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The Learning Disabilities Elf

Limited evidence of commissioners redirecting resources to local service developments in the wake of Winterbourne View scandal

John Northfield

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

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Written by

After qualifying as a social worker, John worked in community learning disability teams before getting involved in a number of long-stay hospital closure programmes, working to develop individual plans for people moving into their own homes. He worked for BILD, helping to develop the Quality Network and was editorial lead for the NHS electronic library learning disabilities specialist collection. This led him to found the Learning Disabilities Elf site with Andre Tomlin as a way of making the evidence accessible to practitioners in health and social care. Most recently he has worked as part of Mencap's national quality team and also been involved in a number of national website developments, including the General Medical Council's learning disabilities site.

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  • Pauline Thomas

    Pauline Thomas

    13 years ago
    I am interested to know whether any professional, organisation or university have studied why these people are presenting with challenging behaviour. Could it be avoided by better understanding of why they challenge? Have they always been challenging? Is it because of changes in their life. Anyone?
    • 2 replies
    • John Northfield
      John Northfield 13 years ago
      Hi Pauline, thanks for your comment. There is a always a good deal of work underway to understand the nature of challenging behaviour, particularly using such approaches as functional analysis and positive behaviour support. I think the point that McGill and Poynter are making however is that there is a huge variation in the policy responses of local authorities to the issue and the way they choose to invest their resources. It seems that there are still some that have not responded quickly enough to the call for investment in local services, leading to the placement of people far from home in ‘specialist’ units.
    • Annonomous
      Annonomous 13 years ago
      The people are deemed to be challenging, however the main cause of these challenges are due to the fact that people with Autism are placed in services where staff do not have sufficient knowledge of Autism and how to support them. If commisioners ensured that specialist placements were actually what they say and that the staff teams are well trained and the environment is one that conciders the sensory and communication needs of people with Autism, they probably wouldn't be challenging. We cannot in all consiouns continue to expect people with Autism to fit into services, we need to develop services to meet the person's needs. It is like expecting a salt water fish to swim in fresh water.