The Campaign for a Fair Society believes that “human rights are for everyone, including the most disabled members of our community, and those rights include the same right to liberty as everyone else” (Hale 2014). The placement and serial detention of people with learning disabilities and/or autism in institutions for long-term care far from their homes is a systemic breach of human rights and a national scandal.
The current census highlights that there are more people in this fundamentally abusive system now than there were 12 months ago; 60% of those in the system have been there for a year or longer; 56% have experienced self-harm, an accident, physical assault, hands-on restraint or been kept in isolation; 64% have been subject to chemical restraint. This is inhumane detention masquerading as treatment and a flagrant breach of Article 5 of the EU Convention on Human Rights, the right to liberty.
There is no lack of policy guidance on the urgency and appropriateness of supporting people with complex needs and challenging behaviour in ordinary, community based settings (Mansell 1993, 2007). Previous government policy on learning disability, ” Valuing People” (2001) and ” Valuing People Now” (2009), also firmly supported the conclusions of the Mansell reports. This policy context underlines the extent of the failure to act and points clearly to the need for a new approach.
The gradual and voluntary approach to reform espoused in Transforming Care and the Concordat has proved an inappropriate and ineffectual response to the plight of people with disabilities highlighted by Winterbourne View. The Campaign for a Fair Society therefore calls for a new and radical strategy to eradicate once and for all the breaches of human rights perpetuated by the current system.
We call for political leadership to:
- use its resources, legislative and executive powers to end the detention and placement of people with learning disabilities in out-of-area in-patient settings
- secure a programme of re-provision which builds capacity and skills in the local provider sector to meet the challenge of wholesale re-settlement of current in-patients in their local communities
- secure the provision of alternative local community living solutions including local short term assessment and treatment for adults, children and young people with learning disabilities and mental health issues/or autism when needed
- coordinate the input of government departments and related groups, including families, which have an interest in the continuing support of people with learning disabilities and/or autism, challenging behaviour and mental health needs
- work collaboratively with people and organisations who are committed to real and lasting transformational change to pursue a radical solution to end this scandal.
NHS England, Local Authorities and the CCGs
We call for NHS Engand, Local Authorities and CCGs:
- to use their powers to deliver and commission services which are equipped to include people with learning disabilities in local mental health services as a matter of reasonable adjustments under equalities legislation
- to provide less restrictive ‘behaviour support’ and respite services close to people’s homes
- to ensure that decisions about care include families
- to ensure that assessment and treatment has regard to people’s human rights to liberty under the EU Convention on Human Rights, Article 5 and complies with the requirement for the ‘least restrictive option’ under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.
Health and Wellbeing Boards
We call for Health and Wellbeing Boards to:
- ensure, as local policy leaders and strategic decision makers, that integrated health and social care funding is effectively used to support local people in local communities and not spent on out-of-area placements which fail adults and children with learning disabilities and/or autism and traumatise both them and their families
- ensure that de-commissioning out-of-area placements is combined with a strategy of building local provider capacity for community solutions and funding local assessment and treatment interventions, as well as funding critical respite services.
Care Quality Commission
We call for the CQC to:
- ensure that their regulation is more robust on ensuring that the ‘least restrictive option’ for assessment and treatment is pursued in each individual case
- ensure that provider outcomes demonstrate effective short-term intervention and resettlement at or close to home
- de-register providers who serially detain people with learning disabilities and/or autism rather than successfully assess and treat them towards resettlement on the grounds of ineffective and poor quality service.
Commissioners, providers and the CQC
We call for all commissioners, providers and the CQC to:
- ensure that families are included in all decisions about care for adults as well as children with learning disabilities and/or autism and to recognise that the involvement of families is integral to their loved ones being able to live safe and fulfilling lives in the community
- ensure that assessment, treatment, care and support is commissioned and delivered in line with the Driving Up Quality Code
- ensure that their staff have a good understanding of the relevant legal frameworks and that legal safeguards are understood, in place and regularly and openly reviewed for every individual in the system, including:
- That the ‘least restrictive option’ for assessment, treatment and care is pursued in each case and at all times
- That people are only ever detained or deprived of their liberty, including being subject to solitary confinement, with the correct legal safeguards under the Mental Health Act, the Mental Capacity Act and the Deprivation of Liberty Safeguards
- That people’s rights to independent advocacy under the Mental Health Act and the Mental Capacity Act are respected.
The Campaign for a Fair Society calls for a radical strategy to end, once and for all, the scandalous detention and placement of over 3000 people with learning disabilities and/or autism in institutions for long term care away from their homes. In the wake of Winterbourne View, voluntary and gradual reform of the assessment and treatment system has been an abject failure and there are more people in this fundamentally abusive system now than there were a year ago. The campaign calls on political leadership, and all those with a role to play in planning, commissioning, providing and regulating care, to ensure that assessment and treatment is provided close to home. De-commissioning of out-of-area placements should be combined with a strategy of building local provider capacity for community solutions and strengthening local support. Respect for people’s human rights to liberty under the EU Convention on Human Rights, Article 5 should be paramount and all decisions about care must comply with the requirement for the ‘least restrictive option’ under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Decisions about care must involve families and/or advocates. Providers who serially detain people with learning disabilities and/or autism rather than successfully assess and treat them towards resettlement should be de-registered. Campaign for a Fair Society believes that “…human rights are for everyone, including the most disabled members of our community, and those rights include the same right to liberty as everyone else” (Hale 2014). People should only ever be detained or deprived of their liberty unavoidably and temporarily under the correct legal safeguards with the outcome of living a safe and fulfilling life in the community always in view. Anything less is inhumane and intolerable in a fair society.
This is an important issue which requires a concerted, committed approach. We would welcome your comments.