Leading self-advocates have called once again for government action to improve care standards for people with learning difficulties, but say they are not surprised by a report highlighting how many services are failing national standards.
The report by the Care Quality Commission (CQC) was ordered by the Liberal Democrat care services minister Paul Burstow in the wake of a BBC documentary exposing abuse at Winterbourne View, an assessment and treatment unit near Bristol, in May 2011.
CQC inspected 72 assessment and treatment units, 39 secure units and 34 residential care homes, and found fewer than one in four were fully compliant (with no minor concerns raised) in the two areas inspectors were checking, care and welfare, and safeguarding.
Nearly half failed to meet one or both of the standards, because of moderate or major concerns, while independent healthcare services were twice as likely to fail to meet these standards as NHS providers.
The report concludes that some assessment and treatment services admit people for “disproportionately long spells of time”, while many are placed in services far from their families and homes.
The report also says there is an “urgent need” to reduce the use of restraint by staff.
Each of the CQC inspections included an “expert by experience”, a disabled person or carer with personal experience of the care system.
Gavin Harding, co-chair of the National Forum of People with Learning Difficulties, said he was “not surprised” by the report.
He said staff needed to “change the culture they work in… putting the person with learning disability first, leading how they want to live their lives instead of staff leading the way”.
He said he wanted to see better monitoring of how services were commissioned and more resources for CQC.
Harding said that sending a person with learning difficulties to a service out of their own area was “a disgrace”, while he warned that people were also being abused by staff in their own homes in the community.
Andrew Lee, director of People First Self Advocacy, said the scale of the problem was not a surprise, and that he had expected the evidence of poor standards to be even greater.
He said: “We have had loads of reports, loads of recommendations, and nothing actually seems to get better.”
He said he wanted CQC inspectors to be given more powers to act immediately over staff use of restraint.
Lee said there did not seem to be the motivation – the “inner heartbeat” – to drive those in authority “to make sure that people do have choice and actually have control, the right support and a good quality of life”.
He called for “stronger consequences” for abusers, but also better monitoring and accountability of local authorities and CQC.
He added: “The politicians need to take it a heck of a lot more seriously, rather than giving it lip service.”
And he said he was concerned that continuing cuts by local authorities were affecting the vital advocacy and other support provided by self-advocacy organisations run by people with learning difficulties.
Laura Broughton, who took part in the CQC inspections as a paid expert by experience, through the charity Choice Support, said: “Some of the people I met should have more help in getting a better life.
“They were often bored and distressed and staff talked to them not as adults but as though they were children. Some of the people weren’t treated as individuals and certainly not in a person centred way.
“I felt some people didn’t get the opportunities they should have because they couldn’t speak or because others felt their behaviour was challenging.”
Independent experts who worked on the CQC report said there was a “notable similarity between the concerns expressed” and the findings of a national audit carried out by the Healthcare Commission in 2006.
In his own interim report on the fall-out from Winterbourne View, Burstow said the CQC inspections showed an “insufficient focus on personalised care planning” while “too often the care which people receive is poor quality”.
Among 14 national actions announced by Burstow, he called for more surprise inspections by CQC inspectors, and said the government would promote “open access” to care settings for families and other visitors, and encourage service-users to be involved in reviewing their own care.
The BBC Panorama programme aired last year in the same week as the publication of John Pring’s* book, Longcare Survivors: The Biography of a Care Scandal, which is based on his 17-year investigation into the notorious and brutal regime of abuse of adults with learning difficulties at the Longcare homes in Buckinghamshire.
Pring said the flaws in the system exposed by Winterbourne View were worryingly similar to those that emerged from the Longcare case nearly two decades ago.
These include a callous indifference in society to the rights of people with learning difficulties; the use of large, isolated, institutional settings; poorly-trained and low-paid care workers; the failure of inspections to spot abusive cultures; agencies failing to communicate with each other and share information; a lack of advocacy for service-users; and authorities failing to take complaints of abuse seriously and ignoring whistleblowers.
*John Pring is editor of Disability News Service
27 June 2012
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