MPs criticise government for inaction since Winterbourne View scandalBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1700 (Published 27 March 2015) Cite this as: BMJ 2015;350:h1700
Failures to close psychiatric hospitals and to tackle the financial disincentives for re-housing patients are to blame for the government missing its target of moving most patients with a learning disability and challenging behaviour into the community, MPs have said.1
MPs on the House of Commons Public Accounts Committee examined changes to care services for people with learning disabilities and challenging behaviour since the Winterbourne View scandal in 2011, when widespread abuse of patients at the hospital was uncovered by the BBC’s Panorama programme.2
The incidents at Winterbourne View prompted the government to commit to moving any people with a learning disability and challenging behaviour out of hospital by 1 June 2014 if they would be better off supported in the community. However, the Public Accounts Committee said, “During the four years since then, children and adults have continued to go into mental health hospitals, and to stay there unnecessarily, because of the lack of community alternatives. The number of people with learning disabilities remaining in hospital has not fallen, and has been broadly stable at around 3200.”
When questioned for the inquiry by MPs in February, Simon Stevens, chief executive of NHS England, admitted that it was “indefensible” that so little progress had been made and that patients “had been badly let down.” He said that a hospital closure programme would be drawn up over the next six months to focus on the North and parts of the Midlands, where NHS hospital numbers were highest, and that steps would be taken to curb referrals to the private sector.
Margaret Hodge, chair of the Public Accounts Committee, said, “It is vital that the closure programme is matched by the necessary growth in high quality community services.”
The report noted that availability of places in psychiatric hospitals had eased pressure on local commissioners to revise their commissioning strategies to expand the capacity and capability of local community services, and it added that financial disincentives to move patients were slowing progress.
The report recommended that NHS England should use its commissioning framework to require local commissioners to promote community based services for people with learning disabilities and that the Department of Health should mandate the use of pooled budgets for care of such patients from April 2016. Only 27% of areas have pooled health and social care budgets, and this shortage results in unnecessary hospital admissions and delayed discharge back to their community, the report said.
Funding should also follow the patient to meet the costs of new community services to help keep people out of hospital, the report said. Currently, hospital discharges are often delayed while complex negotiations take place between NHS England, clinical commissioning groups, and local authorities to develop a joint funding arrangement for a patient’s community placement. Unlike previous moves to support care in the community, the report added, no “dowry-type” payment goes with the patient to meet the costs of supporting people discharged from hospital.
The MPs also said that the Department of Health should strengthen the legal rights of people with learning disabilities and their families to enable them to challenge decisions on the location and nature of their treatment and to ensure that they receive advocacy support in doing so.
Hodge said, “Over a third of patients are in hospitals more than 50 km from their homes, away from their family and friends, and too many people stay in hospital for too long. A fifth of people in hospitals and other institutions had been there for more than five years.”
Cite this as: BMJ 2015;350:h1700