As the Care Quality Commission (CQC) continues to release itsinspection reports on learning disability hospitals and care homes- and continues to find the majority do not meet essentialstandards – more uncomfortable questions are raised for the entireresidential sector. Of the 20 reports the CQC published, only 4facilities were found to be fully compliant with the 2 essentialstandards on which the inspectors focused – the care andwelfare of people who use services, and safeguarding people who useservices from abuse. So, only a fifth fully comply with thebaseline standards required by law. A fifth. One in five.Worryingly, it is becoming increasingly clear that these are notisolated cases. About 60 reports – on a mix of NHS andindependently-run facilities – have now been published, out of theCQC’s planned programme of 150. So far the majority do not fullycomply with these basic standards. While no more Winterbourne Viewshave been unearthed, and most of the CQC’s concerns are describedas ‘minor’, it nevertheless shows that people living in learningdisability residential hospitals and care homes often receivesub-standard care. Indeed, as the CQC admitted earlier in February,many facilities seem to lack person-centred care – one of thecentral tenets of the personalisation agenda. All this raises ahost of questions: why are so many establishments sub-standard? Howhas this been allowed to happen? Why has the regulator not flaggedthis up before? Why do commissioners place people in suchfacilities? Perhaps most pertinently: why does no-one seem to haveput the interests and wellbeing of the people with learningdisabilities who live these places first? If this was any otherpart of the care sector, it would be a national scandal in themedia. And so it should be – such common poor practice isunacceptable and the public need to know about it. Perhaps thenational newspapers are waiting for the full CQC report on all 150inspections due in the spring. Nevertheless, it is becomingincreasingly clear that there are major problems with theresidential model of care, and it is something that everyoneinvolved – from frontline care staff to service commissioners tothe Government – needs to address. Some, such as learningdisability charities Mencap and The Challenging BehaviourFoundation, have said these reports provide justification formoving even further away from institutional care towardssmaller-scale local services, and it is hard to argue with them.The evidence base that shows community-based care provides betteroutcomes for people with learning disabilities is substantial. Butwhile local services are the goal, residential facilities remainand need urgent reform. Whether it is more and better training forfrontline care staff; or commissioners no longer placing peoplewith learning disabilities, out of their local area, and inassessment and treatment centres that seem to neither assess ortreat – 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 throughguidelines, targets or a new strategy; and has to feature action atevery level from the regulator, through commissioners, providers,managers and frontline staff. Only this kind of concerted actioncan ensure that standards are improved, not just to the essentiallevel, but way beyond. When the CQC publishes its final report, theGovernment must take decisive action to address this quiet scandal.Making the necessary changes will take time and money but theycannot be deferred. At the heart of all this are people withlearning disabilities who have a right to live a good life – justas anyone else does – and this must never be forgotten.
