Bradley was intellectually impaired from birth. He was abused by family members and people employed to care for him. His personality evolved in a cloud of hostility and violence. His recent years have been spent around the country in different hospitals before ending up with us, in another hospital. We want him to be able to leave hospital because he wants to and we think he can.
He tells us that he has never been anywhere where people are so kind to him. His mother tells us she is very grateful that we treat him like a human being – a compliment that induces both pride and shame.
Winterbourne View is the hospital where people with intellectual disabilities were victims of inexcusable abuse. The widespread outrage was justified. There were inevitable inquiries and reports as well as criminal trials. The resulting action has been incessant data collection, laudable aims and unrealistic targets. The consistent message has been that too many people with a learning disability are detained in hospitals, often far from their homes and families, and that there should be energetic efforts to try and discharge them to a better place. These messages are justified and rarely opposed by professionals.
In the last year, as a consultant psychiatrist responsible for a group of people with intellectual disabilities detained in hospital, I was repeatedly asked for the same information about people like Bradley. This was often from the same interested parties: the commissioners – the people responsible for deciding how to spend the budget. This information was used to measure whether the attempts to discharge people like Bradley from hospital were successful. The data has been collected but, perhaps unsurprisingly given continued cuts, there has been little progress. So simply measuring, while cutting services, did not result in any change. The census demonstrated an “abject failure”.
The most recent action to address this is the care and treatment review – an independent review by the commissioners accompanied by a hastily gathered group of experts. The pressure on commissioners is being exerted from the top of the NHS. Managers have increasingly urged, or even directed, the discharge of people even when there are clear reasons for not doing so. They are ordering discharges not just to better places, but to anywhere that constitutes a step in what they consider to be the right direction – namely, any move out of hospital. They say Bradley should move somewhere else. He says he doesn’t want to yet. We think we can help him live outside hospital more quickly and more successfully if he stays with us in the short-term and he thinks so too.
There is also little thought given to whether there might be some value in respecting the opinions of the people providing the care. Dedicated professionals have been reduced to tears by the implication in these reviews: that they are somehow motivated by a sadistic desire to lock people up and control them rather than provide care.
We have an established system of care being commissioned by a middle-person between the Department of Health and the hospitals and clinics and, in my opinion there should be someone to challenge the views of doctors and other clinicians (particularly when the people concerned sometimes struggle to challenge things themselves and are at risk of being victims of violent abuse).
Winterbourne View highlighted this. However, to dismiss outright care givers’ opinions is foolish and demoralising. The doctor does not necessarily know best, but they do have knowledge enough to deserve a fair hearing.
Winterbourne View was the location of a scandal. It was not just lack of compassion or poor practice but also a series of criminal acts and it deserved a dramatic response. This should have been well thought out, compassionate and incorporate multiple opinions. What we have witnessed, instead, is a target driven approach that is intrinsically meaningless: discharge somewhere – anywhere. And if you oppose it, you must have nasty intent.
If the next census reports that 50% of people with a learning disability have been discharged, there will be celebration. There might be cause for congratulation, but one should stop and wonder where Bradley is and whether he is still being treated like a human being.
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