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Lack of progress 'indefensible'

Too many children and adults are continuing to go into mental health hospitals and stay there unnecessarily despite the Government promising to change this in light of the Winterbourne View scandal, a report by MPs has warned.

Six people were jailed after an appalling catalogue of abuse of patients by staff at the Gloucestershire private hospital was revealed by an undercover journalist in 2011.

In December 2012 the Government made a commitment that, if a person with a learning disability and challenging behaviour would be better off supported in the community, they should be moved out of hospital by June 2014.

But the Public Accounts Committee (PAC) said t he number of people with learning disabilities remaining in hospital remained broadly the same, which it said was because of a lack of community alternatives.

The report said it was essential the system put people with learning disabilities at its heart.

It said the committee welcomed the acknowledgement from NHS England that it was "indefensible" to make so little progress, leading to people being badly let down.

It added that MPs recognised the complexity of the task in designing and commissioning a model of community-based care and were encouraged by the commitment to set out a closure programme for large mental health hospitals within the next six months.

They said progress should be checked in 18 months' time.

PAC chairwoman Margaret Hodge said: "The Winterbourne View scandal in 2011 exposed the horrific abuse of people with learning difficulties and challenging behaviour in a private mental health hospital.

"Concerns were also raised about a number of other institutions.

"As a result, the Government committed to discharging those individuals for whom it was appropriate back into their homes and communities.

"However, since then, too many children and adults have continued to go into mental health hospitals, and to stay there unnecessarily, because of the lack of community alternatives.

"The number of people with learning disabilities remaining in hospital has not fallen, and has remained broadly the same at around 3,200.

"In evidence to us, Sir Stephen Bubb, who carried out a review into the commissioning of services for people with disabilities, expressed frustration at the lack of decisive action to close hospitals and prevent people being put into institutions.

"NHS England has acknowledged that it was indefensible to make so little progress against the commitment to discharge, as a result of which people had been badly let down.

"The continued operation of large mental health hospitals is incompatible with the department's model of care for people with learning disabilities and challenging behaviour."

Labour MP Ms Hodge said it was " refreshing" that NHS England took responsibility for this lack of progress.

She said it had "now committed to develop a closure programme for large NHS mental health hospitals, along with a transition plan for the people with learning disabilities within these hospitals, from 2016/17.

"It is vital that the closure programme is matched by the necessary growth in high quality community services," she added.

"However, local commissioners have so far failed to deliver the high quality community-based care envisioned by the department.

"Even though the department and NHS England now consider the institutional model of care to be completely inappropriate, local commissioners continue to place people with learning disabilities in mental health hospitals.

"Over a third of patients are in hospitals more than 50 kilometres from their homes, away from their family and friends, and too many people stay in hospital for too long.

"A fifth of people in hospitals and other institutions had been there for more than five years."

She said the Government had set out a s trong presumption in favour of the use of pooled budgets to minimise overlaps between health and social services and save money but only 27% of local areas had voluntarily pooled budgets.

The department should mandate the use of pooled budgets from April 2016, she said.

"Discharges from hospital are being delayed because funding does not follow the individual when they are discharged into the community," she continued.

This acts as a financial disincentive for local commissioners who have to bear the costs and responsibility for planning and commissioning community services.

"Delaying discharge has the effect of institutionalising people, making their reintegration into the community more difficult.

"Some local authorities' reluctance to accept and fund individuals in the community will be exacerbated by current financial constraints.

"The department should set out its proposals for 'dowry-type' payments from NHS England to meet the costs of supporting people discharged from hospital.

"It is essential that the redesign of the system puts people with learning disabilities at the heart.

"Proper consideration must, therefore, be given not just to building capacity in the community, but also to enshrining in law patients', and their families', right to challenge the decisions taken, whether they are about treatment, admission to mental health hospital, or community care services provided - and ensuring they receive the advocacy support to enable them to do so."


From Belfast Telegraph