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Government failed to keep Winterbourne View promise

The government has failed in its pledge to move people with learning disabilities out of hospital and into community care, the National Audit Office has found.

A commitment to move people with learning disabilities and challenging behaviour out of mental health hospitals and into the community was made in the wake of the Winterbourne View scandal in 2011. But NAO figures have found that there were still 2,600 such inpatients as of September 2014.

In 2011 a Panorama investigation exposed shocking abuse that was taking place at Winterbourne View, a private hospital in south Gloucestershire. Undercover footage showed staff repeatedly assaulting and harshly restraining patients under chairs, giving patients cold punishment showers, pulling patients’ hair and forcing medication into their mouths. One patient was left outside in near-freezing temperatures, and staff poured mouthwash into another’s eyes. Victims were shown screaming and shaking, and one patient was seen trying to jump out of a second floor window to escape the torment, and was then mocked by staff members.

Following the scandal the Department of Health set out an action plan in the ‘Winterbourne View Concordat’, which was published in December 2012. It pledged that any inpatient with a learning disability or challenging behaviour, who would be better off cared for in the community, would be moved out of hospital by June 2014.

But the NAO said that at the time of making the promise ministers “had not determined the scale of the challenge involved in increasing the capacity of community placements”.

The report said: “When the Concordat was published, the government did not have information on the ability of local commissioners to put in place the bespoke community placements and personalised care plans required to manage patients’ risks effectively, and prevent patient readmission. Nor had the government analysed the reasons for new patient referrals to mental health hospitals (including the impact on the total inpatient mental health population) or quantified the resources needed to accelerate patients’ readiness for discharge, to meet the 1 June 2014 target date.”

Ministers left it to NHS England and local health and social care commissioners to implement the promises made in the Concordat, in line with the Health and Social Care Act 2012. But this meant that the government couldn’t compel those responsible for delivery to implement the necessary changes.

The NAO report – which echoes the findings of a November 2014 analysis by ACEVO – found there was little motivation for commissioners as there was no financial incentive to bring such patients home, because funding did not follow the patient once they were discharged from hospital. Instead the commissioners are left to bear additional costs of expanding local community services to cope with the discharged patient, while NHS England centrally funded the care while in hospital.

Margaret Hodge MP, chair of the Public Accounts Committee, was “appalled” that the number of patients still in hospitals remains so high.

“People with learning disabilities, admitted to hospitals for assessment and treatment, have been badly let down by government. More than two years since its response to the abuse of patients at the Winterbourne View hospital, it is unacceptable for government to have failed in meeting its core commitment to move people out of mental health hospitals and into the community,” she said.  

“I am appalled that the number of people with learning disabilities who are inpatients in mental health hospitals, around 2,600 in September 2014, remains unchanged since December 2013. This shows that the Department has made absolutely no progress in closing unnecessary mental health hospitals. This is hardly surprising when there is no financial incentive for local areas to bring patients home.”

She added that the she was “deeply concerned” that the NAO had found errors in 70% of the patient records it had looked at.

NHS England now plans to discharge half of the current 2,600 inpatients with learning disabilities to more appropriate settings by the end of March 2015. However according to the NAO “there is so far no timetable or ambition to reduce the inflow of inpatients with learning disabilities into mental health hospitals, or to close mental health hospitals”.

Amyas Morse, head of the NAO, said: “The process of moving people with learning disabilities and challenging behaviour out of hospital, where appropriate, is complex and defies short-term solutions. Unless all parts of the health and social care systems work effectively together, it is unlikely to happen. NHS England has made a disappointingly slow start to this task. Although it has now increased its activity, there are formidable care, organizational and service hurdles to overcome in establishing a new model of care in more appropriate settings.”

Mencap and the Challenging Behaviour Foundation released a joint statement saying the report showed "abject failure" to tackle the issue.

“There needs to be a clear, timetabled nationwide closure programme and investment in and development of local services, so thousands of people can be brought out of inappropriate settings and returned to their local community with good support,” the statement said.  

Care minister Norman Lamb MP said: "Winterbourne View shocked us all and shone a light on the way people with learning disabilities are sometimes treated. We know that the scale and complexity of the issue is a challenge and, although there have been some improvements; we have not gone nearly far enough fast enough.

"Our concordat set out the right route to improvement and was backed by professionals, families and charities. NHS England has published the system’s Next Steps report and we will all redouble our efforts to ensure people get the right care in the right place.”

He added: "I am looking at legislative options to give people with learning disabilities and their families a stronger voice and more rights – and I'm looking at how we can increase specialised housing options, so that more people can live independently but with the support that they need."

(Image credit: Tim Ireland/PA Wire)

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