CBF responds to Health and Social Care Committee report

The Challenging Behaviour Foundation (CBF) welcomes the report published today (13.07.21) by the Health and Social Care Committee, and is pleased that the concerns we have raised in consultation with the committee over the past 4 months have been represented. What is absolutely clear is that, 10 years on from Winterbourne View, repeated inpatient bed closure targets have been missed by successive governments and the provision of community support has not been “transformed“. Clear action must be taken, learning from what has failed to deliver so far, if any improvement is to be seen.

Children, young people and adults with learning disabilities and autistic people are living with the consequences of this failure – and that must change.

As the report rightfully states, “this is a matter of delivery and not further review”. If the 2,055 people with learning disabilities and autistic people who remain in inpatient units are to be supported effectively in the community, and if new admissions are to be prevented, the government must act with greater urgency than they have shown thus far. This is not simply a matter of ‘moving people into the community’. It requires urgent and wide-reaching action, including radical investment in improving community services, overhaul of funding streams for inpatient and community support, an overhaul of the commissioning of services, massively improved training and quality of community and inpatient workforce, the creation of new forms/environments of support tailored to the individual, and more.

The CBF supports the recommendations made in the Committee’s report. In particular, recommendations regarding:

• Improved collection and publication of data around restrictive interventions
• A two year closure period for all ATUs, to be replaced with more individually-appropriate services
• Full DHSC assessments of funding streams for community support and inpatient services, with radical investment and transfer of funding from NHS to Local Authorities to match the difference between the two
• More appropriate staff training, improving the level of learning disability and autism expertise amongst the inpatient and community workforce
• The establishment of the Intellectual Disability Physician NHS role
• The mandatory review of deaths of individuals with learning disabilities and autistic people who die in inpatient or community settings

These must all be made an absolute governmental priority.

Further to the recommendations in today’s report, we make additional recommendations of:

• Far greater investment in evidence-based early intervention and prevention is needed, alongside the Committee’s recommendations regarding early diagnosis. Given the in-depth discussion of the importance of appropriate and individualised community support, it appears to be a missed opportunity that the report does not recommend far greater investment in early intervention – around which community support can be built through the identification of support needs and long-term support planning.
• Regular skills audits for inpatient staff, and a review of the effectiveness of Care Plans in inpatient settings
• An overhaul of commissioning of learning disability and autism services alongside the introduction of regulations placed on commissioners
• The establishment of regional housing networks
• The introduction of a clinical contract signed between inpatient and the referring community service upon admission
• Wider implementation of dynamic risk registers and the ‘Key Worker’ role

These are crucial and practical recommendations which the government must take forward if targets of inpatient bed reductions and “transforming care” are to be met. The government cannot claim to be unaware of the scale of the problems facing social care for individuals with learning disabilities and autistic people. The barriers to meeting the governments targets to bed reductions have been identified many times previously – the government must now adopt a solution-oriented approach built around implementing the solutions identified here and elsewhere.

Recent statements by the Minister of State for Social Care Helen Whately do not suggest the government is acting with the urgency required. We need fewer boards, reviews, reports and promises, and more leadership, action, investment and commitment.

If this action is not taken, the government will continue to miss their own – already under ambitious – targets for transformational change. The recommendations set out above, and discussed in greater detail in the Committee’s report, are what is required if individuals with learning disabilities and autistic people are to exercise their right to receive the right support, at the right time, and in the right place to enable them to live good lives in the community. For more information on how to make effective community support a reality, we would recommend the following papers:

• The CBF and Mencap submission to the Mental Health Act consultation
• Our submissions to H&SCC:
  • Written evidence 9th February 2021
  • Written evidence 13th April 2021
  • Written evidence 15th June 2021 (1)
  • Written evidence 15th June 2021 (2)
• Association for Supported Living “There is an alternative“
• History and future of transforming care
• “Tea, smiles and empty promises” – press statement