News was out last week that the targets set in the Transforming Care concordat were not going to be met. There was naturally the frustrations and fury that followed this. However, three years on I think its about time we looked at this with a bit more realistic eyes compared to the justified knee jerk reactions that followed the initial Panorama programme. I am very aware of public feeling towards this topic. I too was disgusted to see the horrific abuse at Winterbourne View. I want to share my views on why the aims of the Winterbourne View JIP have been off target, and I am aware that all of these views may not be popular with everyone, but there are some questions that we need to ask:
1. Will closing all learning disability hospital services prevent the abuse of people with learning disabilities and stop further abuse such as the horrific scenes seen at Winterbourne happening again.
Absolutely not. One of the first things you are taught in any safeguarding training is abuse can happen anywhere by anyone. If Wayne Rogers, the main perpetrator in the Panorama programme, was working on a 1:1 basis with someone in their own home with no direct supervision would the people he was supporting be any safer? The causes of this horrific abuse aren’t down to the name of the place where the support is given. It is the recruitment, the management, the training, the culture. Many local authorities have closed specialist residential support for people with learning disabilities. Frameworks are driving down prices of specialist learning disability providers and in many cases un-specialising them. The amount of competent support available is likely to reduce over the next few years – will this increase or decrease the risks of abuse? Will this increase or decrease the amount of admissions? The range of specialist provision is being decreased and the myth that its because it was an ATU is being used as a vehicle to drive the closure of highly specialist learning disability support.
It is also important to note the reason most people come into a career in learning disability support is because they genuinely want to support people with a learning disability to have a better life. I have never met anyone so delusional to think they could become a millionaire by working in this field. I have rarely met people who just do it as a job to pay the bills, and even rarer I have been unfortunate enough to meet some people who seem to enjoy the power and authority over vulnerable people who find themselves in this field, and with good management and supervision these people do not last long. When all we see are the horror stories, having a family member moving into support of any kind can be petrifying. This nicely fits the cost cutting agenda as family support is free. Why cant you see the thousands of success stories and amazing things that are happening on a daily basis?
2.Are all learning disability inpatient services the same as Winterbourne View?
Well the obvious answer to this is no. I have visited the good, the bad, and the ugly in my career so far and most inpatient services provide safe and effective care for people. At the time Panorama went to air there was huge criticism of CQC and their ability to effectively regulate learning disability support, having given Winterbourne glowing reports and taking no action. CQC and IHAL then reviewed ATU’s after the programme was aired. They found 68% of NHS ATUs were compliant with safeguarding and 33% of private ATUs were compliant. This was sold as people in NHS care were better cared for. These things don’t happen overnight why did it take the airing of this programme to highlight this to CQC? 2 years ago when these figures came out there was no consistency in the support, with NHS looking more compliant, but 68% being nothing to shout about. How would these scores look in non-ATU based care? How do they look now for ATUs? This focus on how the cause is that the venue was an ATU seems to have smoke-screened how all support for some of the most vulnerable people in society is regulated and how that regulation has failed.
Bill Mumford, CEO of MacIntyre, has been appointed to lead on the Winterbourne Joint Improvement Programme. Mencap are frequently championing the Winterbourne agenda. Two weeks ago abusive practices were seen at a MacIntyre residential school. Last month staff at a Mencap home were found guilty of financially abusing the people they support. There is a real issue with providers leading on this programme. Firstly, they are not infallible. Abuse happens in their services. Secondly, can they really claim impartiality and that they do not have a vested interest? Although the theme of “get them out of ATUs and into safe services like ours” doesn’t really ring that true all the time.
3. Is it a failing that more people have been admitted than discharged in the last 3 years?
Well that is an impossible question to answer without knowing each person’s story. A bigger failing was that people were being admitted to Assessment and Treatment Units with no sign of an assessment, no treatment plan, and no discharge plan. Surely this would be a better indicator of how things have changed? There is something firstly going wrong in community services that people need to be admitted. But that isn’t to deny that some people have bad times, some people become ill and need higher levels of support and skill, and some people pose such a high risk to themselves or others that they need the least restrictive but most secure service available. Secondly, if people aren’t being discharged it is likely to be due to their being a lack of appropriate community support to discharge people to. This brings me back to the frameworks and how are you going to create more competent support when the price being offered to providers goes down and the variety of options decreases?
4. What else don’t we know about the fact there are still people in ATUs?
There are still a list of unanswered questions. How many people are far from home compared to three years ago? How many people are in units larger than 10 people, how many larger than 6 people? How long have people been admitted for? Do they have a discharge plan? Are they being regularly reviewed by the care manager? Are CQC now effectively monitoring these services? Do these services have an open door for families to visit?
Yes, it is disappointing that the targets set in the outrage of the Panorama programme have been missed. But the fact there are still people in ATUs doesn’t seem to be the real failing and there are much bigger questions that need addressing. I don’t work for an ATU, I don’t provide any ATU’s, it could be argued that in my current role I have a vested interest in them all closing and being discharged, but that is not my personal view. The headlines are misleading and providing a smoke screen for the real issues.