More failings in learning disability residential care pose questions about the whole system
29 February 2012
As the Care Quality Commission (CQC) continues to release its
inspection reports on learning disability hospitals and care homes
- and continues to find the majority do not meet essential
standards - more uncomfortable questions are raised for the entire
residential sector. Of the 20 reports the CQC published, only 4
facilities were found to be fully compliant with the 2 essential
standards on which the inspectors focused - the care and
welfare of people who use services, and safeguarding people who use
services from abuse. So, only a fifth fully comply with the
baseline standards required by law. A fifth. One in five.
Worryingly, it is becoming increasingly clear that these are not
isolated cases. About 60 reports - on a mix of NHS and
independently-run facilities - have now been published, out of the
CQC's planned programme of 150. So far the majority do not fully
comply with these basic standards. While no more Winterbourne Views
have been unearthed, and most of the CQC's concerns are described
as 'minor', it nevertheless shows that people living in learning
disability residential hospitals and care homes often receive
sub-standard care. Indeed, as the CQC admitted earlier in February,
many facilities seem to lack person-centred care - one of the
central tenets of the personalisation agenda. All this raises a
host of questions: why are so many establishments sub-standard? How
has this been allowed to happen? Why has the regulator not flagged
this up before? Why do commissioners place people in such
facilities? Perhaps most pertinently: why does no-one seem to have
put the interests and wellbeing of the people with learning
disabilities who live these places first? If this was any other
part of the care sector, it would be a national scandal in the
media. And so it should be - such common poor practice is
unacceptable and the public need to know about it. Perhaps the
national newspapers are waiting for the full CQC report on all 150
inspections due in the spring. Nevertheless, it is becoming
increasingly clear that there are major problems with the
residential model of care, and it is something that everyone
involved - from frontline care staff to service commissioners to
the Government - needs to address. Some, such as learning
disability charities Mencap and The Challenging Behaviour
Foundation, have said these reports provide justification for
moving even further away from institutional care towards
smaller-scale local services, and it is hard to argue with them.
The evidence base that shows community-based care provides better
outcomes for people with learning disabilities is substantial. But
while local services are the goal, residential facilities remain
and need urgent reform. Whether it is more and better training for
frontline care staff; or commissioners no longer placing people
with learning disabilities, out of their local area, and in
assessment and treatment centres that seem to neither assess or
treat - to name but two specific issues that have to be
addressed - the whole sector needs swift, overall action.
This must be driven by central Government, whether through
guidelines, targets or a new strategy; and has to feature action at
every level from the regulator, through commissioners, providers,
managers and frontline staff. Only this kind of concerted action
can ensure that standards are improved, not just to the essential
level, but way beyond. When the CQC publishes its final report, the
Government must take decisive action to address this quiet scandal.
Making the necessary changes will take time and money but they
cannot be deferred. At the heart of all this are people with
learning disabilities who have a right to live a good life - just
as anyone else does - and this must never be forgotten.
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