Winterbourne: closures will happen

One of the perils of having a weekend away is getting a cold. And as any CEO knows, taking any time off for a cold is a no-no. So this was perhaps not the best background for appearing before the Public Accounts Committee (PAC) and the formidable but brilliant Margaret Hodge.

The PAC were taking evidence on the recent National Audit Office report on Winterbourne View and the care of people with learning disabilities. Basically, the report gave more detail about the failures of the health system to provide proper care for people with learning disabilities.

Its evidence very much backed up my own report last November, “Winterbourne view – time for change”, so I was pleased to be able to hammer home messages from my report.

I was keen to be fair and constructive in my analysis, and where I had criticisms to couch them positively. There is no point in not being constructive at this point. And I wanted to be fair in the sense that, as I told the PAC, I have agreed to recall my steering group to review progress in 6 months and then in a year. Woe betide them if they are not making progress on what I have told them needs to be done.

As I said, I think the change of leadership in NHS England is now driving institutional change.

I was critical was on the failure of NHS England, in their response to my report, to confront the need for closures. They retreated behind euphemisms like ‘reconfiguration’ and ‘reshaping’. This simply isn’t good enough. Large-scale institutions have to close. Institutional care is not the right way to look after people with learning disabilities. My report could not have been clearer. I recommended they bring forward a timetable for the closure of inappropriate institutions, but their response did not address this. Indeed it was thoroughly mealy-mouthed about it.

So obviously I laboured this point hard in my evidence session to the PAC.

I was therefore delighted when, in response to grilling by the MPs on the PAC, the CEO of NHS England Simon Stevens said that he wanted to see closures – and he did use the ‘c word’ – and that they will indeed provide a timetable for closures within 6 months. He made a very telling point drawing from his experience in Tyneside, working in mental health, where they closed the old asylums but left open the same style institutions for people with learning disabilities.

This new announcement is significant progress. It signals to the system that things must change. That the  ‘revolving door’, whereby people are discharged into community care and find the beds filled up when they leave, will end. All those lazy commissioners who have block contracts and refuse to properly monitor the people in their care will find they now have to look for community alternatives.

This demonstrates real leadership by Simon Stevens. He should be congratulated for taking a bold step and signalling to the system that the end is nigh for institutional care for people with learning disabilities. Of course it will take time. Community facilities must be developed. But the third sector is there – ready and primed to provide that facility. We now need to be engaged, to scale up our work, so that the institutions can close.

So a really positive outcome to the hearings. I spoke to my old friend Margaret Hodge afterwards and she too was pleased at how positive the hearing had been and a good outcome. She is going to review progress in 18 months so there will be a continuous external review of what the system is doing. This will keep them to the mark.

One of the problems is that there a range of players who need to coordinate actions. For example pooling budgets. I don’t believe a simple call for them will work. I told the PAC the Government should use their powers in the Care Act to mandate pooled budgets. It means the Secretary of State for Health can enforce pooled budgets between local councils and health CCGs. Knowing councils like I do, one-third will willingly pool budgets, one-third will decide it’s not a priority, and one-third will actively resist because it’s cheaper for them to have the health service paying the cost of an institution rather than them supporting people properly in the community. Change will come, but we still need pressure at every level both inside and outside government.