Winterbourne View shows that some policies are ‘out of sight, out of mind’

In a previous post we suggested that outsourcing can be a way to protect unpopular policies. In the case of vulnerable adults with learning disabilities, outsourcing has become a way to abandon them in poorly run institutions far away from their families – until scandals like Winterbourne View force us to confront the abuse that this isolation enables. Blaming poor providers is only part of the picture – we also need to look at the bad policy that enables such abuse to happen.

Winterbourne View Hospital was an admission and treatment unit for people with learning disabilities in Bristol, managed by social care provider Castlebeck. A Panorama programme, Undercover Care: The Abuse Exposed, first shown on BBC One in 2011, uncovered the endemic abuse and neglect taking place at the centre. The programme showed footage of one member of staff who trapped a female patient under a chair whilst he watched television; another female patient was dragged from her bed by two male members of staff. The appalling abuse that took place at Winterbourne was only uncovered because a whistleblower, Terry Bryan, was prepared to raise the alarm.

This is not just about one bad provider, however. Following the scandal, the Government asked the regulator, the Care Quality Commission (CQC), to make unannounced inspections of 150 similar learning disability services. CQC found that nearly half of hospitals and care homes are still failing to meet acceptable standards. The degree of abuse at Winterbourne View is sadly not unique either – it follows other recent scandals in NHS care homes for people with learning difficulties in Cornwall and in Merton and Sutton.

Multi-agency working clearly also failed in the case of Winterbourne View, and the Department of Health has called for more joined up working – the usual mantra after such scandals. Avon and Somerset police were called 29 times but failed to observe any pattern or draw any conclusions about the level of incidents at the home. The local Adult Safeguarding Board received 40 alerts over three years but took no action, whilst CQC decided not to follow up the notifications of abuse it received because it assumed that the local Safeguarding Board was doing so. CQC had also inspected Winterbourne View prior to the Panorama programme and concluded that the service met its standards. Vulnerable individuals have been at a centre of a web of public bodies who are all pointing the finger of blame at each other, from the CQC, the local Safeguarding Board, NHS commissioners, to the police and the local hospital.

But this is not (just) a failure of regulation either. Various reports relating to successive scandals have pointed not only to gaps in multi-agency working, but also to poor training, the pay and conditions of staff employed in adult social care, commissioning focused only on procurement rather than managing contracts, and poor representation of the views and aspirations of disabled people and their families. In other words, it’s time we focused on what’s wrong with the policy as well.

Many people assume that the NHS or local authorities provide services for people with a learning disability, but scandals like Winterbourne View highlight that much of the social care system is outsourced to providers who run these services to make a profit. Despite the perception of over-regulation of these services, something is not working if cases like Winterbourne View, Cornwall and in Sutton and Merton continue to emerge – and these are just the ones we know about.

Despite the rhetoric of ‘localism’,  ‘choice’ and ‘personalisation’ that underpins the Government’s open public services agenda, too many adults with a learning disability are still being placed in poorly-run institutions far away from their families and friends. This is the argument of 86 individuals and organisations that wrote a joint letter to Paul Burstow MP, the Minister for Care Services.

Admission to an assessment and treatment unit such as Winterbourne View is supposed to be time limited to complete a new assessment and treatment plan or change medication. However evidence points to the fact that people go in and stay in. The CQC Count Me in 2010 census looked at providers of in-patient learning disability services. It found that 67% of all patients in England and Wales had been in hospital for one year or more, 53% for two years or more and 31% for more than five years. This policy could be characterized as ‘out of sight, out of mind’, which was the theme of a recent report from Mencap in how to stop the neglect and abuse of people with a learning disability.

Many people with a learning disability want to live in the community that they come from, near their family and friends, with support available locally. Mencap and other providers have called for policy changes, in particular the closure of these residential assessment centres, to be replaced by a system of local care and support. One of the problems of Winterbourne View was that in some cases families were actually refused contact or had contact their family member restricted in some way. Abandoning people in long-term residential centres far from their families leaves people feeling very isolated, especially for older people with a learning disability where their parents may be frail or have passed on with family contact left to siblings or distance relatives.

To place one person in one of these assessment and treatment units can often cost in excess of £150,000 per year. Supporting people in their local community would cost significantly less. Large sums of public money are being spent on inappropriate treatment that many people with a learning disability and their families don’t want to access. A wider debate about the policy is urgently needed. If charities, families and people with a learning disability are telling us they would like a different approach to delivering care and support, why is this being ignored? The Government’s recently announced open policy agenda is all about ensuring that more expertise and evidence informs policy, wherever this input comes from. What price genuinely open policy if it might threaten the current lucrative market for outsourced delivery in which services users have little voice?