Is the spectre of Winterbourne View finally beginning to shift? (original) (raw)

It’s not often that the formidable Margaret Hodge ends a session of the Commons public accounts committee, which she chairs and where she takes no prisoners, by commenting: “A jolly positive hearing.” So when she did so after taking evidence on what has become known as the Winterbourne View problem, it confirmed that something special had just occurred.

That something was the first public commitment by NHS England chief executive Simon Stevens to close hospitals that have become a kind of home, albeit a highly questionable one, to some 3,000 people with learning disabilities or autism whose behaviour is deemed “challenging”.

“I am afraid the time has come,” said Stevens, “to say that some of these remaining facilities are going to have to close and care is going to have to be re-provided in a radical way.” A “planned transition programme” would be finalised within six months, he continued, with closures taking effect within two years.

The announcement came out of the blue, less than two weeks after a position paper by NHS England plotted a fresh way forward, but made no explicit mention of closures. It had been implicit, Stevens told the committee, but “I think the time to be explicit is upon us”.

Jon Rouse, the Department of Health’s director general for social care, local government and care partnerships, was equally explicit. “Yes, some of these larger institutions have got to close,” he told the committee. “ They are completely inappropriate in terms of modern-day care models.”

So what does this mean? First, it’s a recognition that simply exhorting local commissioners to stop placing people with learning disabilities in so-called assessment and treatment (A&T) units in hospitals, then leaving them there for years on end, is never going to work. To paraphrase only slightly the words of Sir Stephen Bubb, who produced an independent report on Winterbourne towards the end of last year, as long as the beds are there, commissioners may be financially incentivised to fill them.

Second, Stevens’s commitment is one that will hold whatever the outcome of the general election. The Winterbourne agenda has been taken firmly into the ownership of NHS England, which must now prove it can deliver where previous joint initiatives have failed – and failed abjectly, to quote care minister Norman Lamb.

And third, this is something that will affect not only the 58 NHS A&T units in England, but also the 49 operated by the private sector. The closure programme proposed by Stevens will determine the fate of the former, with most capacity likely to be shut. What is expected for many of the latter is a new system of independent care and treatment reviews. This approach has already begun with more than 1,000 existing in-patients, of whom almost 600 have been discharged from hospital.

Stevens said all individuals being considered for an A&T unit would have such a review either before admission, or within a few days of placement, to ensure the referral was justified.

Any further expansion of A&T units is meanwhile being blocked by the Care Quality Commission. As England’s chief nursing officer, Jane Cummings, disclosed to the committee, the commission – acting on NHS England’s clinical advice – has already refused a licence to operate for a private provider that wanted to open a new unit.

So there do at last seem to be grounds for optimism that most of the people languishing in A&T units will soon be provided with more suitable accommodation in community settings. The spectre of the Winterbourne View scandal that has hung over the learning disability sector for almost four years may be starting to shift.

The snag, however, is money. Rouse confirmed that barely one in four local areas had voluntarily pooled or aligned its health and social care budgets to facilitate the transfer of patients from hospital into the community. Giving powers to the centre to order such budget reforms would be an idea in the forthcoming learning disability green paper, promised by Lamb but dependent on action by the next government.

As regards the idea, proposed by Bubb, of using innovative social finance to set up new accommodation and support in the community, Rouse said it “deserves serious consideration”.

For a moment, Hodge’s geniality almost cracked. “Why can’t we just get on and do it?” she asked. “To say it’s going to go into a green paper fills me with horror. It suggests to me that our successors will be sitting round the table in a couple of years’ time having the same conversation.”

Assured that this would not be the case, she relaxed again and said the committee would return to the topic in 18 months. Stevens has his deadline.

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