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Half of Care Homes ‘Fail Patients with Learning Disabilities’

Half of Care Homes ‘Fail Patients with Learning Disabilities’

A quarter of vulnerable disabled people in care homes – including those with challenging behavior and autism – are at risk of being shut up in rooms or held down in arm locks because staff do not know the rules on restraint, an official report has found.

People with severe learning disabilities are languishing for up to 17 years at a time in temporary units designed for a few months’ stay, the Care Quality Commission, the health watchdog, disclosed.

The findings emerged from a series of unannounced emergency inspections in the wake of the Winterbourne View scandal last year.  Eleven care home workers have admitted a total of 38 charges of ill treatment under the Mental Health Act. They will be sentenced in the next few weeks.

Paul BurstowPaul Burstow, the care minister, ordered the review after undercover footage for a Panorama programme showed staff at the residential hospital in Bristol appearing to taunt and abuse the vulnerable adults.

The covert video appeared to show vulnerable residents being pinned down, slapped, doused in water and taunted

Out of 145 homes inspected almost half were failing to meet basic care or welfare standards and inspectors found concerns about the use of restraint in one in four.

The CQC warned that the use of seclusion – including segregating distressed patients – was “far too” common.

Overall the inspectors said they found no evidence of abuse on the scale of that alleged at Winterbourne View but only a quarter of the homes and units inspected were passed with no concerns at all.

Overall 48 per cent failed on either or both of the two key measures of care and welfare or safeguarding people from abuse. Only a third of privately run services made the grade, twice as bad as NHS units.

The main initial findings of the review revealed:

- Too many people are placed in in-patient services for assessment and treatment and are staying there for too long.
- This model of care, says the review, goes against government policy and has no place in the 21st century.
- People should have access to the support and services they need locally – near to family and friends – so they can live fulfilling lives within the community.
- Winterbourne View was an extreme example of abuse, but evidence was found of poor quality of care, poor care planning, lack of meaningful activities to do in the day, and too much reliance on restraining people.

Finally it says that all parts of the system – those who commission care, those who provide care and individual staff, the regulators and government – have a duty to drive up standards. There should be zero tolerance of abuse.

The review underlines good practice guidance on supporting people with learning disabilities, autism and those with challenging behavior which have been key planks in previous reports.

And the review reiterates key cornerstones such as:

- The responsibility of commissioners to ensure that services meet the needs of individuals, their families and carers;
- A focus on personalisation and prevention in social care;
- That commissioners should ensure services can deliver a high level of support and care to people with complex needs/challenging behavior and
- That services/support should be provided locally where possible.

Evidence shows that community-based housing enables greater independence, inclusion and choice and that challenging behavior lessens with the right support, says the Review.

The Association of Supported LivingThe Association of Supported Living‘s report There is an Alternative describes how 10 people with learning disabilities and challenging behavior moved from institutional settings to community services providing better lives and savings of around £900,000 a year in total.

This is about personalisation, starting with the individual at the centre, living in the community. The first level of support for that individual includes the people, activities and support all people need in their every day lives – family, friends, circles of support, housing, employment and leisure.

Camille Leavold, managing director of Abbots Care said that the review in effect outlined a blueprint for the care of vulnerable people in the community – practices which Abbots care have pioneered since it was set up in 1995.

She said the review also showed that assessment centres of this type are outdated and do not serve people with challenging behavior and Autism for long term treatment.

She stressed as the report does that the model of care outlined goes against government policy and has no place in the 21st century

“I totally agree that people should have access to the support and services they need locally – near to family and friends – so they can live fulfilling lives within the community

“At PA Care the findings made in the report emphasise the specialist nature of our service and how our aim to support people with all types of challenging behavior and Autism to live independent lives in their communities – which we have been doing since 1995, she added

One of the main drivers for the Directors who started Abbots Care was their joint experience of working in institutional settings before the Care in the Community Act) in 1990 and realising that people with all types of disabilities could be supported in their own homes.

Camille added: “At Abbots Care we are committed to supporting people with Autism and challenging behavior to live fulfilled lives within their communities.”

Mr Burstow said in his forward to the interim review: “Living in the community, not kept isolated, institutionalised and apart. That was the goal of the closure of long stay hospitals and the campus closure programme. And for many people with learning disabilities and their families it has made a huge difference to their quality of life.

“But with the closure of long stay hospitals and the campus closure programme, a new form of institutional care developed: what we now know as assessment and treatment units. Not part of current policy, and certainly not recommended practice, these centres have sprung up over the past thirty years. Containment rather than personalised care and support have too easily become the pattern in these institutions.

“Even now, without the Winterbourne View Serious Case Review, there is compelling evidence that some people with learning disabilities and autism are being failed by health and care. Around the country there are excellent examples of personalised care, focused on supporting people in their community. But that excellence is not universal. There is insufficient focus on personalised care planning. And too often the care, which people receive, is poor quality.

“This is not good enough. I am very clear that we must be taking action at a national and local level to support commissioners to redesign services towards the personalised model we expect, to commission for quality and outcomes and to improve the quality and safety of services.

“So as much as this report sets out a road map for making sure that people with learning disabilities receive the support and care they need, it is just the beginning.

“I hope that people will read this report and offer their views and ideas on what we propose to do.

“Once the criminal proceedings have been concluded and the Serious Case Review published I will make a full and final report from this review – setting out firm actions at a national level to ensure that these very vulnerable people receive the personalised care and support they need and deserve. And through the Learning Disability Programme Board, which I chair, we will maintain focus and follow up with a report a year later, to make sure that real progress is being made.”

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