Winterbourne View – Time for Change
Transforming the commissioning of services for people with learning disabilities and/or autism
The Winterbourne view scandal, exposed by the Panorama programme, shocked the nation. It led to the Government pledge to move all people with learning disabilities and/or autism inappropriately placed in such institutions into community care by June this year. Not only has there been a failure to achieve that movement, there are still more people being admitted to such institutions than are being discharged. This has caused anger and frustration.
In light of the need to achieve progress Simon Stevens, the CEO of NHS England, asked me to consider how we might implement a new national framework , locally delivered, to achieve the growth of community provision needed to move people out of inappropriate institutional care. Only by a big expansion of such community provision can we achieve a move from institution to community. So we need a mandatory national commissioning framework that delivers that expansion, pooled budgets, and a focus on the individual’s needs not the system boundaries. The role of the many voluntary and community organisations that both advocate for and provide services for people with learning disabilities and/or autism is crucial to that aim, as are the individuals themselves, their families, clinicians, managers and professionals across the health service and in local councils, who need to work together to achieve a dramatic turn-around.
In tackling this challenge it became clear to me that we need both a major expansion of community delivery driven by better commissioning but also, crucially, the empowerment of people with learning disabilities and/or autism and their families. That means a clear and robust Charter of Rights and an effective “Right to Challenge”, backed by strong advocacy and support, that enables citizens to demand change. We also propose that community based providers have the right to propose alternatives to inpatient care from commissioners. And we support a major expansion of the right to request a personal budget; again we believe this underpins an empowerment of the individual citizen to have care and support appropriate to them. In other words we need to drive change from the top through better commissioning and from the bottom up through empowering people and families to challenge the system.
Underpinning a shift to community provision and away from inappropriate institutional care are exciting proposals for workforce development and a new social finance fund. In developing community provision we need social finance to support capital development so we propose a “life in the community social investment fund” which will support the provision of working capital, investment in housing and an investment readiness partnership fund. This is a new proposal but we recognised that developing community provision needs the funding that social finance can provide and I urge Government and NHS England to push ahead with funding to make this happen promptly.