Sweeping changes are needed in the organisation and ethos of the NHS’s dedicated inpatient facilities and care homes for people with learning disabilities, the health watchdog for England has said.
Care at NHS facilities for people with learning disabilities falls short of modern safety and quality standards, says the Healthcare Commission in a new report, and many people live in bleak accommodation far away from their families.
Institutional failings mean that many people are being deprived of their human rights and dignity and have little access to advocacy services, few choices about how they live their lives, and limited activities, the report says. Services are too reliant on drug treatment to control behaviour, it says, when the evidence that this is a reasonable response is limited.
The commission announced last July that it would investigate standards of care in all NHS facilities in England for people with learning disabilities after finding longstanding abuse and neglect in such facilities in Cornwall and Carshalton, south London (BMJ 2006;333:116 doi: 10.1136/bmj.333.7559.116-c).
It audited 638 inpatient services provided by 72 NHS trusts and 17 independent organisations. Although most of England’s 169 000 people with learning disabilities live in their own home or in care homes regulated by the Commission for Social Care Inspection, about 4000 live in long stay hospitals, campus-style accommodation, or short break and secure facilities, mainly in groups of six to 12 people.
The report found that many of these services operated “off the radar of the healthcare system” and had “poor leadership, inadequate training and no framework to measure the performance of services.”
Five organisations were referred to local authorities because of concerns about the overall standard of care being provided. One was Bromley Primary Care Trust, which asked the commission to help improve its facilities.
Anna Walker, chief executive of the commission, said that the audit had not uncovered the scale of neglect and abuse found in Cornwall. “This report, however, does paint a bleak picture,” she said. “Services for people with learning difficulties are not generally unsafe, but they are poor. These services are regularly neglected and too often old fashioned and institutional.
“I want to be clear that there are many members of staff working hard for the people they serve. But they operate in a system where too many people are not given choices and control over their lives. Care is not personalised, living environments are poor, and activities are few.”
The commission made 2548 recommendations to improve care; and services are required to develop action plans to address these. Strategic health authorities would be monitoring how the plans were implemented. The commission said it would carry out spot checks of the services included its audit in the next round of annual performance ratings of trusts.
Ivan Lewis, the minister for care services, announced that the government was launching a consultation to reform the care given to people with learning disabilities. Among the proposals is one to transfer responsibility for commissioning services from the NHS to local government. The government was already planning to close all NHS campuses by 2010, which account for over half the people covered by the report, he added.
A Life Like No Other: A National Audit of Specialist Inpatient Healthcare Services for People with Learning Disabilities in England can be seen at www.healthcarecommission.org.uk.
