The recent publication of Homes not Hospitals, the latest attempt to solve the problem of people with learning disabilities getting stuck in assessment and treatment units (ATUs), seems to have some sensible ideas that could make a difference – but now they have to be made real. And experience tells us that is the really tricky bit.
So, after the failures of the Winterbourne View Concordat, the Winterbourne View Joint Improvement Partnership and the Bubb Report, none of which managed to significantly reduce the number of people with learning disabilities resident in ATUs in recent years, this time it is the turn of the NHS and their local government partners to have a crack at the problem. But this might be the plan that has the best chance of success.
The plan: ‘Building the right support: A national implementation plan to develop community services and close inpatient facilities’ was produced by NHS England alongside the Local Government Association and the Association of Directors of Adult Social Services. It sets out the need for, among other things, local housing that meets the needs of people with learning disabilities, such as schemes where people have their own home but have ready access to on-site support staff, and a rapid expansion of the use of personal budgets. It aims to reduce the number of people in ATUs by 50% in three years.
In addition, budgets will be shared between the NHS and local councils – something that has been called for over many years. Allied to that, councils and NHS bodies will join together to deliver more co-ordinated services, with 49 new local Transforming Care Partnerships being established to work with people with lived experience of these services, and families, carers and local stakeholders, all with the aim of agreeing robust implementation plans by April 2016, and then delivering on them over the succeeding three years.
All these initiatives are welcome. The timetable is much more realistic than the Concordat’s 18 months, as is its goal of moving 50% people out of ATUs over a three year period – it is sometimes overlooked that people can’t move out of ATUs until the right services are in place in the community.
As the 4½ years that have elapsed since the Winterbourne View scandal have shown, getting the services in place that can help people with learning disabilities to live successfully in the community after leaving an ATU – and those that can prevent someone getting to the point where it is felt they have to go into one – is a difficult and time-consuming business.
But, with the NHS and councils working together, there is a greater chance of services that fit the needs of local people with learning disabilities being developed. Once community-based services are in place, there will be an alternative to ATUs, for commissioners to use. This should then lead to ATUs being closed.
But, as Dimensions’ chief executive, Steve Scown, noted, this only applies to NHS-run facilities. Of course, Winterbourne View was privately-run by the now defunct Castlebeck. So there will be nothing to stop commissioners continuing to buy beds in ATUs in the private sector, which seems like a large oversight.
However, and as I’ve already noted, the plans do seem to be the best that have been produced to date. There is also £45 million being set aside for them, which is more than has been committed in the past. Whether that level of funding will be enough is another matter.
Now, NHS England has to drive this plan forward and ensure that local areas are following its objectives and holding those areas to account if progress is not being made. This plan cannot be allowed to wither on the vine, as previous ones have done.
As Rob Greig, chief executive of the National Development Team for Inclusion, said in his blog, although there are thorny issues that still need to be addressed, if the plan is to be successful, it merits support rather than cynicism. So, while there is a long way to go, this plan seems to have the best chance of – finally – developing the facilities that people with learning disabilities and behaviour that challenges need to live successfully in the community. However, effective implementation is the key to all of this: without that, little will change and people with learning disabilities will continue to be let down, and badly let down, by the system.