Last week we finally got the news that many of us have been hoping for: 3,000 people living in outdated and inappropriate assessment and treatment (A&T) units will be discharged. They will live where they belong, surrounded by their family and friends and in the community, with appropriate support.
This comes some 30 years after the closure of long stay hospitals began, and the introduction of community care. It could mean that we are nearing the day when no one with a learning disability is forced to live behind a locked door.
The news, announced by NHS chief executive Simon Stevens, came as a surprise to many of us in the industry who have been promised action since Winterbourne View, but have so far only seen a trickle of change rather than the tidal wave we need.
Local authorities face a challenging task. Despite the Winterbourne View report and cries for change over recent years, last month’s Learning Disability Census 2014 revealed that 5% of patients, or 155 people, were ready to leave A&T units but lacked the funding and support needed to make the move. If we can’t help that 5% to make the transition, what chance do we have of a smooth progression for the rest?
Finance to make this happen is the first critical issue. It currently sits within the NHS system rather than local government. The NHS must ensure that money is transferred with individuals to their community based arrangements, enabling local providers to hire staff and develop these services in anticipation of the change.
However it is not just a question of increasing budgets. Local authorities and providers need to entirely remodel how they work together to develop effective solutions and deliver robust, expert provision in the community. Arrangements must also empower the people supported and their families with the freedom to choose their own provider and genuinely shape their future support.
There also needs to be an effective model to help ease the transition from A&T units into the community. Many of these individuals are hundreds of miles away from friends and family and have had no contact with the outside world for years. I believe that it is essential that we ensure provider selection takes place whilst people are in the A&T units, to help bridge the gap and enable support staff to weave the lives of the individuals they support into the social fabric of their new homes.
The proposed closures are expected to take effect within two years and I firmly believe that these problems can be solved with enough commitment from all who have the power to make these changes happen. The result would profoundly enhance the lives of people who have had their freedom taken away.
My only fear is that these changes won’t reach everyone. The NHS has the power to close the 58 NHS operated A&T units, but not the 49 operated by the private sector. It is possible that alternative provision run by the private sector could grow to take up the slack as people leave NHS hospitals. Those units run privately are expected to be put under greater scrutiny by CQC, but how far will this go?
Will CQC stop registering this provision altogether? I believe it must. Will local authorities stop buying support from these remaining private sector units? They must. Will the private sector develop different models with different names that are still in effect institutions?
Brandon Trust works with thousands of people, many of whom have profound learning disabilities and autism, and I am yet to meet one whose quality of life has not been improved by living in the community with the right support. We are a step closer to making community care possible for everyone, but thousands of people remain behind locked doors and as a sector we must work together to find the key.
