The term Transforming Care was first used in the Department of Health’s 2012 report “Transforming Care: a national response to Winterbourne View Hospital” and since then it has become a shorthand for the work that this and the previous government have done to reduce the number of autistic people and people with learning disabilities in inpatient hospitals.
Unfortunately it doesn’t appear that a lot of work has actually been achieved.
The above is the data from January 2022 that Mencap collects. I was listening to Tom Cahill recently at the Learning Disability Nursing Symposium. Tom is the new NHS National Director of Learning Disability and Autism. He said that he wants to lose the data, the statistics, the numbers and wants local NHS provision to know that Kevin Smith who is 34, has been in the hospital for 15 years and has been ready for discharge for 10.
He hasn’t be in the role long, but I think this approach, this personal approach is so much better. The people in the hospital are then just numbers, they are actual people. They have families, they have people outside of the hospital setting that care about them. Personal stories are harder to ignore than ‘I’ve got 50 people on my caseload who are currently in hospital, fit for discharge.’
I also think part of the problem is the lack of suitable provision that is out there for people and the rise of McResidential and Supported Living Providers who are only out to make a quick buck. I guess I should explain both points.
McResidentialI mean this term in two different senses. The first, residential services setup by people who want to do the bare minimum to make it work, this includes the property itself in terms of fixing, fittings and making it actually look like a home, staff (including recruitment), the training of staff, the pay of staff and the resources available to the team.
The second, is big organisations. Now, I have no issue with big organisations, except for, some of them. Some big organisations have remained true to their roots and have ensured that they have setup in a way that allows senior managers to remain connected to what is going on, in a way that promotes good practice. Others on the other hand, have got so big, they’re Senior Managers have become distanced from what’s actually going on. And whats also part of it, is providers receiving referrals for people either from discharge from hospital back to the community or a person who is at risk of hospitalisation and just see £££, which then ends up a significant placement breakdown because the provider did not adequetely assess the individual needs properly and match that up to his staff’s training and capability.
In conclusion to this blog, I guess there are several things I’d like to see – but by any means not an exhaustive list. I believe the actual solution to this will be a combination of so many different ideas.
- That Regulation 18 & Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 more strongly regulated. Too many service providers claim to be specialist in managing behaviours of concern but do not have a fit and proper Behaviour Specialist. Now this will be the subject of another blog post but a RRN/BILD Act approved 5 day Instructor course DOES NOT qualify you as a behaviour specialist.
- Service providers, a persons named social worker, any named LA team that works with an individual need to be held to more account when placements fail. ie an investigation/review why it went wrong, how it went wrong, what has the teams around the person learnt around it, does there need to be a referal to safeguarding or regulatory bodies like Social Work England, Health Care Professions Council and/or the Nursing and Midwifery Council.3. I’d like to see more robust service providers.
- Legilsation requring that anyone sectioned the primary goal is to discharge, with consideration not to discharge early, but for people sectioned for reasons of behaviour, this needs to be met with the appropriate staffing (PBS/ABA professionals, RNLD’s) so that a discharge with 18-24 months is achievable.
Like I said, this list is not exhaustive and there are numerous other things that could go a long way or even better my suggestions. Let me know your thoughts in the comments below!