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Warning money 'posturing' causing post-Winterbourne View inertia

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The government is set to pledge additional money in a bid to boost the programme launched to reduce the numbers of people with a learning disability in long-term placements following the Winterbourne View abuse scandal, it has emerged.

Speaking at the Association of Directors of Adult Social Services spring seminar, NHS England’s national director for learning disabilities Ray James said “posturing over money” by councils and the NHS had left some people with complex needs “forgotten” in an assessment and treatment unit (ATU) and other inappropriate settings.

Mr James also provided an update on progress under the programme, which was originally launched in 2012 and sought to rapidly reduce the number of people with a learning disability in long-term placements by June 2014, after a pattern of abuse was uncovered at the Winterbourne View specialist hospital near Bristol in 2011.

LGC revealed in 2016 that significant variations in the development of regional partnerships between councils and clinical commissioning groups to transform care meant the numbers of inpatients had remained constant.

Mr James said more than 2,500 people still remain in long-term placements and there continues to be “profound variation” across the country in terms of the number of beds and rates of admissions.

The current plan aims to reduce the figure by 35% by March 2019 and there has been a 16% decrease over the last two years.

Mr James said when NHS England published the Building the Right Support strategy for developing community services in October 2015, 50% of inpatients are no longer in those facilities but other people had been admitted since.

He said 80% of care and treatment reviews over the last six months had not led to an admission.

However, Mr James said funding issues “had not been resolved” and money was not adequately “flowing down the system” to be spent on community support as beds had not been decommissioned at the rate required.

He said decommissioning would be scaled up over the next 12 months.

“I’m encouraged that there is likely to be some additional money for the programme. Decisions on that are due next week,” Mr James said. “Similarly, I want to get greater visibility and certainty on the sum of money that we can move from specialist commissioning down the system quickly in order that people feel able to take some decisions around investment.”

Mr James urged directors of adult social care to take a close personal interest in how arrangements between their councils and the NHS regarding people with the most complex needs are working.

He challenged directors to ensure there is no stalemate in discussions on providing support following discharge and “posturing about the money”, as this was the biggest cause of “inertia” in the system.

Mr James added: “I have had some examples escalated to me of disputes of six to nine months of public bodies completely forgetting the individual who is still in an ATU at the end of it.”

He said it was directors’ “personal leadership responsibility” to find a resolution adding: “When I say do not tolerate any posturing about the money, you might think I am talking about your health colleagues - I am also talking about your staff when they are representing you in some of these discussions.”

Mr James also said he had met learning disability commissioners who had never met a person with a learning disability.

He added there was “pretty strong consensus” across government on the adult strategy but “probably less” about the right approach for children, with autism “a particular component of that”.

”I would urge you all to satisfy yourselves about both how significant and how specific your commissioning work around people with autism is,” Mr James said.

He added there are currently 220 inpatient children and young people, with only 80 of those in specialist learning disability settings.

Mr James said 60% of those not in specialist provision had been diagnosed with autism but not with a learning disability. 

Last month LGC revealed significant weaknesses in support for children with special educational needs and disabilities (SEND) are being identified in an increasing number of areas amid concern funding is insufficient to meet rising demand.

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