Winterbourne report: long term hospital beds for people with learning disabilities to end by 2014

BMJ 2012; 345 doi: (Published 11 December 2012) Cite this as: BMJ 2012;345:e8431
  1. Ingrid Torjesen
  1. 1London

The Department of Health for England has pledged to move as many people as possible with a learning disability or autism out of inpatient hospital care and into care in a community setting.

The commitment was made in the department’s final report into the neglect and abuse of people with learning disabilities at Winterbourne View Hospital in Bristol, which was published yesterday.1 The abuse at the hospital was uncovered last year by the BBC’s Panorama programme.2

The minister for care and support services, Norman Lamb, told a press conference: “I thought we had addressed the problem of institutionalised care some time ago, then you discover that it is quietly going up again.”

A “complete culture change” in society was needed, he said. “Would we ever tolerate someone with cancer getting the wrong sort of treatment or the wrong sort of care? No, we wouldn’t. Yet we have for too long tolerated people with learning disabilities put into the wrong settings.”

The report outlines the steps that should be taken to bring about this cultural shift. By April next year primary care trusts must have produced a register of all people with learning disabilities or autism in NHS funded care who have mental health conditions and who exhibit challenging behaviour. The cases of these people who live in hospitals or large scale residential care must be reviewed by June, and anyone considered to be in hospital inappropriately must be moved to a community based setting by June 2014.

Jo Webber, interim director of policy at the NHS Confederation, which represents most NHS organisations, said that the six month deadline was “highly ambitious.” She added, “While we recognise the importance of timely case reviews to make sure people have the right support in the right place, we must ensure that the quality of that assessment allows a good, supportive alternative to be delivered, even if that takes a little longer to make a reality for everyone.”

An estimated 3400 people are in NHS funded learning disability inpatient beds in England. Around 1200 of these are in assessment and treatment units; these are supposed to be short stay facilities, but an investigation by the Care Quality Commission found that some people were there for years.3 Lamb said that no more than 400 people should be within assessment and treatment centres at one time and that the large ones were “inappropriate settings” and must close.

Rather than sending people to residential units far from home, every area will be required to provide high quality care and support services by April 2014. The NHS and local authorities will be expected to develop joint plans and to pool budgets to avoid “gaming,” where local authorities shift responsibility for patients on to the NHS.

There will be no new money for services, Lamb said. Hospitals such as Winterbourne View cost around £3500 (€4340; $5630) a week, but individualised care and support were often much cheaper. However, between £2m and £5m would be available to local authorities to help with set-up costs.

Other plans are to hold the boards, directors, and senior managers of organisations providing care to greater account for the safety and quality of that care.

“We need to have a situation where people who run the care organisations and health organisations—public, private sector, or voluntary—know that they are accountable for the service they provide and that there are consequences if they don’t,” Lamb said. “Next spring we will announce proposals to address the gap in the law on effective corporate accountability.”

These could include criminal sanctions for people who own and run the organisations and tougher regulatory powers for the Care Quality Commission to ensure that organisations are run by fit and proper people.

The report also promises guidelines next year on the proper use of restraint and a review of the use of antipsychotic drugs.


Cite this as: BMJ 2012;345:e8431