“There are far too many people with learning disabilities or autism staying too long in hospital or residential homes and even though many are receiving good care in these settings, many should not be there and could lead happier lives elsewhere. This practice must end.”These were the words of the Liberal Democrat care services minister Norman Lamb as the government published its final report this week on the abuse at the Winterbourne View private hospital.But the Royal Commission on Law Relating to Mental Illness and Mental Deficiency had reached a similar conclusion. In 1954. As did the 1971 white paper, Better Services for the Mentally Handicapped, which recommended that long-stay hospital settings for people with learning difficulties should gradually be replaced with support in the community.So too, 30 years later, did the next learning difficulties white paper, Valuing People, which also talked about the need to phase out the use of long-stay hospitals.As I wrote in October, there was nothing particularly new or shocking about the Winterbourne View scandal. Excessive profits, poorly-trained and low-paid staff, a bullying ring-leader, an isolated institution, light-touch inspections, over-medication, frequent use of violent “restraint” of patients with “challenging behaviour”, whistleblowers and service-users ignored, concerns dismissed by the authorities… this has all been seen many times before.
So too had the inevitable outpouring of outrage from media commentators, charities, and, of course, politicians.
I have no doubt that Norman Lamb was sincere when he said this week: “Like many, I have felt shock, anger, dismay and deep regret that vulnerable people were able to be treated in such an unacceptable way…”
But so I’m sure was the Labour health secretary Patricia Hewitt in 2006 when she said, in the wake of a similar scandal, the widespread abuse of patients with learning difficulties at Budock Hospital in Cornwall: “The abuse that’s been uncovered of people with learning disabilities is an absolute disgrace. It is completely unacceptable.”
Hewitt added then: “The trust has already taken steps to put things right in Cornwall. Now we’ve got to learn lessons from that and make sure this does not happen again to other vulnerable people.” But it did happen again.
There is much to be welcomed in Lamb’s report, and in its 63 recommendations. Measures to hold companies to account for the abuse that takes place in their institutions are long overdue, and – who knows – could even be Winterbourne View’s most important legacy.
But this is not the first government report to call for improved staff training, tougher inspections, fewer hospital beds, more advocacy, and better communication with service-users and their families about their care and support.
And even without all of its other recommendations, the report is demanding “high quality care and support services in every area”. And that will not come cheap. The Department of Health seems convinced that this will be paid for with the money saved by not using ruinously-expensive private hospitals and assessment and treatment centres. But knowing the funding pressures weighing down on every local authority and health body in the country, this is not an entirely convincing argument.
A key thing that the white papers of 1971 and 2001 – and the 1959 Mental Health Act, which followed the Royal Commission – had in common was not only a desire to move away from institutionalised, hospital-based care, but the failure by the government of the day to provide the necessary funding to implement their recommendations.
And if there was one striking omission from this week’s report, it was detailed discussion of funding.
The document mentions the high fees charged by Winterbourne View, and the savings reported in a study by the Association for Supported Living, which described what happened when people were moved from institutions into the community. There is also a brief mention of Department of Health funding for its leadership improvement programme, and of funding arrangements when responsibility for a service-user is passed from the NHS to a local authority. But apart from that… nothing.
And if the government – and Norman Lamb – really were so desperate to promote “a culture and a way of working that actively challenges poor practice and promotes compassionate care across the system”, why then did they only appear to order an audit of out-of-area placements for people with learning difficulties in health settings? Why not also audit the placements of all those other people – many of them sent to residential homes far away from their placing authority 20 or 30 years ago when the old long-stay hospitals were closing? True, many of them will no longer be alive, but some of them will. What about their safety and welfare?
The Department of Health has been told several times about concerns with this group of people, and the risk that they have been exposed for many years to serious neglect and abuse in isolated care settings. Are their placements not worth auditing as well? Or is that too expensive?
More than 50 years of broken promises suggest that, yet again, the limits of a government’s commitment to the welfare of people with learning difficulties will be measured in pound notes.