The gap between the rhetoric and the actual care delivery on the ground
This week we heard the shocking news that only 28% of the learning disability services inspected by the Care Quality Commission (CQC) complied with government standards, with almost half (48%) of the services inspected not complying with the CQC standards for welfare and safeguarding.
It is outrageous that half of services still aren’t meeting these standards 12 months on from the Winterbourne scandal when we are dealing with issues related to basic human rights and quality of life for some of the most vulnerable individuals in society. This needs to change now. The question to consider is what has happened to improve the services that were found to be failing during the first round of inspections - what action has been taken since then and has it been closely monitored?
One interesting finding was that private care facilities were twice as likely to fail as compared with NHS organisations. One of the reasons private facilities can be of poorer quality is that they are removed from local communities, thus people are going to live in areas where they do not have local connections and the service is not connected to local informal monitoring structures, such as parents knowing people who live there or Learning Disability Partnership Boards. The CQC need to identify the factors that result in private care being worse, if they don’t do this the problems will not be resolved. However, this should not be allowed to distract us from the fact that quality of care is simply not good enough across all services.
Whilst we have no problems in principle with the recommendations made by CQC, the challenge is to make sure that these recommendations are implemented. There is already plenty of information available to support organisations and services to ensure the best possible outcomes for people with learning disabilities but there still seems to be a gap between the rhetoric and the actual care delivery on the ground. We need to find a way for regulators to check that action plans for improvement are in place and inspected to see that improvements have been made. What role will the Clinical Commissioning Groups, Health and Well-being Boards and the Commissioning board each have in commissioning these services?
Care for people with learning disabilities varies greatly from one service to another. If we are to see a real difference and great improvement in service delivery, there needs to be stronger requirements for services to develop local, person-centred care. Our involvement in the Department of Health’s research on the impact of person-centred planning in 2005 showed that putting people with learning disabilities at the heart of the planning process led to a 70% improvement in quality of life. It also empowers people with learning disabilities as decisions are not made without them but with them. A local citizen-led service which helps develop and improve care and support and which involves family carers as well as people with learning disabilities in visiting and giving feedback would reduce the chances of services failing to meet welfare and safeguarding standards.
One example of where this works well is our quality-checking project in Kingston which involves local people with learning disabilities carrying out checks on the services provided. It doesn’t seem to be a coincidence that most of these under-performing services are for people who live miles away from their home.