the time for change was when the government committed to end all inappropriate placements in Assessment and Treatment Units (ATUs) two years ago in the Winterbourne View Concordat. Apparently not, as we still have more people being admitted to ATUs than leaving, according to the latest figures from NHS England.
This report stated that a planned closure programme of inappropriate institutional in-patient facilities supporting patient choice is needed, as is improved training and education for NHS, local government and provider staff.
So far, so familiar for anyone who remembers the Concordat. Of course, the big difference is that Bubb’s report only makes recommendations, rather than the “will do” statements laid out in the Concordat; statements it has since failed to implement.
That’s not to say there aren’t some good recommendations in the report – there are. For instance, the introduction of a Charter of Rights for people with learning disabilities and/or autism and their families would be a positive move. This would give people with learning disabilities and their families a 'right to challenge' decisions and the right to request a personal budget
Likewise, a requirement for local decision-makers to follow a mandatory framework that sets out who is responsible, for which services and how they will be held to account, including improved data collection and publication is another sensible idea.
Of course, we already know what good provision looks like – there are numerous examples around the country – and have done for 20-odd years since the original Mansell report. In short and overly-simplistic terms: Big institutions don’t work: small, community-based individualised provision does.
David Cameron has welcomed the report in Parliament, although he didn’t apologise for the government’s failure to meet the June deadline for moving people out of ATUs and into the community, or offer any explanation for why.
But will this report lead to lasting change? Difficult to say, although the cynic in me is doubtful, given the lack of detail in how the recommendations are going to be enacted, and the general failure of the system to change in recent years despite government direction and efforts from some within the sector.
But, that said, this report does put the issue back up the political agenda, so maybe this time something could change. It couldn’t do much worse than the last one.
NHS England has been left with some big questions from this report and its response will be very interesting to see. As will Norman Lamb’s proposed Green Paper.
The deaths of Stephanie Bincliffe and Connor Sparrowhawk – among others – demonstrate how we don’t need more reviews or more talk of how things need to change, we need actions now to stop people dying needlessly in such institutions. Properly realised plans with set goals, realistic deadlines and people/bodies responsible for ensuring they are enacted are needed – and quickly. Without it, I can envisage sitting here in another 2 years writing about the latest report into ATUs and how the time for talk is over and action is needed now.