Organisations), published his final report Time for a Change: The Challenge Ahead on 22 February 2016, almost 5 years after the showing of a Panorama programme that exposed the abuse and neglect of residents at Winterbourne View. In the aftermath of the programme the Government made a promise to move everyone with learning disabilities and/ or autism inappropriately housed in a hospital out of those settings by June 2014.
Despite Government’s promise the deadline was missed and almost three and a half years later there had been barely any change. As a result of the ensuing criticism Sir Stephen was asked by the National Health Service England (NHSE) to chair a steering group to examine services for people with learning disabilities and/or autism.
His first report, Winterbourne View – Time for Change was delivered in November 2014. In that report he made a number of recommendations, the key priorities being:
- The closure of inappropriate institutions and the ramping up of community provision; and that
- Government legislate for a Charter of Rights for people with learning disabilities and their families. Both of these were accepted by NHS England and by the Government.
In his final report Sir Stephen considers the steps that have been taken by the Government since his last report and concludes that progress has been made in the last year. He reports that the NHSE has announced a major programme to move people with learning disabilities out of hospital and into their communities and that in October 2015 the Transforming Care Programme published a national plan for services for people with learning disabilities and/or autism entitled ‘Building the Right Support’. By 2019 the Transforming Care Programme intends to reduce the number of inpatient beds by up to 50% nationally and develop community–based services to prevent people from being admitted to hospital and to ensure that there are meaningful alternatives to hospital-based care across the country.
Sir Stephen is nevertheless critical of the progress. He believes that the scale of the problem has been underestimated, pointing to research suggesting that 3,500 people are currently in hospital-based settings; which is 900 more than stated by the government programme. In his view 10,000 extra members of trained staff will be needed to support people in their own community.
The report makes two key recommendations.
- An independent evaluation of this programme. He suggested that a real-time, independent evaluation commissioned by the Department of Health with the commitment to publish all interim and final evaluation reports;
- A Learning Disabilities Commissioner be appointed who would have a statutory duty to promote and protect the rights of all people with learning disabilities and/or autism in England’.
Specifically Sir Stephen questions whether the amount of £15 million that has been made available by NHSE to Transforming Care Partnerships for capital projects will be sufficient. The review calls on NHSE and DH to explain publically how this fund will be administered and, given £15 million is unlikely to be adequate, how it will ensure that sufficient continuing investment is available as the rate of people being discharged increases over the next 3 years.
In recommending that a learning Disabilities Commissioner be appointed he points out that the Government has yet to introduce the recommended legislation on rights. He refers to the Government’s response to the Green Paper ‘No voice unheard, no right ignored’ which does not commit to legislative change to enshrine in law rights for people with a learning disability. He comments that “nearly five years after the scandal at Winterbourne View Hospital we are still waiting to see any changes – it is time that someone is given the job that needs doing, which is making life better for all children and adults with learning disabilities and ensuring their rights are respected and enhanced, and their views taken seriously.”
The report also calls on the Transforming Care Programme to consider the accreditation of training in Positive Behavioural Support with a view to establishing an appropriate body to manage the design of a PBS Standard and tiered accreditation systems for individuals and organisations delivering and receiving PBS.
It highlights the risk to those with learning disabilities and/or autism of the capping of housing benefits to Local Housing Allowance Rates that is to start in April 2016. He recommends that the Government makes an explicit exemption for supported housing.
The findings in Sir Stephen’s report are supported by a report published on the same day by the Royal College of Nursing (RCN) which says that many people with learning disabilities are still unable to receive the care and support they need because of issues with staffing services and strategy.
Sir Stephen accepts that “there is a commitment to closures and to developing community care [on the part of the Government] and that there is a step change in the attitudes of the national partners responsible for setting the agenda.” He believes however that “failing to deliver this new programme is simply not an option” and that “success will be recognised only when the closure of hospitals is made possible by the development of community based services, with people who have learning disabilities, their families and carers at the centre of the design.” He believes that the Transforming Care Programme can achieve changes on the ground but cautions that the challenge has been underestimated before.