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Government fails to keep community care pledge for people with learning disabilities

Promise made in wake of Winterbourne View scandal to move people out of mental health hospitals into community

Caroline White

Friday, 27 March 2015

The government has failed to keep its promise—made in the wake of the Winterbourne View scandal—to discharge patients with learning difficulties from mental health hospitals and provide community care for them, say MPs.

There has been no closure programme for large mental health hospitals, with too many children and adults being admitted to these facilities and forced to stay there in the absence of community alternatives, says a report* published today by the House of Commons Public Accounts Committee (PAC).

Covert filming at the private mental health hospital Winterbourne View in 2011 exposed horrific abuse of people with learning difficulties and challenging behaviour, prompting concerns to be raised about several other institutions.

As a result, in December 2012 the government committed to discharging those individuals for whom it was appropriate back into their homes and communities by June 2014. However, the number of people with learning disabilities remaining in hospital has not fallen, and has remained broadly the same at around 3,200.

In evidence submitted to the PAC inquiry, Sir Stephen Bubb, who carried out a review into the commissioning of services for people with disabilities, expressed frustration at the lack of decisive action to close hospitals and prevent people being put into institutions, said PAC chair, Margaret Hodge.

“NHS England has acknowledged that it was indefensible to make so little progress against the commitment to discharge, as a result of which people had been badly let down. The continued operation of large mental health hospitals is incompatible with the Department’s model of care for people with learning disabilities and challenging behaviour", she said.

NHS England has now committed to develop a closure programme for large NHS mental health hospitals, along with a transition plan for the people with learning disabilities within these hospitals, from 2016-17.

But Mrs Hodge emphasised: “It is vital that the closure programme is matched by the necessary growth in high-quality community services. However, local commissioners have so far failed to deliver the high quality community-based care envisioned by the Department.”

Over a third of patients are in hospitals more than 50 km from their homes, while one in five people in hospitals and other institutions have been there for more than five years.

NHS England should use its commissioning framework to require local commissioners to comply fully with the Department’s stated aim to promote community based services rather than hospital admissions for people with learning disabilities, recommends the report.

The Winterbourne View Concordat favoured the use of pooled budgets to minimise overlaps between health and social services and save money. But only 27% of local areas have voluntarily pooled budgets. The Department should mandate the use of pooled budgets from April 2016, says the report.

Discharges from hospital are being delayed because funding does not follow the individual when they are discharged into the community, a situation that has been made worse by current financial constraints, says the report, which recommends that The Department of Health set out its proposals for 'dowry-type' payments from NHS England to meet the costs of supporting people discharged from hospital.

The Department should set out the responsibilities on local health and social care commissioners to put in place commissioning strategies which ensure an adequate provision of the range of community services and housing required by people with learning disabilities and challenging behaviour.

Further steps should also be taken to enshrining in law patients’, and their families’, right to challenge the decisions taken, whether they are about treatment, admission to mental health hospital, or community care services provided – and ensuring they receive the advocacy support to enable them to do so, says the report.

* Care services for people with learning disabilities and challenging behaviour. House of Commons Committee of Public Accounts. Fifty-first Report of Session 2014–15

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