The key issues contributing to the problems at Winterbourne View are not in doubt so why is the pace of actual change so slow?

The fundamental question is this: “Who can bring about the changes that will mean we do not continue to allow people to be placed in ‘institutional’ settings miles from their families with no plan for them to be returned to a suitable, long term care setting?”

The answer is the Local Authority and NHS commissioners who have taken the decision to make these placements.  The individual concerned, their families and the providers of the services (whether private or NHS) are powerless and it is not part of CQC’s remit to question the appropriateness of any particular type of care that has been commissioned.

Despite the Department of Health’s interim report recommending that the right model of care is commissioned ‘to focus on the needs of individual people, looking to avoid the factors which might distress people and make behaviours more challenging’, people are still being placed in similar services with no certainty that things will be any different for them than it has been for those we have already heard about.

Commissioners have been charged with having a greater degree of involvement in the monitoring of Assessment & Treatment Centres (ATCs) and the individuals placed in their care, and some providers have reported that this is happening, but it is nowhere near universal. The reality for individuals and their families is that they are powerless in the face of the state placing them in a closed environment, with no realistic means to challenge decisions and without any obligation for their detention to reviewed (in contrast to the position of people sectioned under the Mental Health Act 1983 where detention must be reviewed by an independent tribunal, at least after the first six months of detention).

Anthony Collins Solicitors believe that immediate steps should be taken by the Secretary of State for Health to:

  • Give clear directions to Commissioners of all ATC or similar services to ensure:

    • Every new or existing placement in an ATC or similar setting of someone with a learning disability or autism is:

      • Authorised at a senior level supported by a full and detailed ‘best interests’ analysis;
      • Reviewed with formal reporting to a senior officer every three months; and
      • Cannot be for more than six months without the approval of the Secretary of State

The above should only be seen as temporary protections, in the medium term the Department of Health, possibly through NICE, and working with all stakeholders, including user organisations and providers, must develop agreed criteria for placements in ATCs that will limit to the absolute minimum, both who is placed in them and how long they stay there. This will also involve:

  • Ensuring alternative models of support that are accessible and situated within the local area became the norm;
  • Family and other carers (including professional carers) being involved in the overall service planning and development and review of individual placements; and
  • A system which ensures transparency and accountability on the part of Commissioners.

It is a measure of our health as a society how we treat the most vulnerable people.  The Government has shown a willingness this week to push through regulations to protect our Ash trees, why can the same urgency not be shown towards people with learning disability and autism?

John Wearing is a partner at Anthony Collins Solicitors.

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