The combined health and local government effort to move people with learning disabilities out of hospitals has been an “abject failure”, the care services minister has said in a scathing assessment.
In a frank interview, Norman Lamb described the bid to move people with learning disabilities out of hospital settings following the Winterbourne View scandal as his “most depressing and frustrating task”, after it emerged that the programme’s original target had been shelved.
Mr Lamb accused commissioners of an “abject failure” to “challenge established ways of doing things”, and said it was “disturbing” that people with learning disabilities were still being placed in hospital settings despite the government’s call for a major shift towards community-based care.
the minister’s comments came as Bill Mumford, the new director of the programme, said the government’s original aim of a major reduction in hospital placements by 1 June would “have to be changed” and that he was “redefining where we want to be and the timescales to get there.”
In the wake of the Winterbourne View scandal, the Department of Health and a wide range of groups including NHS England, the LGA and the Association of Directors of Adult Social Services signed a concordat that pledged to “support everyone inappropriately placed in hospital to move to community-based support as quickly as possible and no later than 1 June 2014.”
In an interview with LGC’s sister title Health Service Journal, Mr Lamb said: “I’m left completely frustrated. I’ve obviously questioned myself about what more I could have done.
“What really upsets me is that when you have a whole load of organisations who signed up to the concordat… I felt that [as these] organisations [were] committing to something, one had a reasonable expectation that they would deliver, or aim to deliver.
“But to then discover that it’s business as usual in too many places I find very distressing, so it makes one somewhat cynical about this.
“The abject failure of some people in the system to do the right thing and change the model of care just makes me all the more determined that we see this through, even though it will take longer than I originally hoped,” he said.
Mr Lamb added that he had two discussions about the issue with new NHS England chief executive Simon Stevens since he started the post on 1 April. “I think he shares my view about the complete unacceptability of this,” he said.
Data from NHS England showed that, by the end of December last year, 1,932 people did not have a transfer date identified. An LGA report said the figures “confirmed that the hospital discharge programme is seriously adrift from the original national milestones”.
Asked why the programme had failed to meet its targets, Mr Lamb cited an absence of data about placements and the difficulties in transferring funding from NHS England to local commissioners.
A mechanism would have to be put in place to allow funding to transfer from NHS England to local commissioners when an individual was moved from a hospital setting, he said.
Mr Lamb described an “institutional inertia” across the system, but also said NHS England had not given the issue a high enough priority.
He said many clinicians were still choosing to place people in institutional settings.
“We have to understand better why there are so many cases where clinicians have decided that institutional care is the right setting when there are many people working in learning disability services who believe that institutional care for many of these people is not the right setting,” he said.
Mr Lamb said he sometimes felt “ashamed” when talking to families about how they felt ignored by commissioners and providers, adding that one option could be offering a “second opinion” to clinicians about the choice of placement.
Several senior figures in local government questioned the original target, with one saying it was “completely unrealistic and plucked out of the air”. But Mr Lamb insisted his original deadline was “absolutely appropriate”.
Mr Lamb also said that until Mr Mumford was brought in in January, he was unhappy with the workings of the Winterbourne View joint improvement programme, the national partnership set up to make sure people were moved from hospital settings.
“At one stage I was presented with regional summaries for what the position was around the country,” he said.
“I just said that was utterly hopeless. It sort of covers the great and the awful. It tells you absolutely nothing.”
In an interview with LGC this week, Mr Mumford said: “The original objective will have to be changed.
“Given the nature of Winterbourne View the sector reacted very strongly, but in doing so perhaps didn’t quite understand enough about the situation of people and the different types of hospital settings.
“Nobody defined what “appropriate” was, and nobody quite understood what the numbers were.”
He said the programme would aim to reduce the number of people with learning disabilities in hospital; reduce the length of stay for people that did go to hospitals and make sure those in hospitals had a “positive experience”.
“How we will measure that needs to be thought through,” he said.
Professor Juliet Beal, NHS England’s director of nursing, said: “A detailed plan, with key performance indicators, will be presented to the NHS England Board in May 2014.
“This will reflect comprehensive regional plans at CCG level indicating numbers of patients and projections for reducing the inpatient numbers.”