In the wake of the outcome of last week’s court proceedings involving support staff who worked at Winterbourne View hospital, there have been continuing calls to ensure that people with learning disabilities and complex needs are not placed far from home in isolated services, but receive local, skilled support. The Mansell report drew attention to the potential continuing impact of a failure to invest in local services in the early 1990s and reiterated this point in the refreshed guidance published in 2007.

The concerns about out of area placements and institutional services remain however. At the time of the publication of the serious case review into the events at Winterbourne View, Mencap and the Challenging Behaviour Foundation drew attention to the fact that the two charities had received over 260 reports from families concerning abuse and neglect in institutional care since the breaking of the Winterbourne View scandal in June 2011.

In October last year, we posted about a survey of out of area placements used by five London boroughs which suggested that private sector providers, the main accommodation provider, were those most likely to under-perform on meeting standards of care.

This most recent study of commissioning activity in the south east of England also casts some doubt on whether lessons are being learnt. The authors set out to look at the characteristics of the highest cost placements in the area by contacting learning disability commissioners to ask for information about the five highest cost residential placements they commissioned for adults with learning disabilities.

They found an average placement cost of £172,000 per annum, but this average masked a wide variation in costs.  They also found that the people placed were mainly young and male with high rates of challenging behaviour and/or autism spectrum disorder.

The majority of the high cost placements were in out-of-area residential care with the highest costs associated with hospital placements and those for people presenting challenging behaviour.

The authors conclude therefore that young, male adults with challenging behaviour and/or autism are those who are most likely to be using very high cost residential support and that this is likely to be in out-of-area residential care.

They also state that they found

limited evidence of plans to redirect resources to more local service developments.

High Cost Residential Placements for Adults with Intellectual Disabilities, McGill, P. & Poynter, J , in Journal of Applied Research in Intellectual Disabilities, 25: 584–587