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Bubb suggests radical changes to learning disabilities care

But care provider wants more action to challenge institutionalisation

Louise Prime

Wednesday, 26 November 2014

Today’s report into the future care of people with learning disabilities doesn’t go far enough to ensure systemic change, claims a specialist care provider. Dimensions UK broadly welcomes Sir Stephen Bubb’s independent report, commissioned following the abuses uncovered at Winterbourne View care home and elsewhere, but warns that it’s unclear how the report will be acted upon.

The Bubb report revealed this morning by NHS England aims to address the serious shortcomings in the provision of support for people with learning disabilities. In Winterbourne View – Time for change, Sir Stephen calls on the Government to draw up a Charter of Rights for people with learning disabilities and/or autism and their families, that should underpin all commissioning; and he says the Government and NHS England should require all local commissioners to follow a mandatory commissioning framework that should be accompanied by a closure programme of inappropriate institutional inpatient facilities. He also argues that:

  • People with learning disabilities and/or autism and their families should be given a ‘right to challenge’ decisions to admit or continue keeping them in inpatient care and should receive independent expert support to exercise that right, including high-quality independent advocacy.
  • NHS England should extend the right to have a personal budget (or personal health budget) to more people with learning disabilities and/or autism, including all those in inpatient care and appropriate groups living in the community but at risk of being admitted to inpatient care.
  • Community-based providers should be given a ‘right to propose alternatives’ to inpatient care.

Sir Stephen, who is chief executive of charity leaders’ body ACEVO, said: “We urge immediate action, to close all Winterbourne-style institutions and ramp up community provision … The time for talk is over. It’s time for people with learning disabilities or autism and their families to be put first.”

Care and Support Minister Norman Lamb responded: “I am going to consult on changing the law to speed up delivery of the Winterbourne View commitments – to see people living in the community wherever possible and able to challenge decisions about their care.”

Dimensions UK, a not-for-profit social care provider for people with learning disabilities or autism, said that although it broadly welcomed the Bubb report – particularly the proposal for a charter of rights, and the recommendations on positive behaviour support – it had serious criticisms. It said the report doesn’t go far enough to ensure systemic change, and called it ‘somewhat naïve’ in places. It pointed out that the NHS’s own figures show that more people with learning disabilities are still being admitted to Assessment and Treatment Units than are leaving, despite the Government’s published target to end such inappropriate placements by last June.

Lisa Hopkins, executive director of practice development at Dimensions, commented: “The Bubb report accurately identifies that many ‘responsible clinicians’ employed by the major providers of Assessment and Treatment Units and Independent Hospitals can be risk averse, and disinclined to make recommendations for discharging people. What the report omitted to say is that many of these clinicians are also incentivised to keep people locked up in these units.  We believe this represents a conflict of interest ...

“It is also unclear how the report will be acted upon. The Department of Health, local authorities, CCGs, and the NHS have not yet formally backed the proposals.”

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