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Progress 'too slow' in learning disability care transformation

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NHS England has been too slow to act in its closure of inpatient wards for people with learning disabilities, while failing to ensure the necessary replacement community support is in place, according to charities.

It is unacceptable there has been no “tangible” progress on the ground, despite a “clear roadmap” of action recommended six months ago in an independent report produced following the abuse scandal at Winterbourne View hospital, they said.

“Building capacity in the community is an absolute priority. But the recommendations made to this effect…have seen little progress”

Stephen Bubb

Sir Stephen Bubb, the chief executive of the Association of Chief Executives of Voluntary Organisations (ACEVO), noted that his report – Winterbourne View - Time for Change – was commissioned by NHS England in the first place after the government failed to meet its own deadline to close large-scale inpatient services by summer 2014.

In today’s six month-review of progress, he acknowledged there had been “a definite shift in the commitment to change” by NHS England, demonstrated through plans in its Transforming Care programme.

He noted that a full timetable for ward closures was due to be published in October, which he is to review.

But he said there had been “little to no discussion” with providers and the third sector more widely about how to improve community facilities.

Sir Stephen called for NHS England to set up a “transition taskforce” mandated to work with providers, commissioners and families to set out the national framework for scaling up community provision.

“In the last four years, people with a learning disability have seen… deadline after deadline pass for moving people out of in-patient units”

Mencap and CBF

In the foreword to his review, Sir Stephen said: “Time for Change was clear that building this capacity in the community is an absolute priority.

“But the two recommendations made to this effect – workforce development, and investment in community-based services – have seen little progress,” he stated.

“This is unacceptable and risks undermining the work being done elsewhere to create a new framework of care for people with learning disabilities and/or autism,” he said.

The charities Mencap and the Challenging Behaviour Foundation echoed his concerns. They called for “urgent priority” to be given to improving community provision, including investment in the workforce.

Jan Tregelles, chief executive of Mencap, and Viv Cooper, chief executive of the Challenging Behaviour Foundation, said: “In the last four years, since Winterbourne View, people with a learning disability and their families have seen little meaningful change on the ground and deadline after deadline pass for moving people out of in-patient units.”

mencap chief executive Jan Tregelles

Mencap chief executive Jan Tregelles

“Developing community services should have been started a long time to go and must result in high quality local support and services or the change we all want to see will not happen,” they said. 

This must include investing in a highly skilled community workforce to support children and adults with a learning disability to meet their individual needs,” they added.

Earlier this year, NHS Engand board papers revealed plans to close inpatient facilities for people with learning disabilities would first be implemented in the Midlands and East, and North regions of England.

A report by chief nursing officer for England Jane Cummings included in the papers said 30% of learning disability patients in hospital on 1 April 2014 had now been discharged into the community following assessment.

However, a recent update by NHS England and other organisations on their work to improve learning disability care shows in places the rate of admissions to wards is outstripping discharges. It said from March 2014 to May 2015 there was an overall reduction of 140 people in inpatient care in England.

Ms Cummings, who is leading the work, said: “All the agencies involved in this work are clear that while a great deal of progress has been made we still have lots to do to transform and improve care for people with learning disabilities.

“We are committed to driving through changes at a fast but safe pace, we are on track to do so, and I will be setting out the closure and reprovision plans in October as previously announced,” she said.

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Readers' comments (3)

  • We are not surprised! The whole thing has been useless from the start. The people managing to escape from these units do so because of the massive fights put up by their families - whilst Bubb held breakfast meetings - who paid for his breakfast? ;-)

    Nothing will improve until private companies are excluded from systems at are currently making huge profits at the expense of people who should be at home. Nothing will change until the NHS and LAs stop employing power mongers who think they own anyone with any form of disability and can further their own nast little games by controlling the lives of vulnerable people. Don't be offended by this - you all know somebody in your workplace who fits the bill - blow the whistle now and things might start to change!

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  • I think a big problem here is that commissioners now appear more and more often to have LD as an add-on to their other commissioning responsibilities. Although clearly there are some very talented LD Commissioners many now find themselves with the LD portfolio without the experience necessary to be able to identify exactly what needs to be put in place to avoid the need for admission to an inpatient service in the first place. Those that know what needs to be done often don't know how to implement the changes or if they do know how they have problems shifting the resources into community provision.

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  • Terry Bryan should have called the cops at Winterbourne or at least LA safeguarding. Res units absolutely essential except that they need to be sufficiently excellent and fun to cause the subject to want to stay. That is the only criteria.

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