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BASW England launches Homes not Hospitals campaign

Autistic people and people with learning disabilities should not be in hospital units, but supported to live independent and fulfilling lives

The BASW England Homes not Hospitals campaign has been launched because too many people with learning disabilities and autistic adults are being failed by the housing and care system. 

Detained in hospital Assessment and Treatment Units (ATUs) or in restrictive care arrangements and seclusion units, often for years, these citizens are not being given the right housing, care and support to enable them to live independent and fulfilled lives. 

The aim of the campaign is to promote preventative approaches in terms of commissioning, human rights-based practice, the role of social work and legal literacy to reduce the risk of situations from reaching the point of hospital admission.

Where the person is already subject to this type of care and treatment regime, they need to be supported to leave as quickly as possible to a place they want to live with the right support in place.

BASW England has worked collaboratively with people and families with lived experience, service providers, local authorities, Chief Social Workers, NHS England, ADASS, CQC, NICE and key partner organisations from across the sector with view to influence policy and practice reform, with a Human Rights focus. 

We are calling for everyone across the social work community and beyond in health, social care and housing to support this campaign and action being taken to lobby the Government.

A set of resources, webinars, statements and guidance have been developed to promote the campaign, which you can use in practice and also to promote our cause.

Homes not Hospitals - Key documents to support social workers

BASW England National Director, Maris Stratulis, commented on the campaign: “The timing of the launch during the COVID-19 pandemic is significant. COVID-19 has revealed many underlying health and social inequalities, including through the tragic excess deaths of people with learning disabilities and the unknown number of autistic people that have lost their lives.

“These resources developed collaboratively with people and families and key partners from across the sector have been designed to support best practice with commissioning and to enable social workers to uphold people’s human rights. The aim is to take a person-centred approach and to call for a national review of existing commissioning arrangements and accountability with the appointment of a lead commissioner.”

Leading coordinator of the campaign is BASW England Professional Officer Liz Howard, who can be contacted at liz.howard@basw.co.uk

Liz says: “The Homes not Hospitals campaign is direct response to the call from BASW members to do something in response to the human rights abuses of people with learning disabilities and/or autistic people. We are fast approaching ten years since the panorama expose at Winterbourne View and the situation in terms of restraint, segregation and seclusion remains the same for far too many people.

“As social workers our practice is underpinned by social justice, safeguarding and upholding people’s Human Rights, and ensuring people’s voices are heard. That is what the Homes not Hospitals campaign is all about.

“The key documents and resources that have been co-produced and launched today provide social workers with the opportunity to be part of this campaign and create change through their direct practice with people and families and through system change as organisational leaders.

“We are keen to hear from anyone that wants to get involved, get in touch to find out more and how BASW England can support you and your organisation.”

The problem

Too many people with learning disabilities and autistic adults are admitted to secure settings because of the lack of the right housing and care and there are issues with funding and huge delays to discharge into adequate support and homes.

Preventative, community-based services should be in place to avoid this from happening. The in-patient hospital environment is not therapeutic and is actively damaging which reinforces justification for restraint and ongoing detention.

It is a false economy not to have the right homes with the right support in place to help people live the dignified and happy lives that they deserve.

The Government have been aware of the issue for some time and have made various promises to get the number of inpatients down, yet targets have been missed.

The latest figures, from March 2021, reveal that there are at least 2,050 people with a learning disability and/or autism in NHS-funded learning disability inpatient beds.

This is far off the target the Government set ten years ago of 1,700 by 2019. Sadly, the figures are no better for young people.

In fact, the number of under 18s with a learning disability and/or autism in inpatient units continues to grow. Since 2015, the figure has nearly doubled from 110 children 6 years ago to 210 as of March 2021.

As written evidence from Parliamentary debates highlight, not enough progress has been on these issues. An extract from the minutes of Committee meetings says: “A number of Select Committees have carried out inquiries into the Government’s progress in this area, all of which have raised concern ranging from the continuation of abuse and mistreatment, concerns of breaches of human rights and the failure of NHS England and the Government to meet reduction targets.”

“The Government’s target to deliver a 35-50% reduction in inpatient beds by March 2019 was missed. There was then a promise to deliver the 35% reduction by March 2020, which was missed as well. The next target is to deliver a 50% reduction in inpatient beds by March 2024.”

A new cross-departmental Government strategy has been promised by the Government, but this has yet to the published.

Lived experience

Nobody can explain the issue better than those with lived experience of these hospital units. Amy Telford is autistic and spent three years in such a unit. She recalls “no real autism support” and her struggles to “integrate into the everyday life of the ward”.

“The unit was loud and so intense, it just wasn’t nice,” says Amy. “I got stuck there because they couldn’t find a more suitable autism specialist unit."

"They were the wrong environments, they weren’t recovery-based and autism specific, even though they were saying they were.”

Now living in the community with a support plan, Amy is much happier. "If I had the plans I have now when I was younger, a lot of what I went through could have been avoided. Also, having the support in the community rather than having to be in an in-patient unit would have really helped."

"It has been a long journey and it’s so sad it has taken that long to get the help I needed."

Of course, parents and family members of people in these units suffer too. Andrea Attree describes her struggle trying to get support for her daughter Danielle, who is still in the system.

Andrea says, “She was going through a crisis that could easily have been supported in the community. There are so many parents who don’t know what to do, they are frightened. It is a really hard fight, it takes up your whole life, every time you complain there is an obstacle. It just wears people down.

“We need to stop thinking we need more hospitals. We wouldn’t need these places that cost millions of pounds to build and run if we had the community services. If we don’t break that cycle, we are just investing in a broken model.”

Meanwhile, Samantha Lamb who has learning difficulties said: "If I was to meet the Prime Minister my message would be stop putting people in assessment and treatment units and put more funding into the community so people can live a normal life in the community. "

"People with learning difficulties like me need to be trained up to work in the community with other people with learning disabilities and peer advocacy.”

Wider support

Our campaign has many key stakeholders and has already gained support from people with lived experience, principal social workers (PSWs) and organisations promoting better opportunities for autistic people and people with learning disabilities to live the life they choose with the right housing and support.

Some of our supporters include Andrew Reece, Head of integrated Learning Disability Service at Camden local authority, who said: “I was on the team looking at best practices in commissioning. We need to take these documents further and show commissioners everywhere that it is possible to do the right thing for and with the people who need support. Let's just roll up our sleeves and do it!”

The campaign has the support from members of the Government, such as Fran Leddra, chief social worker at the Department of Health & Social Care. She said: “I really welcome BASW’s new resources… As social workers, we are committed to upholding the rights of the individuals we support and ensuring they are treated with dignity and respect.

“It is important that we ensure those services we commission do the same…These resources are a must read for social workers and will really help improve practice and deliver the best possible outcomes for citizens.”

Mary Simpson, chair of Autism Alliance has described our resources as “vital to support the role of the social worker and commissioning to reduce the risk of situations reaching the point of hospital admission.”

While, Stephen Chandler, president of ADASS, said: ‘‘ADASS would like to place on record our thanks to BASW for the enormous time, effort and expertise which was invested in the production of these resources. We will be recommending to ADASS Members that they take careful consideration of the content.”