RobGreigThe steering group set up by NHS England to cut the number of people who live in assessment and treatment-style (A&T) units needs to rethink its objectives if it is to have the best chance of succeeding, a group of learning disability experts has said.

The Ideas Collective, which includes Dame Philippa Russell; Fiona Ritchie, managing director of learning disabilities at Turning Point and Rob Greig, chief executive of the National Development Team for Inclusion (pictured), believe that the steering group’s aims – as outlined last week – will only lead to short-term and superficial change if they are not revised.

In a letter to Sir Stephen Bubb, the head of the steering group, the Collective said that while there is a wealth of evidence, knowledge, best practice and policy designed to address the problem, “the fundamental problem is that organisations and individuals throughout our sector do not follow this… because there is no requirement for them to do so.”

The group added that Bubb needs discuss with those who gave him his mandate whether he has the authority to address this, including:
• The levers to be used by NHS England to require compliance with policy, evidence and best practice
• Similarly how local government can be required to change its commissioning practices
• DH’s willingness to address policy obstacles, for example by transferring resources currently locked into regional specialist commissioning to local authorities as people move out of distant hospital beds.

Community support
Turning to the steering group’s objectives, the Collective said that simply introducing a closure programme for A&T units will only create problems in other areas of the social care system.

“The use of assessment and treatment beds is a demand consequence of inappropriate or poor support from community health and social care services – frequently starting in childhood,” the Collective said in the letter.

“If people are simply moved out of them without action to also reduce demand, the places will immediately be filled by new people who are being failed by local services. We want the demand to stop because the community can support all people appropriately.”

The Collective called for a concerted programme that has, as one of its objectives, achieving a significant reduction in the number of A&T beds/independent hospitals, based on the following four elements:
• A programme of ‘hands-on’ support to local authority and NHS commissioners to understand and implement best practice and thus develop local service competence in each area
• Active person centred, individualised design with all people living in A&T units/independent hospitals with a view to properly funded local services being put in place for them
• A recognition of the need for a small number of A&T beds and independent hospitals in each local area as part of the local care pathway
• The creation of levers, sanctions and incentives that will require local commissioners to follow and implement policy and best practice.

In terms of developing a social capital programme for investment in community resources for the people currently living in A&T beds and distant independent hospital provision, the Collective welcomed the idea of additional funding to support housing development. “However, this will only make a positive difference to people’s lives if it is done in a personalised way for people to draw down funds as needed to create their own housing solution,” they said.

“We are concerned that the statements about the use of this money to date have implied or explicitly proposed its use to develop group homes, and long term provider contracts. The evidence is clear that the formation of group living services where individuals have not chosen who they live with, or where they live, is a major contributory factor to the scenario that created the need for ATUs in the first place. Similarly, investing capital funds in buildings based services has created medium term financial liabilities for commissioners and inflexibility of service. A different mind-set is needed for how this possible resource might be accessed and used.”

With regard to a commissioning framework for learning disability services, the Collective believes it can only succeed if it is ‘bought into’ and covers NHS and local authority social care. “The NHS should be commissioning services in ways that support local authority commissioned services to deliver good outcomes and prevent service breakdown.”

However, the Collective’s understanding is that, while the group is talking to ADASS’ Learning Disability Group chair, it has no authority in regard to local authority commissioning. “Without this, a new NHS commissioning framework will be akin to ‘clapping with one hand’,” they said.

Further reading: Report points way to better commissioning of learning disability services

In addition, the Collective supported the steering group’s objective to increase the skills of the learning disability workforce, but acknowledged that real challenge rests in factors outside the sector’s influence – such as pay rates that would attract people to work in this area and the unwillingness of commissioners to fund services at levels that would attract and retain good quality, skilled staff. “Any ideas on how to address this would clearly be helpful.”

The Collective also called for greater involvement for people with learning disabilities and family carers in the steering group – currently there is only one of each.
In conclusion, the Collective said: “If your [Bubb’s] group continues with the focus and priorities previously stated, then we fear that another opportunity will have been wasted and any change will merely be superficial and short term – leaving other people with learning disabilities and families to bear the consequences in the years to come.”