Half of learning disability services do not meet minimum standards of care

BMJ 2012; 344 doi: (Published 27 June 2012) Cite this as: BMJ 2012;344:e4402
  1. Ingrid Torjesen
  1. 1London

Half of all care homes and treatment centres in England that care for vulnerable adults do not provide services that meet minimum standards, an inspection by the health regulator the Care Quality Commission (CQC) has found.1

The Department of Health asked the commission to undertake a series of unannounced inspections of services for people with learning disabilities or autism and challenging behaviour as part of a wide review of how the health and care system supports this group of people. The review was prompted by a BBC Panorama documentary that filmed verbal and physical abuse of residents at the Winterbourne View home near Bristol.2 A subsequent CQC investigation found that staff at Winterbourne View were too ready to use restraint and that 10 essential standards were not being met, including a failure to protect patients against risk. The hospital was closed, and 12 people were arrested.3

CQC inspectors subsequently visited 145 other hospitals and care homes that provide services for vulnerable adults and found that 69 of them (48%) failed to meet at least one of the two standards assessed: care and welfare; and safeguarding patients’ health and wellbeing from abuse. Forty one facilities met both standards but with minor concerns, and 35 met both standards with no concerns.

The 145 premises comprised 68 NHS trusts, 45 independent healthcare services, and 32 care homes. Independent healthcare services that provided assessment, treatment, and secure services were less than half as likely as NHS providers to meet both standards: 33% of the independent services and 68% of NHS trusts met both.

The commission’s report criticised the failure of services to treat patients as individuals and pointed out that providers still needed to learn lessons about the use of restraint. It said that commissioners needed to review the care plans of people in treatment and assess services urgently to ensure that patients received care in the appropriate settings.

Jo Williams, chairwoman of the CQC, said, “Although many of the services we inspected were intended to be hospitals or places where people’s needs were assessed, we found that some people were in these services for too long with not enough being done to help them move on to appropriate community based care.”

She added, “All too often inspection teams found that people using services were at risk of being restrained inappropriately because staff often did not understand what actions count as restraint, and when restraint happened there was inadequate review of these [actions] putting people at risk of harm or abuse.”

At the same time as the CQC released its findings, the Department of Health published an interim report into Winterborne View Hospital setting out how the quality and safety of services for people with learning disabilities will be improved.4 It said that unannounced inspections from the CQC will be promoted, along with “open access” for families and visitors and encouraging people receiving care to review it. This will be underpinned in the autumn by a national public commitment (concordat) to deliver the right care for this group of people from organisations such as the Association of Directors of Adult Social Services, the Local Government Association, the medical royal colleges, and the NHS Commissioning Board. In addition, the NHS Commissioning Board will agree by January 2013 how to use NHS contracting and guidance to embed quality.

The care services minister, Paul Burstow, said, “There is compelling evidence that some people with learning disabilities are being failed by health and care services.

“Our national actions will mean that people have access to good care, closer to home. They will make sure that those who provide [and] commission care and care staff know exactly what part they must play and what standards are expected of them.”


Cite this as: BMJ 2012;344:e4402


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