Little desire for change at private learning disability hospitals

Private sector learning disability hospitals have little incentive to change their policies to be more in line with government guidelines on providing individualised local services for people with complex needs, a report has found.

The National Development Team for Inclusion (NDTi) report found several particular challenges that limit progress towards changing services to reflect national policy, including financial concerns, market demand and commissioning. The report is based on an 18-month Department of Health-funded project designed to encourage private sector providers of learning disability hospitals to change their services to reflect national policy as set out in Valuing People Now and the Mansell Report. National policy recommends individualised local services for people with complex needs rather than congregate hospital settings.

Particular challenges to achieving this include:

• A lack of desire by most private sector hospital providers to change their services whilst a market for them in their current form still existed
• That financial return to the organisation was a greater driver than the delivery of national learning disability policy
• Whilst some private sector providers and staff do wish to change the hospital services, the current challenging economic climate is making it increasingly difficult for them to do this whilst also achieving financial returns for the organisation – and hence change is not taking place
• That local commissioners therefore hold the key to changing learning disability hospital provision but that, at present, there are insufficient levers in the system to make this a priority for NHS and local authority commissioners.

However, less than half of private sector providers – including some of the largest – engaged with the project. The report also found that national policy is largely irrelevant in influencing change. NDTi found only 2 providers, of those that engaged with the project, which appeared to have a serious intent to change their provision to be in line with policy – despite the offer of 18 months of free development support to assist them. From this, the NDTi concluded that unless the regulator, the Care Quality Commission, is required to enforce the policy in a more rigorous way – rather than just review standards within service design that is out of line with policy – then direct influence of policy upon providers does not appear to be a route to change. The NDTi project was completed before the recent Panorama expose of alleged abuse at the Winterbourne View hospital in Bristol.

However, Rob Greig, NDTi chief executive who led the work, said the recent abuse highlighted by Panorama shows why the change that this project was intended to help achieve is needed. “The learning from this work highlights the important roles of Government and local commissioners in changing such hospitals, as the market on its own clearly will not result in that.”

To read the full report click here.