Part 2 on the progress of the Transforming Care programme
by Jon Corr, Head of Services - Adult Complex Needs, Safe As Houses
In 2011 a BBC’s Panorama program exposed the abuse of patients at Winterbourne View, an independent hospital for people with learning disabilities and/or autism. A shameful mistreatment of vulnerable individuals in which Judge Neil Ford QC, described as an “Institution in which systematic abuse' of vulnerable people took place.
He said “The hospital was run with a view to profit and with a scandalous lack of regard to the interests of its residents and staff” and added “A culture of ill-treatment developed and as is often the case, cruelty bred cruelty”.
This prompted further inspections by the CQC of 150 hospitals and care homes for people with a learning disability, where they discovered inadequate practice in inpatient services including poor person-centered care, limited appropriate activities and a lack of monitoring and learning from incidents of restraint.
In response to these findings, in December 2012 the Department of Health launched the policy Transforming Care: A National Response to Winterbourne View Hospital, stating that “Hospitals are not where people should live” and pledged that everyone inappropriately placed in hospital would move to community-based care as quickly as possible, and no later than 1 June 2014.
Was this target reached? In a word…. No.
But surely in 2021 it’s been reached? Sadly, that’s a No too.
Why? Well in order to answer such a complex question, let’s take a look at the current picture of Transforming care:
Was this target reached? In a word…. No.
The latest NHS figures show that there are at least 2,070 people with a learning disability and/or autism currently in Assessment and Treatment inpatient units. Within these units, people may experience physical restraint and being kept in isolation.
As someone who has worked in hospital settings, please allow me be the first to say that the safety of an individual, other patients and staff is paramount and I’ve seen incredibly positive strides made in terms of least restrictive practices, particularly since the Winterbourne View scandal.
Two of the latest figures really shock me however; the 160 delayed discharges in a month and the one that staggers me the most is the average length of stay… 5.4 years. How can someone that enters a building for assessment and treatment not leave for over 5 years? I mean, if I walked into A&E and they told me the waiting time was 5 years, I’d probably pop my shoulder back in to place myself and leave as quickly as I could.
Unfortunately, individuals with a learning disability and/or Autism don’t have that option when sectioned under the mental health act. I’m not being naive here and I understand from experience that there is certainly no quick fix… But 5 years? Surely we can do better than this.
"... never-ending iceberg of many individuals stuck in hospital settings who fall under the Transforming Care Agenda"
Tony Hickmott was 21 when he first went into institutional care but he’s now 44 and is thought to be one of the longest-held patients in a secure unit in the UK. Unfortunately, Tony is just the tip of what seems like a never-ending iceberg of many individuals stuck in hospital settings who fall under the Transforming Care Agenda.
People tend to be admitted to ATUs in crisis situations and sectioned under the Mental Health Act. They can deteriorate for many reasons, and a major issue is the environment; they often aren’t appropriate, safe or fit for purpose. This means it is harder to get patients discharged as they continue to be seen as a risk to themselves or others.
In October 2021,160 people had their discharge delayed, in one single month. Hospitals don’t just hold on to individuals for the fun of it and the reasons can greatly differ but there is a vast lack of appropriate community accommodation and services to support people like Tony to live a more independent life, and one that is close to their family.
This is why The Transforming Care Agenda is so far behind. These individuals are incredibly complex and require specialised, bespoke environments and support within the community to lead independent lives.
Having worked in the front line of care ranging from secure settings to residential, I can’t help but feel that there is a major gap in terms of environment and support. Something we at Safe As Houses are working hard to fill. By collaborating with care providers, clinical commissioning groups, local authorities, families and service users we may just be able to find people like Tony a safe place they can call home.
10 years on from Winterbourne, we’re not at all where we should be, but by working together we can be.
Greater collaboration and transformative thinking is required and personally I’m proud to be working within a team that is actively looking at providing tangible solutions to solve what is nothing less that a stain on our society. If you wish to speak to our team on any areas of Transforming Care and our work, please email email@example.com.