A damning report by care regulator the Care Quality Commission (CQC) has found that half of residential services for people with learning disabilities did not meet essential standards.
This is the main finding in the CQC's report that analyses the results of 145 unannounced inspections carried out in the wake of the abuse uncovered by the BBC Panorama programme at Winterbourne View Hospital. Inspections focused on examining the care and welfare of people who use services, and whether people were safe from abuse. Of the 145 locations inspected, only 35 fully met both standards with no concerns. Meanwhile, 69 services failed to meet one or both standards, with 35 failing on both standards. The remaining 41 met both standards, but had minor concerns.
The 145 locations comprised:
- 68 NHS Trusts providing assessment and treatment and secure services and includes two that were residential care homes
- 45 independent healthcare services providing assessment and treatment and secure services
- 32 residential care homes providing residential care.
The CQC found that independent providers were twice as likely to fail to meet essential standards as NHS providers. Only 33% of independent providers met standards, compared to 68% in the NHS. In addition, the CQC found that some assessment and treatment services admit people for disproportionately long spells of time and that discharge arrangements take too long to arrange.
The report also found that there is an urgent need to reduce the use of restraint, together with training in the appropriate techniques for restraint when it is unavoidable. Many of the failings identified in the report are the result of care not being centred on the individual and that too often people are fitted into services rather than services being tailored to people's individual needs, the report found. The CQC said this raises important questions about the patterns of commissioning behaviour and practices across England and that there is now an urgent need for commissioners to review the care plans for people in treatment and assessment services so that they can move on to appropriate care settings.
Where inspectors identified concerns, they raised these immediately with the providers and managers of services. Specific safeguarding concerns were found at 27 locations that required referral to the relevant local authority safeguarding adult team. In these cases inspectors either requested the provider to make the referral (which they followed up to confirm was done) or made the referral themselves.
Dame Jo Williams, chair of the CQC, said: "People who use these services need care and support and they and their families need to be treated with care and respect. While our inspections found examples of good care, too often they found that services were not meeting the individual needs of people. "This isn't about developing more guidance - there's plenty of evidence about what constitutes good care and good commissioning - it's about making sure that providers, commissioners and regulators focus on care that is based on individuals. "Although many of the services we inspected were intended to be hospitals or places where people's needs were assessed, we found that some people were in these services for too long, with not enough being done to help them move on to appropriate community-based care. "All too often, inspection teams found that people using services were at risk of being restrained inappropriately because staff often did not understand what actions count as restraint, and when restraint happened there was inadequate review of these putting people at risk of harm or abuse." However, while the report highlights serious concerns about the nature of services for people with learning disabilities, there is no evidence that points to abuse on the scale that was uncovered at Winterbourne View, Williams added. "However, every single case of poor care that we have found tells a human story and there is plenty of room for improvement to help a group of people whose circumstances make them particularly vulnerable."