Background
There are defining moments in the history of health and social care, one of them being the Panorama programme into the serious abuse of patients at Winterbourne View Hospital in Bristol which was broadcast ten years ago in May 2011. The public outcry contributed to a change in senior management at CQC and the abandonment of what was felt to be a light-touch approach to regulation. It also led to the Transforming Care Agenda which focused on reducing the number of people in hospital settings with a learning disability or autism. The 10th anniversary is a time to reflect on the extent to which changes to regulation and commissioning have delivered a more community-based model of care in this sector.
Care Quality Commission
There is no doubt that CQC has adopted a firm position in relation to new services for people with LD or autism since it first published its guidance called Registering the Right Support back in January 2016. It has applied what is known as the national model of care, namely services that are small in scale (typically no more than 6), based in or near a residential community and cater for local need. CQC has been criticised for stopping investment in new community services given the restrictions it has imposed through its promotion of the national model. What has happened is that there has been a move away from care homes to supported living services, even though ironically the latter often do not fulfil the national model in terms of their size. It will be interesting to see how CQC regulates this sector in the next few years, having issued revised guidance in October 2021 called Right support, right care, right culture which applies to all settings, including supported living.
Commissioning
Back in 2012, there were around 3,400 people in inpatient LD facilities. The intention was for this figure to fall to 1500 by 2017. However, this was never achieved, and the current total is around 2,050.
The Health Select Committee on 14 April held a session on the treatment of autistic people and individuals with learning disabilities. It heard from a doctor who said that around a third of those in inpatient settings would benefit from discharge: roughly 700. So, progress has been made but there is still much to do. One of the concerning aspects noted by the Committee was the rise in restrictive practices and sectioning, an issue that has been highlighted by CQC over the last year.
Conclusion
Sadly, there will of course always be a need for inpatient settings to treat mental health issues but significantly the Government White Paper on mental health states that LD and autism should not be considered mental disorders warranting detention. The consensus is that there needs to be a major expansion in community provision with clear pathways to ensure people do not end up in inpatient facilities for years and years. We know what works. We just need regulation and funding to make it happen.
Click here to read about the article written by Neil Grant and Bryan Higgins in the Care Agendas June issue.