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Health and Social Care – How it should be done
If you are a provider of services for adults with autism and challenging behaviour, you may have spent time over the last few years defending your services in the face of very public and very fierce criticism. Winterbourne View made the provision of residential care for vulnerable adults open to widespread scrutiny and judgement.
We thought we had cracked it back in the heady days of Care in The Community. People who had been in long stay hospital all of their lives were able to enjoy the freedom of ordinary living in their own homes. Thousand-bed hospitals were emptied and turned into housing estates. Institutional care was no longer the only choice for adults with learning disabilities.
I used to opine that I had never met anyone that couldn’t be enabled to live independently, given the right support. Why were these people being subjected to the worst form of institutional cruelty? Why were they being locked away far from home? Why was our utopian ideal of care in the community failing them? Open mouthed with horror watching the film evidence of atrocities meted out at Winterbourne, I wondered how this had come to be.
A challenging minority
The simplistic answer is of course that for some people with learning disabilities, independence requires a level of support that is not feasible – economically or practically – due to the level of challenging behaviour they display. With the pressure on funding that has followed local authority cuts, the reduction in trained specialist nurses and the lack of available community options for safe and secure care, the only option for people who challenge may be a specialist in-patient setting. These placements provide containment at a huge price, but evidence suggests that they do not work to prepare patients for community living fast enough or successfully enough.
So, the new draft model sets out to define what quality services should look like for this group of people. It is a document to help commissioners provide the right type of care; as such it could well be the opportunity for providers to be more innovative and responsive.
The main thrust of the model is around recognising the additional mental health needs of some people with learning disabilities, providing the right treatment and support and enabling a life plan to be created that can grow with the individual, enabling them to develop control and achieve greater independence. Care pathways that involve multi-disciplinary working are central to the model, using a range of professional involvement and intervention.
Coordinate and prosper
The thread that runs through this document is planning and coordination of proactive, not reactive services. It speaks of the use of mainstream ordinary services with additional help, rather than the default of specialist provision. Person-centred care is key, with the emphasis on lifelong support, not just crisis management.
As a provider, it would benefit you to consider how you can make your services fit with this type of model. You will already be using person-centred planning and likely have worked at delivering positive behaviour support. This is your opportunity to work with community teams through CAMHS or primary care to see what services might be required in the future. A mixed economy of provision would suit this model very well; one that is responsive to need and flexible to change.
Ginny Tyler – QCS Expert Learning Disabilities Contributor