CQC: half of learning disability services are not up to scratch
Caring Times, September 2012
A Care Quality Commission (CQC) programme of inspections of services for people with learning disabilities found 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. CQC says many of the failings identified in the report are the result of care not being centred on the individual, and 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. CQC chair Dame Jo Williams said people who used these services needed care and support and they and their families needed 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,” said Dame Jo.
“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 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.”