Andrew Holman fears the failure to deal with the underlying problems in health and welfare provision is behind the lack of progress in moving people into the community.
As anyone reading my views about the unnecessary and indeed abusive use of Assessment and Treatment Units (ATUs) will know, I firmly lay the blame at the door of many health care commissioners. Their lack of expertise and oversight, of joined up working with social care and (despite knowing it was a problem) the lack of anyone in any position of authority doing anything about this for a great many years have all contributed to this impasse. Without sorting out those holes in health and welfare provision very little will change; indeed, add to that the savage cuts to the budgets of local services and we begin to see the scale of the challenge.
It is not surprising, therefore, that whilst the Winterbourne View Joint Improvement Programme has very successfully seen some people move out of these places, they failed to meet the deadline of 1 June to see everyone inappropriately placed move on. Incredibly, they saw an increase in their use, with more people being sent to them than discharged. I believe, this was because of the failure to address these underlying problems.
Platitudes
When I wrote to the Care Minister Norman Lamb about these concerns earlier this year, the reply from civil servants was full of platitudes – yes, they know there are problems here and there but they are all in hand. GPs know how to get “the best outcomes for their patients” when buying these services. Commissioners would soon have ‘standards’ letting councils know how their commissioners compared to others and Healthwatch would find out what people thought of their services during their visits.
Yet in a later interview the Minister described the Programme’s lack of progress as “an abject failure … the most depressing and frustrating task” he had faced. Talk about a disjointed response! Labour has called on the Government “to commit to a two-year deadline to end the practice of placing vulnerable people with learning disabilities at (ATUs) for long periods of time” – but without mentioning how the other problems would be solved.
Jan Tregelles of Mencap, and Vivien Cooper of The Challenging Behaviour Foundation, chipped in to more accurately sum up. “A new deadline is important but we really need to see the development of long-term and sustainable care in local communities to ensure people get the right support, in the right place, at the right time. What is imperative is that a clear plan is drawn up which engages everyone who has a role to play in not only moving people out of units but also preventing people being unnecessarily moved into them.”
They continue: “Urgent action needs to be taken to bring together better informed clinical decision-making with the development, funding and monitoring of local support and services. Further delays in this programme are simply not acceptable”.
NHS England’s decision to appoint Sir Stephen Bubb to come up with and implement a plan overnight with the help of a handful of his members has caused a storm in grass roots learning disability circles. Bubb’s lack of involvement in his ‘breakfast meeting’ and subsequent development of his plan has rightly got Gavin Harding (National Forum and Winterbourne View Engagement Group) and Gary Boulet (People First England) steaming.
Gary expressed surprised at the announcement. “There’s no doubt people with a learning disability should have been involved to plan this,” he said. Gary is also involved with the Learning Disability Alliance which aims to bring people together to work for better solutions.
Disappointed
Gavin says: “I was disappointed to see that Stephen Bubb had not spoken to people with learning disabilities or families”. He goes on to talk about the incidents of abuse in almost all settings for people with learning disabilities and concludes that a lot of organisations should “get their own houses in order” first and, perhaps controversially, “we need to change the way providers work in the community before moving people into the community”. Whilst Gavin has a point, my fear there is that some people will have to wait in institutions a very long time before that happens.
Gavin is looking forward to working as co-chair with Norman Lamb on his group and he will not be a token co-chair. But the lack of clarity about their role under Bubb’s leadership will be a problem.
They have now decided to set up a wider group, involving others but I fear the decisions NHS England have taken with Bubb have gone too far already.
As Gavin reminds us,“We do need to work together on this. We will be stronger together as a team. We may disagree with each other but we need to be strong.” Let’s hope, for the sake of those incarcerated in these institutions, it doesn’t take too long.
Andrew Holman is Director of Inspired Services.
