1 The Winterbourne View Concordat
commitments
1. On the basis of a report by the Comptroller and
Auditor General, we took evidence from the Department of Health
(the Department) and NHS England about care services for people
with learning disabilities and challenging behaviour. We also
took evidence from the Challenging Behaviour Foundation, the Association
of Chief Executives of Voluntary Organisations, and the former
head of campaigns and policy at Mencap.[1]
2. A learning disability is a reduced intellectual
ability and difficulty with everyday activities, which affects
someone for their whole life. A minority of people with learning
disabilities show challenging behaviour. They can present a risk
to themselves, and others such as their families and the public.
Treatment programmes for people with learning disabilities are
not a cure, but help the person to understand and manage their
behaviour and relationships, improve their communication skills,
increase their independence levels and reduce any risks they pose.[2]
3. In May 2011, a BBC Panorama television
programme showed staff abusing inpatients with learning
disabilities at Winterbourne View, a private mental health hospital.
In June 2011, the hospital closed and its patients were transferred
to alternative services. The police investigation resulted in
11 criminal convictions of staff at the hospital. In the Government's
response, it gave as a central commitment that, by 1 June 2014,
if anyone with a learning disability and challenging behaviour
would be better off supported in the community, then they should
be discharged back to their homes and community care. As a consequence,
the Government expected to see a dramatic reduction in hospital
placements and large mental health hospitals closed, so that a
new generation of inpatients did not take the place of people
then in hospital.[3]
4. The Department has lead responsibility for delivering
the commitments the Government made following the Winterbourne
View scandal. The Department sets the strategy to meet the Government's
commitments and to enable changes and measure and monitor progress.
In line with the Health and Social Care Act 2012, NHS England,
mental health hospitals, and local health and social care commissioners
determined how to meet the commitments. The NAO estimated that,
in 2012-13, the NHS spent £557 million on services for inpatients
in mental health hospitals with learning disabilities and challenging
behaviour. In addition, in 2013-14, local authorities with adult
social services responsibilities spent £5.3 billion on services
for adults with learning disabilities.[4]
5. Despite the Government's expectation of a dramatic
reduction in the number of people with learning disabilities in
hospital, the number has not fallen but has been broadly stable
over the last year (3,250 in September 2013 and 3,230 in September
2014). The Department told us that, in December 2012, when agreeing
the Concordat, it underestimated the scale of the task involved
in moving people with learning disabilities out of mental health
hospitals, how difficult it would be for commissioners to adjust
their decision making, and how long it would take to achieve its
objectives.[5]
6. In March 2014, the Department realised that its
governance structure for supporting local areas and local commissioners
to improve services was not effective, and that it was not making
progress, as local commissioners were still commissioning hospital
services for people with learning disabilities, and the number
of people in hospital was not falling as it had intended. Consequently,
the Department developed a new accountability framework, which
it intended would bring about the desired change to the commissioning
of local rather than hospital services.[6]
The need to improve data
7. The Department told us that in 2011-12, its data
on patient numbers had been "absolutely non-existent".
It considered that it has since made significant progress on improving
its data, while recognising that it is still not good enough,
and that data remained one of the biggest issues on which it needed
to improve. The Department explained that if it had waited until
it had perfect data on people with learning disabilities, it would
have lost at least another year in its efforts to transform their
care.[7]
8. There are currently two different sets of data
for the number of people with learning disabilities in mental
health hospitals.[8] One
is the annual census of mental health hospitals by the Health
and Social Care Information Centre. The other is NHS England's
quarterly survey of commissioners. The 2014 census reported that
3,230 people with learning disabilities were in mental health
hospitals at 30 September 2014. The quarterly data reported that
2,600 hospital places for people with learning disabilities had
been commissioned by the NHS in England in September 2014. The
Department explained that it could not completely reconcile the
two population figures. The Department told us that it was moving
both methods of data collection to the Health and Social Care
Information Centre and considered that doing so would provide
it with greater clarity on the reasons for the discrepancies between
the two figures.[9]
- The Department and NHS England still, however,
lack real-time data on the number of people with learning disabilities
and challenging behaviour in mental health hospitals. In addition,
it also lacks information on those who are receiving treatment
services in community settings, those who have contacts with the
criminal justice system, or those transferred between or readmitted
to hospital. The gaps in the Department's data on the people with
learning disabilities are in sharp contrast to the quality of
its data on other activities, where it is able to keep an accurate
count of inpatient admissions and interventions, such as heart
operations.[10]
1 C&AG's Report, Care services for people with learning disabilities and challenging behaviour Session 2014-15, HC 1028, 4 February 2015 Back
2
C&AG's Report, paras 1.1-1.2 Back
3
C&AG's Report, paras 1.7, 1.9, 1.13 Back
4
C&AG's Report, paras 4-5, 1.5 Back
5
Qq 17-18, 26; C&AG's Report, para 2.9 Back
6
Q 34 Back
7
Qq 17-19, 24 Back
8
Q 20 Back
9
Qq 25-27 Back
10
Qq 19-21, 24, 30-32; C&AG's Report, paras 26, 1.3, 2.19-2.21 Back
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