Winterbourne View – Reasons for Optimism?

Excuse my cynicism, but this is not the usual conduct of Governments; but is a behaviour we should encourage.

I write of the Government’s final response to the abuse of people with learning disabilities at Winterbourne View which was published this week. Allow me to briefly rehearse some of the history of this. Following the abuse faced by people at Castlebeck’s Winterbourne View hospital, all the leading figures in the learning disability sector collectively wrote to David Cameron outlining the actions required to help ensure it didn’t happen again. The response from the previous Minister (Paul Burstow) and the DH was to largely ignore what was suggested. No discussions with politicians, one short meeting with one official, no follow up to discuss the ideas that were suggested. There followed an interim report that was so weak it was shocking. Cue another letter demanding action to Paul Burstow, this time signed by even more people and renewed lobbying. Still more prevarication followed. Only three months ago, we were still being told that the Coalition’s belief in (i) localism and (ii) the market, meant that central Government had limited powers (or desire?) to act in ways that everyone else knew were needed.

It is always a tad risky to laud any politician because you never quite know what they are going to do next, but Norman Lamb took an immediate interest in this issue upon his appointment a few weeks ago as Care Services Minister. He met with representatives of ‘the letter’, and with families to hear their story and – so I understand – told the DH civil servants that the previous DH response was not good enough. Crucially, he saw the need for central Government leadership and action. As a result, fifteen months after a programme of action was proposed to David Cameron and the DH, the Government has produced a set of proposals that are remarkably close to what was suggested all that time ago.

Let me just share a few headlines of actions that were absent until the last few weeks:

• A clear commitment to a timetabled review of people living in so called ‘assessment and treatment’ hospitals with the aim of them moving to more appropriate services.
• A DH funded, national programme to support CCGs and local authorities develop the commissioning skills and strategies around services for people who challenge in order to reduce the demand for inappropriate services.
• A recognition that behaviour that challenges usually starts in childhood so the Department for Education are partners to the proposed action plan.
• A requirement that independent advocacy in made available to all people placed in such institutions.

Add to this things like a more robust approach to regulation by CQC, a national inter-agency service specification as a ‘template’ for commissioners and NICE committing to producing evidence based guidance, then we have a potentially cogent plan for change. Don’t get me wrong, the report and proposals still have flaws. Just taking two of the examples above - action from the DfE is worryingly vague and there is no expectations/commitment to the funding of independent advocacy from commissioners. Nonetheless, there is much to be supportive about in the new document – which is why the NDTi, along with many other organisations from the sector, have agreed to sign the Concordat that commits to work towards the implementation of these actions.

However, the report’s publication is no more than the end of the beginning of the Winterbourne View story. People are still living in Winterbourne View type institutions. If the commitments contained in it are not turned into reality, then nothing will have been achieved. We all have a responsibility not only to do the things we have committed to do through that report, but also to hold everyone else to account.

The last year has shown how the learning disability field can be effective when speaking with one voice. When that voice was initially ignored, it continued to press the case. Through a combination of behind the scenes negotiations and public demands, a sensible and realistic set of actions have finally been accepted by a listening and supportive Government Minister. Achieving this impact is something that the learning disability sector as a whole can and should take credit for.

Three pieces of learning flow from that which, hopefully, will be remembered in the future:

1. For the Government – remember that the learning disability sector knows what it is talking about and is persistent - so next time listen and act immediately rather than waste over a year of being in denial.
2. For the learning disability sector – remember that when you speak with a united voice and don’t accept no for an answer, you can effect change for the better.
3. For local authorities and CCGs (who now have to make this change happen) – ensure you work with and learn from the learning disability sector nationally. That sector will be positive allies for change, but also determined critics if you now once again fail people who challenge and their families by commissioning poor quality, inappropriate services.