Mental Health Matters: Preventing another Winterbourne View

It is almost 10 years to the day that experts warned fundamental changes were needed in the care of vulnerable adults. The warning came following the revelations of harrowing abuse at Winterbourne View. 

That winter, Transforming Care was launched to achieve a dramatic reduction in the number of people with a learning disability in hospitals.

Since then, there have been more high-profile abuse scandals at Cawston Park and Whorlton Hall. There have also been all manner of programmes and reports and action plans.

At the end of April 2022, there were 2,005 inpatients with a learning disability or autism, and more than half (56 per cent) had a total length of stay of more than two years.

Under 2015’s Building the Right Support plan, NHS England aimed to halve the number of inpatients by 2019. However, this target was missed and the deadline was pushed to 2023-24 in the long-term plan. 

The number of people with a learning disability in hospitals fell by 39 per cent from March 2017 to January 2022, but the number of hospitalised people with autism has actually risen by 20 per cent.

With less than two years to go, just six of 42 integrated care systems have achieved the long-term plan target.

In its new Building the Right Support action plan, the government acknowledges the slow progress. It suggests the rise in inpatients with autism could be driven by higher levels of diagnosis due to increased awareness of the condition, particularly in younger female patients.

The plan cites planned reforms to the Mental Health Act which will prevent people from being detained without a clear mental health need. However, to truly improve lives, substantial investment is required in supported housing, social care, and bespoke community support.

‘Where’s the urgency?’

There are pledges in the new plan to boost supported housing. The £11.5bn affordable homes programme includes a government pledge to increase the availability and choice of housing for those with a learning disability or autism by 2026. It also proposes to use the NHS capital programme to encourage systems to prioritise funding for these groups.

However, no specific assessment has been carried out yet analysing the suitability of supported housing for those with a learning disability or autism. NHS systems may also look askance at using precious capital to solve what is, in effect, a housing problem without contributions from other agencies.

The plan says NHSE has committed to a programme developing small community-driven organisations to deliver high-quality, bespoke support. While this places the right focus on community, the aim is to expand the programme to just eight ICSs by March 2023, meaning national progress could be very slow indeed.

Dan Scorer, of Mencap, told Mental Health Matters that, based on the current trajectory, England is on course to miss the inpatient target for a third time: “In the plan, we just don’t see the urgency. Most of the changes and initiatives only start from the middle of 2023.”

While he read with interest of the billions for housing, he added: “How much of that is actually going to people with a learning disability?

“Undoubtedly, there’s a shared vision. But there are real questions about accountability.”

Rachael Dodgson, CEO of social care provider Dimensions, agreed there needs to be more funding, adding a lack of suitable housing is cited as a key factor in almost half of the delayed discharges of those with autism or a learning disability. 

The government’s decision to accept some of the recommendations in a Health and Social Care committee report means it will be held to account on the financial commitments in the plan.

However, despite a move by NHSE to avoid admitting people to hospital settings rated “inadequate” by the Care Quality Commission unless there are exceptional circumstances, the government rejected another recommendation to prevent commissioners buying services from “inadequate” hospitals.

Government has also rejected proposals to close all assessment and treatment units by July 2023, and to independently review all inpatient deaths.

‘Nothing has changed’

Rebecca Davis’ brother Elliot came home in June, four-and-a-half years after being admitted to an inpatient unit hundreds of miles away from their home in North Yorkshire.

He had been fit for discharge since September and Ms Davis’ family worked with specialist lawyers to bring him home. But the 29-year-old feels families should not have to fight.

She said Elliot had “no quality of life”, and she felt like “nothing had changed” since Winterbourne View.

Elaine Clarke had a similar fight, which ended in tragedy. In December, a report warned of a “decade of failings” in the treatment of her brother Clive Treacey, who died in an assessment and treatment unit in Nottinghamshire in 2017. 

Ms Clarke said she feels that if Clive was still alive today, he might still be in a hospital.

She told Mental Health Matters she feels the latest plans “fail to hold up a mirror to why Clive’s human rights would still be denied, and why he was not protected or kept safe”.

Mental health minister Gillian Keegan warned instances of abuse and poor care such as in Winterbourne View were “unacceptable”.

She added: “I am determined that, working with our partners, we do everything we can [to] stop this from happening again.”