Ministers vow to cut hospital placements for people with learning disabilities

The Government has promised a “dramatic reduction” in the number of hospital placements for people with learning disabilities, after publishing the final report into the mistreatment uncovered at Winterbourne View private hospital.

The programme of action set out in the Department of Health’s report also includes the publication, by Spring 2013, of proposals to strengthen accountability of boards of directors and senior managers for the safety and quality of care which their organisations provide.

“We will consider both regulatory sanctions available to the Care Quality Commission and criminal sanctions,” it explained. “We will determine whether CQC’s current regulatory powers and its primary legislative powers need to be strengthened to hold boards to account and will assess whether a fit and proper persons test could be introduced for board members.”

Other measures to bring about “fundamental change” include:

  • A review of all current placements by June 2013. “Everyone in hospital inappropriately will move to community-based support as quickly as possible, and no later than June 2014”;
  • By April 2014, each area will have developed a joint plan to “ensure high quality care and support services for all people with learning disabilities or autism and mental health conditions or behaviour described as challenging, in line with best practice”;
  • The CQC will strengthen inspections and regulation of hospitals and care homes for this group of people. This will include unannounced inspections involving people who use services and their families, and steps to ensure that services are in line with the agreed model of care;
  • A new NHS and local government-led joint improvement team will be set up to lead and support the transformation;
  • The Department of Health and the Department for Education will develop and issue statutory guidance on children in long-term residential care in 2013;
  • The Department of Health will revise statutory guidance and good practice guidance to reflect new legislation and address findings from Winterbourne View. This will be completed in time for the implementation of the Care and Support Bill. It will see Safeguarding Adults Boards put on a statutory footing (subject to Parliamentary approval) and local authorities empowered to make safeguarding enquiries;
  • The Department of Health will work with the CQC to agree how best to raise awareness of and ensure compliance with Deprivation of Liberty Safeguards provisions to protect individuals and their human rights. It will report by Spring 2014;
  • During 2014, the Department of Health will update the Mental Health Act Code of Practice, including to take account of the Winterbourne View report.
  • Guidance on best practice on positive behaviour support will be published by the end of 2013 “so that the physical restraint is only ever used as a last resort where the safety of individuals would otherwise be at risk and never to punish or humiliate”;
  • The Department of Health will work with independent advocacy organisations to identify the key factors to take account of in commissioning advocacy for people with learning disabilities in hospitals, and to drive up the quality of independent advocacy. The Action for Advocacy Quality Performance Mark will be strengthened and the Code of Practice for advocates will be reviewed to clarify their role.

The report said staff at Winterbourne View routinely mistreated and abused patients, and management allowed a culture of abuse to flourish.

“The warning signs were not picked up, and concerns raised by a whistleblower went unheeded,” the Department of Health said.

The report concluded that many people were in hospital who did not need to be, and that they had a right to be given the support and care they needed in the community.

Writing in the foreword to the report, Care and Support Minister Norman Lamb said: “The scandal that unfolded at Winterbourne View is devastating. Like many, I have felt shock, anger, dismay and deep regret that vulnerable people were able to be treated in such an unacceptable way, and that the serious concerns raised by their families were ignored by the authorities for so long.”

The report can be viewed here. 

Philip Hoult