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.

Winterbourne and Addenbrookes

I'm up in Cambridge this afternoon with my colleagues from ACEVO, working with the third sector in Cambridgeshire and Peterborough to develop a consortium to provide a joined up service on the elderly and people with long term conditions (LTC). We will be working with the health service here. Its exciting work and an example of our sector joining up - not just locally but with specialist national charities in LTC.

We had our first meeting of the steering group on the Winterbourne pledge on Monday. A good session but we are still forming and working out our remit. We agreed we need to make our documents public so we will be putting up the membership, terms of reference and minutes on the NHS England website soon.

We're trying to co-commission a national framework locally delivered that can help ensure better outcomes for people with learning disabilities. And that means moving from an institutional approach to community; from officials to users.

And as I said in my last blog, it is good to have Gavin Harding on our group (he is the co-chair of the new Department of Health assurance group). We discussed how best to ensure effective involvement of people with learning disabilities. Given that we must deliver our report in October it's crucial to have these conversations now.

I was talking to the local government group on learning disabilities "Finding Common Purpose" this morning on all this. Councils are key partners here, especially in commissioning. There is a new opportunity here with the NHS England steering group. And the stories told in the comments on my Blog on Monday put these matters in context; they’re about people in their communities who need a better deal.

Winterbourne

One thing I learnt from my time in the big move from institutional to community care in mental health in Lambeth (Tooting Bec) in the 80s was the need to ensure the voice of the client, carers and families are heard.

I know that my recent blog post caused concern because it implied only the providers have the answers and that we already had the worked up plan.  I know that the issues raised from Winterbourne View, and what has happened since, are of deep concern, and I'm sorry that my blog caused upset. It was certainly not my intention. A sin of omission not commission.

None of the providers have all the answers.  But along with others they are clearly part of the answer and we now have an opportunity to work together to develop solutions that meet the needs of people with learning disability, their families and carers.

We have our first meeting of the Steering Group on developing a new national framework for learning disability care on Monday. We have a tight timetable. And as with any group we will need a strong focus on outcomes and a relentless drive that ensures the plans deliver better outcomes for people with learning difficulties.

Speaking to Philipa Bragman of Change (http://www.changepeople.org/) yesterday she stressed the culture change needed in the way services and support are delivered to people with learning disability.  Change is a leading national human rights organisation led by disabled people. Based in Leeds they have employed people with learning disabilities. She told me about their experience of a co-working model of employment which means people with learning disabilities co lead on projects with non learning disability people on equal terms and pay.

I contacted Vivien Cooper of the Challenging Behaviour Foundation (www.challengingbehaviour.org.uk) as a number of people suggested she could connect me to people I need to engage with.

As Vivien wrote on her website,

"I hope that this group will be an opportunity to address the lack of progress so far and to overcome the significant barriers. We know what needs to be done, and we get it right for some people – it cannot be beyond us to all to work together to deliver the outcomes we want to see.”

I wrote last week to members of the national Forum and had a lively discussion with Gavin Harding (Voices for People - gavinvoicesforpeople@gmail.com) who will Co-Chair a new DH assurance group with Norman Lamb MP.  He was keen to work with us to get positive change. Alongside that I have written to the families of people who were at Winterbourne View

One of the ideas put forward is a forum, where we can bring together all the stakeholders in a Summit so we can discuss the steering group's ideas and plans as they develop. There has been support from many people for this approach.  Gavin made the point we must do this so we can practically discuss how we can work together on the task.

The whole country was shocked by the serious abuse and appalling standards of care at Winterbourne View.  Without a detailed plan and collective action, progress on putting this right has slipped. Three years on, there has been hardly any movement towards helping vulnerable people with learning disabilities move into local communities.

It’s a scandal that only a third of the people who were in the so called Assessment and Treatment Centres last April have been transferred out and that even today, more people are being sent into them than are being discharged.

So, our focus as a steering group over these next 3 months must be how we can provide a national framework for local delivery which will ensure the pledge that was made is honoured.

I hope that people will want to work together – and will share their knowledge, expertise and experience to shape what we do and how we do it. I know that if we don’t do this, we will have wasted an opportunity.

