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Into perspective: Safeguarding for adults with learning disabilities

Has safeguarding for adults with learning disabilities improved in the wake of recent scandals?

Regrettably, the adult social care sector is all too familiar with scandals relating to the mistreatment of people with learning disabilities. In the last decade, the high-profile cases of abuse uncovered at Winterbourne View and Whorlton Hall have highlighted fundamental failures in safeguarding procedures designed to protect vulnerable people. In response, successive Governments and the NHS have pledged to reduce the number of beds in these types of institutional care settings.

However, according to the Health and Social Care Committee’s report, ‘The treatment of autistic people and people with learning disabilities’, published in July 2021, over 2,055 people remain living in secure institutions today. The report summarises that these people are unable to live fulfilled lives and are too often subject to unacceptable treatment, akin to the scandals aforementioned. As recent as August last year, the closure of Eldertree Lodge, a Staffordshire-based mental health unit, in light of CCTV footage capturing unprofessional and abusive staff behaviour, is a stark reminder of the seemingly unsolved problem of providing adequate safeguarding for adults with learning disabilities.

Community first

A lack of community-based support has been identified as a barrier to eradicating institutional mistreatment and abuse from the care and support of people with learning disabilities. Rather than focusing solely on improving safeguarding (despite remaining crucially important), it has been suggested that greater funding for community initiatives could prevent the need for admission to inpatient units altogether. Indeed, Government’s 2019 NHS Long Term Plan set a new target of a 50% reduction of inpatient bed use for people with learning disabilities and/or autism by 2023/24, compared to March 2015 numbers. In June 2021, there had been a 30% reduction. Additional Government funding, ringfenced for improving access to care and support in the community, would represent a clear intention to protect adults with learning disabilities from further mistreatment and abuse. Facilitating an environment in which people can live comfortably, independently wherever possible and close to the homes of friends and family, should take precedent over efforts to bolster safeguarding measures as the primary solution.

Addressing restrictive practices

According to Mencap, there were 3,620 reported uses of restrictive interventions within institutions in September 2021. This includes physical, chemical and mechanical restraint and being kept in isolation. While restrictive practices may be applied to prevent someone from hurting themselves or others, as outlined in the Mental Health Act 1983: Code of Practice, the Care Quality Commission (CQC) has previously raised concern about the ongoing excessive use of restrictive practices in its report ‘Out of sight – who cares?’, published in October 2020. The report explains that a lack of available training and support for staff often prevents people with learning disabilities from being cared for in a way that meets their individual needs, increasing the risk of staff resorting to restraining, seclusion and segregation.

It is clear that there is still much work to be done to ensure that safeguarding adults with learning disabilities describes a process that is genuinely designed to protect vulnerable people from harm. As is so often the case, improvements will likely be reliant on increased central funding – not only to support the development of more community initiatives aimed at reducing the need for institutional admissions, but to also provide staff with the correct training so that people with learning disabilities receive adequate support from people who understand them.

We must work together to safeguard vulnerable adults

One often ignored safeguarding issue is the inadequate provision of support for people living in Assessment and Treatment Units (ATUs) without any plan for discharge. Indeed, the proportion of patients with a planned discharge date is falling, from 57% in 2019 to 42% now.

ATUs are designed to be a short-term safe space or refuge during a crisis – not a place of permanent residency. Last month, however, it was revealed that 100 people with learning disabilities and/or autism in England alone have been held in these specialist hospitals for at least two decades.

Indeed, 2,000 people spent last Christmas inside an ATU. For 60% of them, this will have been their second consecutive Christmas away from loved ones. This is a clear failure to safeguard adults with learning disabilities. Everyone admitted to an ATU should have a discharge plan put swiftly in place, through a pre- or post-admission Care and Treatment Review (CTR). But a stronghold of bureaucratic and institutional barriers prevents this from happening. Currently, over two in five people living in ATUs do not have an in-date CTR.

Discharge decisions rest with the Responsible Clinician – usually, the ATU’s consultant psychiatrist, who is more often than not highly risk-averse. With fees potentially reaching thousands per week, there is also an alarming financial disincentive to discharge.

Similarly, if someone is in an ATU for less than five years, the council must pay for their subsequent health care. However, if an individual is there for longer than five years, the NHS must pay for it. While we know first-hand that stretched local authorities are doing everything possible, this represents a perverse incentive to prolong discharges.

On Human Rights Day (10th December), through our ‘locked up for Christmas’ campaign, we shared seven policies to finally help deliver on the Government’s vision of transforming care.

We must work together to safeguard vulnerable adults, like Aaron, who spent his life in and out of hospitals and care homes, until the council and Dimensions joined together to find the right support for him.

Resources such as our ‘Best Practice Guide to Moving Out of ATUs’ mark small steps in the movement to safeguard adults with learning disabilities. However, until we are all on board, progress will remain slow and fleeting.

Steve Scown, Chief Executive of Dimensions UK

Policy will only get us so far

There is a pattern when it comes to abuse scandals involving people with learning disabilities. Abuse often happens in places that are isolated, not always by geography but often by the lack of visitors, families, and friends. In most of the scandals the abuse was raised by a whistleblower from or close to the team and/or a relative. Sadly, their voices were not always heard immediately and, in some cases, ignored by those who were able to protect people and act.

We have regulation and legislation that places people at the heart of service design and yet each year we see the patterns of old being played out, damaging the lives of people and families. Why are we unable to learn the lessons and make the progress that is so needed when some of this is so simple?

We are designing support and care for people, offered by another group of people. The things that make us all safer are connections, to each other and the communities we work and live in.

If the past two years have taught us anything it is that people, and by that, I mean staff closest to the people we serve, and their families are the ones who kept and continue to keep people safe. We saw extraordinary demonstrations of what value-based support looks like for real at a local level.

What has been missed and continues to be missed in recent social care white papers is the
need to value our front-line workers, not just with platitudes or offers of more training but in their status and pay. Policy will only get us so far – as someone said to me there is not a problem that can be fixed by a piece of paper alone. Progress will be made when we all start to connect in ways that are about people and not process. At the end of the day, it is people who keep people safe.

Sarah Maguire, Chief Executive, Choice Support

 

 

 

 

 

About Sarah Maguire

Sarah Maguire BA (Hons), M.A, CIPD, Fellow of Centre for Welfare Reform

Sarah has worked in the VCSE sector since the mid 80’s. In November 2017, Sarah became a Chief Executive following the merge…

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r of Choice Support and mcch and is now the Chief Executive of the newly formed Choice Support. Sarah is the Co-Chair of Learning Disability England, a Trustee of the Association of Mental Health, a m ember of the NHS Leaders Panel and is on the advisory panel for the Access Charity.

About Steve Scown

Steve Scown is the Chief Executive of Dimensions UK, a leading charity that supports people with learning disabilities and autism. Steve trained as a learning disability nurse at the high security Ram…

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pton Hospital and worked in a number of NHS management positions before joining the voluntary sector in 1993.

He has an MSc in Public Service Administration and a keen interest in understanding how organisations undertake change and how they contribute beyond their organisational boundaries.

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