National report finds half of learning disability services did not meet standards

25 June 2012

Care must be more focused on individual people, says CQC.

A Care Quality Commission (CQC) programme of inspections of services for people with learning disabilities found that there was a one in two chance of people being in a service that did not meet the required standards.

The findings are revealed in a national report that analyses the results of 145 unannounced inspections carried out in the wake of the abuse uncovered by the BBC Panorama programme at Winterbourne View Hospital. Inspections focused on examining the care and welfare of people who use services, and whether people were safe from abuse.

CQC inspectors were joined by professional experts and ‘experts by experience’ – people who have first hand experience of care or as a family carer and who can provide the patient or carer perspective.

Overall, CQC found that nearly half the hospitals and care homes inspected did not meet the required standards.

The inspections conclude that some assessment and treatment services admit people for disproportionately long spells of time and that discharge arrangements take too long to arrange.    

CQC says this raises important questions about the patterns of commissioning behaviour and practices across England and that there is now an urgent need for commissioners to review the care plans for people in treatment and assessment services so that they can move on to appropriate care settings. 

The report also says there are still lessons to be learned by providers about the use of restraint. There is an urgent need to reduce the use restraint, together with training in the appropriate techniques for restraint when it is unavoidable.

Many of the failings identified by this report are the result of care not being centred on the individual. CQC says that too often people are fitted into services rather than services being tailored to people’s individual needs.

Of the 145 locations inspected:

• 69 failed to meet one or both standards (of which 35 failed on both standards)
• 41 met both standards, but with minor concerns
• 35 fully met both standards with no concerns

The 145 locations were made up of:

• 68 NHS Trusts providing assessment and treatment and secure services and includes two that were residential care homes
• 45 Independent Healthcare Services providing assessment and treatments and secure services
• 32 residential care homes providing residential care.

Independent Healthcare services (33 per cent compliant) were twice as likely to fail to meet the standards as NHS providers (68 per cent compliant).

CQC inspectors have since returned to many services where concerns were identified to check that improvements have been delivered.  Where concerns were identified the location was required to provide an action plan to show how they would improve.    All non compliant services will receive unannounced inspections.   

Dame Jo Williams, Chair of the CQC, said: “People who use these services need care and support and they and their families need to be treated with care and respect. While our inspections found examples of good care, too often they found that services were not meeting the individual needs of people.

“This isn’t about developing more guidance – there’s plenty of evidence about what constitutes good care and good commissioning – it’s about making sure that providers, commissioners and regulators focus on care that is based on individuals.

“Although many of the services we inspected were intended to be hospitals or places where people’s needs were assessed, we found that  some people were in these services for too long,  with not enough being done to help them move on to appropriate community-based care.

“All too often, inspection teams found that people using services were at risk of being restrained inappropriately because staff often did not understand what actions count as restraint, and when restraint happened there was inadequate review of these putting people at risk of harm or abuse.

“While the findings published today highlight serious concerns about the nature of services for people with learning disabilities, we can offer some reassurance. There is no evidence that points to abuse on the scale which was uncovered at Winterbourne View Hospital.

“However every single case of poor care that we have found tells a human story and there is plenty of room for improvement to help a group of people whose circumstances make them particularly vulnerable.”    

Where inspectors identified concerns, they raised these immediately with the providers and managers of services. Specific safeguarding concerns were found at 27 (18%) of locations which required referral to the relevant local authority safeguarding adult team. In these cases inspectors either requested the provider to make the referral (which they followed up to confirm was done) or made the referral themselves.

150 inspections were carried out as part of the programme. This national report provides an analysis of the findings of 145 inspections as the first five pilot inspections were excluded.

Ends

For media enquiries call the CQC press office on 0207 448 9401. For general enquiries call 03000 616161.

Notes to editors

Inspection teams made unannounced visits to 150 services. More than 100 were NHS and independent services that provide services such as assessment and treatment, rehabilitation and longer term care. The others were adult social care locations.

They checked two outcomes:

• Outcome 4 Care and welfare
• Outcome 7 Safeguarding adults from abuse.

But where our inspectors found problems with other outcomes, they also reported on these.

Our inspection teams were led by CQC inspectors,  joined by ‘experts by experience’ -  people who have experience of using services, either first hand or as a family carer and who can provide the patient perspective and by a professional advisor.

