Dan Parton cutLast weekend saw the fourth anniversary of the broadcast of the BBC’s Panorama documentary uncovering abuse at Winterbourne View, the residential hospital for people with learning disabilities. Since then, have things really changed for people with learning disabilities who are placed in such institutions? Sadly, the answer is no.

The documentary still shocks today. The shouts of pain – physical and emotional – from residents being abused by the people who were supposed to be caring for them are something that has never left many of those who heard them. They certainly have never left me. 

At the time, the outcry in the national media was supposed to lead to lasting change in the sector that would mean that never again would such abuse occur, and that the vast majority of people who were resident in assessment and treatment units (ATUs) would be moved back into the community.

Indeed, after all the myriad reviews and investigations – including the jailing of 11 people involved in the abuse at Winterbourne View – the then coalition government launched its Winterbourne View Concordat in late 2012, which set out plans to ensure that all people inappropriately housed in ATUs would be moved back into the community within 18 months.

It sounded so good. But the reality was never close to matching what was laid out on the page and the target was missed by some distance. Four years ago, about 3,500 people were living in ATUs. At the end of March this year, 2,395 were living in such units, according to statistics from the Health and Social Care Information Centre (HSCIC). And these are only the ones we know about: 56 out of 221 clinical commissioning groups did not provide data towards the HSCIC’s figures, meaning that it is likely that the figure is even higher.

So, in four years, and after so many people – politicians, providers, NHS managers, social care leaders and others – said that change had to happen, only just over 1,000 more people, overall, are now living in the community. And the latest HSCIC figures show that more people went into ATUs than came out in March.

Since Winterbourne View, no more scandals on that scale have been uncovered – although an ongoing legal case could prove to be as explosive. But tragedies are still occurring in ATUs. Connor Sparrowhawk – or ‘Laughing Boy’ (LB) – is just one name that springs to mind. He drowned in a bath in an ATU, a death that the coroner ruled was ‘preventable’. Which seems something of an understatement.

The model of care that was inappropriate in 2011 is still inappropriate now, but people still get stuck in these places for years on end – 6% have been resident in such units for more than 10 years, according to the HSCIC. Quite how much assessment or treatment is provided in that time is not recorded.

While there is a need for a small number of people to go into such units when they are unwell, it should only ever be a temporary measure – they should be assessed and treated, as the name suggests – and from day one there should be plans for moving them back into their community.

The reasons why so many people are still resident in ATUs are numerous and complicated. Putting in place the necessary services in the community has proved difficult, for instance, especially with reducing social care budgets. 

But in some cases, there hasn’t been the will to make changes. Sometimes, placing a person in an ATU solves a problem for a commissioner, rather than them having to think about putting in place new or different services that might carry more of a cost.

There is still hope for change. Of the 2,395 people currently in an ATU, more than half have a date set for a move back into the community, so there are indications that some progress is being made.

Likewise, there are hopes that the Disabled People (Community Inclusion) Bill – better known as the LB Bill, in memory of Connor Sparrowhawk – will make it onto the list of Parliamentary private members’ bills later this week. The Bill seeks to ensure that local authorities and NHS bodies have a statutory duty to have ‘due regard’ to the need for disabled people to be included in the community, among other measures.

There are also many examples of good practice out there where community facilities and services are in place so people with learning disabilities, even in a crisis, don’t have to be sent to an ATU. That shows what can be achieved, and the sector needs to get better at promoting these examples of good practice right across the country.

But if we are to secure lasting change and see Winterbourne View and its ilk confined to history, it will require much more work and that needs to be driven by those at the top. This includes central government, commissioners and service providers working together to make change happen. Whether these people have the will to do so remains to be seen. Without that, though, it is only a matter of time before the next Winterbourne View occurs.