We need commissioners who understand the needs of people with learning disabilities

Alison Giraud Saunders, Co-Director of the Foundation for People with Learning Disabilities:

"Last week the Care Quality Commission (CQC) published its report on inspections of the services run by Castlebeck, following closure of the Winterbourne View unit in South Gloucestershire. Half the services inspected failed to meet acceptable standards.Yet CQC said that some were doing well. This variability within one organisation shows there must have been serious system failures, as well as weaknesses in the system of regulation and inspection that failed to notice these problems before. The problems common to the poorly performing services included:

• lack of personalised care planning and risk management
• lack of access to advocacy
• poor leadership from local managers
• low staffing levels in relation to the needs of the people being supporte
• lack of training matched to the needs of the people being supporte
• “very poor” supervision
• poor understanding of the Mental Capacity Act
• tolerance of unacceptable attitudes and behaviour by staff
• over-reliance on restraint

CQC is going on to inspect 150 other services, but no-one should be waiting for those results before learning lessons from this latest report. None of these problems are new, nor are they specific to for-profit organisations. Previous reports (for example, the all-too-recent ones from NHS services in Cornwall and Sutton & Merton) highlighted similar poor practice. And there is no shortage of guidance on good practice in commissioning, service design and service delivery.

Yet a recent survey of 32 Primary Care Trusts (PCTs), conducted by Community Care magazine, showed that 20% of people with learning disabilities who had been placed by those PCTs in learning disability hospitals had been there for five years or more. Clearly people with learning disabilities who have mental health problems may need admission to hospital in some circumstances, just like anyone else, but this should be for active treatment followed by prompt discharge to competent local services.

So the system failings shown up by the latest CQC report are only part of the story: big questions remain about how support is planned and commissioned for people whose behaviour challenges services or who have mental health problems in addition to a learning disability. Every person placed in Winterbourne View (and the other services criticised by CQC) is the responsibility of a commissioner somewhere. Those commissioners have a duty to ensure that proper plans are in place for each person and that regular reviews check on the person’s welfare and progress.

In many areas (in both health and social care) there are big changes happening in commissioning, with posts being merged, people being made redundant, and loss of both expertise and ‘organisational memory’ of what has gone before. Joint commissioning across health and social care is being stopped in some areas. Creative local services are being threatened by budget cuts. Now more than ever we need competent, confident commissioners who understand the needs and preferences of people with learning disabilities and their families, and who understand how to plan, organise and monitor personalised support even in tough times."