The Winterbourne View Concordat and Bubb's challenge

I was surprised. I had gone for a meeting with Simon Stevens, the new NHS England Chief. As with all such meetings, I had my requests. But instead he got there first. "I have three asks", he announced.

The first was what the third sector could do to support the implementation of the Government's pledge on Winterbourne.  Following the Winterbourne View scandal, the Government promised to move all learning disability clients out of inappropriate in-patient facilities into the community. The appalling abuse of people with learning disabilities exposed by the Panorama programme in Winterbourne View, an institution meant to care for them had shocked a nation. Norman Lamb MP, the Health Minister rightly said that not only must there be serious consequences for the Winterbourne View abusers, but that there were also wider issues in the care system that needed to be addressed. In particular, he insisted that all clients in inappropriate in-patient settings should be cared for near their families and in community settings. It was a courageous move.

Sadly, the pledge that those people would be moved by 1st June this year was not met. Not only has that not happened but there are now more people in such placements.  Simon Stevens was clear that only the third sector could deliver the promise and he wanted me to look at a plan for "co-commissioning" between the NHS and my members.

A challenge, clearly, but one I was  up for. I gathered together my top provider members in learning disability for a breakfast to discuss our options . They were enthusiastic for the task; people like Jan Tregelles of Mencap, Steve James of Avenues Group, Robert Longley-Cook of HFT, Mark Lever of NAS, the indomitable Su Sayer of United Response and Ben Rick of the Social Investment Business.

Turning words and talk into a plan requires some skill. Fortunately I have the team at ACEVO that can do this. Mark Winter, my multi-talented Head of Health Commissioning wrote up our Plan on the back of that breakfast, which we characterised as a "national framework, locally delivered".

In essence this envisages the closure of most or all of the current inpatient facilities and the transfer of clients to appropriate community placements near their families . This will require investment in buildings,  converting houses or building new. However social finance can cover this on the back of sensible commissioning i.e. 10 year contracts.  With will,  it is entirely  doable. And if we all share the interests of the 3,250 clients we need to move into better community settings we will do it. Of course with any such task there will be a multitude of views and interests but I've been pleased so far that we all seem to be on the side of sorting it out : and that means being client focused.

We submitted The Plan and it was accepted. And I have now been asked to Chair the Steering Group that will guide the development of that, "national plan, locally delivered". The deadline is October. I report to Simon Stevens.  The group first meets on the 28th but already we are working on outlines and challenges.

I'm both pleased and daunted by this task. So far the system has been unable to implement the Government pledge - so what makes me think I and my third sector colleagues can? I guess it's my strong belief in the power of the third sector and our ability to deliver against the odds, as well as our passion to succeed for our people.

The task is in fact not  dissimilar, if  smaller, than that faced in the 80s when it was determined that all mental health asylums be closed and people cared for in the community. A patchy programme but one everyone now knows was exactly right. I chaired Tooting Bec Hospital (a large asylum in South London) then and I worked to ensure its closure but with a proper community provision in and around Lambeth. We know that institutional care is not the answer and if we put the needs of the citizen first we will work to support them in the community whatever their challenges.

If we do succeed we show the NHS what our sector can achieve.  This is the first time the NHS has undertaken "co- commissioning" with the voluntary sector so it's a challenge for us and for them. Many of the challenges faced by the NHS require the fuller involvement and commissioning of the third sector. This may prove a model for wider use. Central to delivery not peripheral to it.

Jan Tregelles, the determined CEO of Mencap, organised a visit for me and my ACEVO colleague Mark to the home of five people in London where Mencap provide support. What I saw was incredibly positive and made me determined that we will succeed because this is ultimately about better lives for people who have not had the life chances many of us enjoy and who are to open to abuse or neglect. Our sector has the skill to give them a better life and the stronger outcomes that hospitals and places like Winterbourne View have not always given them.

So just as well I haven't got any holidays booked over the next few months!

UPDATE

Well I see that my blog has attracted some attention! Good. This issue needs as much energy behind it as possible. However, just to be very clear, we are at the early stages of scoping the remit of the steering group. We have already contacted user led organisations and will be contacting families and people with learning disabilities today, as we had planned to do all along. It would be quite unthinkable to do otherwise.