CQC set up an advisory group to help it plan the programme.   CQC’s Chair, Dame Jo Williams, chairs the group. The members came from a range of voluntary, charitable and other organisations that work with or represent people with learning disabilities and their families.

The learning disability inspection programme was launched in response to the abuse revealed by undercover filming by the BBC Panorama programme. CQC apologised for failing to respond to warnings of abuse at Winterbourne View. Matters concerning Winterbourne view are the subject of a serious case review which is expected to be published later this year.

Further information

There is information on CQC’s website about how to share concerns and complaints about a social care service, a council, independent healthcare services, the NHS or CQC.

Report a concern or a complaint

You can also report a concern by calling us on 03000 616161.

Helpful links

The Challenging Behaviour Foundation has provided this list of organisations providing independent support to families with disabled relatives

Support for families

Families provide long term love, care and support for their disabled relatives, and speak up for them. Even when people leave home, they do not leave the family. Families continue to offer a lifetime of involvement and support, and know a great deal about their relative’s needs and wishes, likes and dislikes.

When the services and support for a relative go wrong it can be very difficult for families to deal with. They may be faced with a barrage of information and decisions to take, as well as coming to terms with what has happened. It is important that families know where they can get impartial information, and find out what support is available to them. There is a list below of organisations which you may find useful.

It is important to note that family carers must be consulted and involved in keydecisions about the care and support of a relative who is unable to make these decisions (unless you have specifically asked not to be involved). There is a proper legal process that must be followed, under the Mental Capacity Act 2005. For example, your relative cannot be moved to another service without involving you, and others who know your relative well, in the decision-making process. For more information about this, see “Making Decisions: A guide for family, friends and other unpaid carers” Copies available by phoning 0300 456 0300 or download from http://www.justice.gov.uk/protecting-the-vulnerable/mental-capacity-act

Organisations providing independent support

Ann Craft Trust

Provides advice to anyone who has a query about the protection of vulnerable children and adults, including professionals, parents, carers and family members.

Tel: 0115 9515400 (Mon-Thurs 9am-5pm, Fri 9am – 4.30pm) or email ann-craft-trust@nottingham.ac.uk

The Challenging Behaviour Foundation

Provides telephone and email support from a Family Support Worker on challenging behaviour associated with severe learning disabilities and related issues. Tel. 0845 6027885 or email info@thecbf.org.uk

Free information sheets and DVDs about good support for people who have a learning disability and behaviour described as challenging.

Disability Law Service

Provides telephone or email advice on community care law. Free to disabled people and their family carers www.dls.org.uk Tel: 020 77919800 e-mail advice@dls.org.uk

Mencap Learning Disability Helpline

Provides advice and information on all issues relevant to people with learning disabilities and their families in England, Wales & Northern Ireland.

England: Telephone: 0808 808 1111 or email help@mencap.org.uk

Northern Ireland: 0808 808 1111 or email mencapni@mencap.org.uk

Wales: 0808 808 1111 or email information.wales@mencap.org.uk

National Autistic Society

If your relative has an Autistic Spectrum Condition you can contact the National Autistic Society which offers advice and information to people on the autism spectrum and their families: Mon-Fri, 10am – 4pm.www.autism.org.uk Tel: 0808 8004104 or email autismhelpline@nas.org.uk

Hft Family Carer Support Service (FCSS)

provides free information and support to all family carers of people with learning disabilities. For help or more information call 0117 9061751; email familycarersupport@hft.org.uk; write to FCSS at Hft, 5 – 6 Brook Office Park, Emersons Green, Bristol BS16 7FL and see FCSS

Respond

Respond works with children and adults with learning disabilities who have experienced abuse or trauma, as well as those who have abused others, through psychotherapy, advocacy, campaigning and other support. Respond also runs a free helpline: 0808 808 0700. If you call outside opening hours leave a message and someone will get back to you. For more info see Respond

Voice UK

Voice UK are a national charity supporting people with learning disabilities and other vulnerable people who have experienced crime or abuse. They have a helpline for carers, parents and professionals on 080 8802 8686 (Mon-Fri, 9am – 5pm) or email helpline@voiceuk.org.uk

Other useful contacts

Samaritans

Confidential emotional support 24 hours a day, 7 days a week to those experiencing despair, distress or suicidal feelings. Tel: 08457 909090 or email jo@samaritans.org