Under lock and key

The programme focused on the plight of young people with complex learning difficulties and/or autism who are still being looked after in institutionalised settings. This is despite the Government’s commitment to taking such service users away from this type of accommodation after the Winterbourne View Hospital scandal.

In January 2015, the Department of Health (DoH) published its report entitled Winterbourne View: Transforming Care Two Years On. It reported: “we know how many people are in inpatient settings, where they are and who is responsible for them”, but conceded that “the commitment to transfer people by 1 June 2014, from inappropriate inpatient care to community-based settings was missed.”

Few could disagree with the DoH’s statement that “everyone inappropriately placed in hospital should be supported to move to community-based support where there are quality care support and housing services based on the model of good care.”

However, in reality, sufficient community placements simply do not exist. Our client “John” was moved to an assessment and treatment unit in 2011. We supported John and his mother in their fight to secure John’s discharge. This included working within the tribunal procedure and lobbying health and social care commissioners, as well as NHS England. It was an uphill struggle to identify a community placement that could meet all of John’s needs. Thankfully, in June 2016, John was at last discharged to his new accommodation, where he has since thrived. Ironically, it is within yet another hospital – albeit one without a high fence and numerous locked doors to navigate to reach the outside world. John has his own flat, decorated according to his tastes and organised to meet his needs and is unaware his home is registered as a “hospital”.

John was hoping for a stable “forever” home, but, as this is a hospital placement, the commissioners will be expecting him to move on in due course – but to where?

Due to an overly prescriptive approach to regulation, the Government’s regulator (the Care Quality Commission “CQC”) has inadvertently blocked access to the very best care.  Some potential service users and their families have been devastated to have had new placements cancelled at the last minute due to service providers’ problems with registration.

Anyone working in the sector relating to the provision of care for this cohort of service users will be aware of the storm clouds brewing in relation to the shortage of suitable services.  All agree that the best care should be person-centred, which means taking young people out of institutional settings and placing them geographically near their families.  This type of care is expensive and lack of public funding means that the private sector has been stepping in to fill the gap for some time.

Since February 2016 providers (with excellent ratings with the CQC and years of experience in this area of care) have found themselves frustrated by the CQC’s approach to registration of new residential homes for exactly this cohort of service users. Following the publication of its policy on registration and variations to registration for providers, “Registering the Right Support”, the CQC confirmed that it would be unlikely to register any care home with more than six beds. It also indicated a strong preference to settings within the community, which, in reality means urban settings.

Whilst on the face of it this is a laudable aim, the “one size fits all” approach has inadvertently resulted in a moratorium on investment in, and the building of, desperately needed bespoke homes for potential service users. For many providers, six beds is simply not financially viable and often a slightly larger, non-institutional setting can mean access to excellent and bespoke services resulting in more freedom than in a smaller residential setting. As John’s case demonstrates, it is neither registration nor size that makes the difference. The question should be, “does this feel like home to me?”

Regrettably, due to the uncertainty in registration, private investment has dried up.

It is hoped that the CQC will bring real commitment to the consultation process and expedite applications on a case by case basis to urgently revitalise the market.

Further information

For more information please see the health and social care section of our website or contact Sarah Knight.

Alternatively, if you require advice and support in securing more appropriate services for a person with learning disabilities or autism, contact Sheree Green.

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