Tuesday, 27 January 2015
Closing the institutions
There was an interesting story in the Sunday Times about plans to close Calderstones Hospital, the biggest of the NHS institutions for people with learning disabilities and autism. It’s not surprising that Calderstones, as one of the largest and having had a very bad CQC report, should be the first.
One of the things that struck me in doing my Report in November was the strange reluctance of the ‘system’ to talk closures. They preferred the 1984-esque ‘bed reductions’. But this is to ignore the lessons of history.
When we closed the old mental asylums this was done as part of a clear closure programme. Politically it was agreed that institutions were not right for people with mental health problems, and that closure was going to happen. Clearly, then, there had to be a strong programme to support the move of thousands into the community. But no one doubts that it was the right approach. And no one would want to go back to the old ways. So why do we tolerate the existing system for people with learning disabilities? I made a clear recommendation on closure. It’s good to see NHS England are to implement it.
Now NHS England need to be brave and clear on closures. I’m pleased they want to start with Calderstones. But being coy and using vague language and circumlocutions to avoid the problem is not going to work. It’s not about ‘reconfiguration’ or ‘bed reductions’. It’s a principled stand which says clearly: large institutions are not an appropriate form of care in the 21st century.
The third sector is happy to work with NHS England, and I propose that they look at commissioning a consortium of charities and social enterprises (local and national) to work with each individual and family to ensure proper, effective placements. We must all ensure a proper closure programme happens within that context. But the bottom line is that we need whatever is best for all those people with learning disabilities who are in such institutions. Doing this effectively will also mean working with the commissioners and management of hospitals like Calderstones. I’m sure we can all work together to do this.