Flux = Rad

(from The Beano)

On Twitter this morning, Martin Routledge (@mroutled) posted the following in response to David Brindle’s story in The Guardian headlined ‘NHS to shut many residential hospitals for people with learning disabilities’ (http://www.theguardian.com/society/2015/feb/10/nhs-shut-residential-hospitals-learning-disabilities-winterbourne-view ):

“@GdnSocialCare interested to hear thoughts of @ndtirob @AliciaWood_HSA @GeorgeJulian @chrishattoncedr – beginning of end or…”

I’ve been out and about all day so have mulling on this without much clarity, but rather than clogging up people’s twitter feeds with 100s of ill-formed tweets I thought I’d just do a quick blogpost instead.

I watched the Public Accounts Committee session where Simons Stevens, Chief Executive of NHS England first mentioned the c (closure) word (the full transcript of the session is here http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/public-accounts-committee/care-for-people-with-learning-disabilities/oral/18031.pdf ). To be honest, at the time it didn’t strike me as that big a deal, largely because any plan that involved significant numbers of people not being in these services any more (like the, er, Winterbourne View objectives?) would have to mean some closures anyway. 

Just a few observations, issued from different parts of my brain:

[Policy wonk part of brain] 1) The responses to the Public Accounts Committee didn’t contain anything materially new from the NHS England Transforming Care document (which to be fair was only published the week before – see my take on this here http://chrishatton.blogspot.co.uk/2015/01/a-second-ferrero-rocher-sir.html but really read the #justiceforLB Herb Audit Office report here http://justiceforlb.org/wp-content/uploads/2015/02/JusticeforLBAudit.pdf ). However, public mention of closures from Simon Stevens (with his ‘NHS Change Day’ lightbulb commitment the following day to ‘help improve services for people with learning disabilities’) raises the public stakes in ways that must be helpful.

[Policy wonk part of brain] 2) The Public Accounts Committee seemed fairly aghast that some of the big failures of the original programme (which seem to me largely commissoners and providers of these places swaggering up to the DH in best Horrible Histories rap style and chanting “You gonna make me?”) basically have been left unaddressed, with NHS England taking the rap but at the same time tiptoeing round commissioners, service providers, social care generally (who they?) and the Ministry of Justice rather than tackling them head on. As John Lish noted in a superb analysis of the session (http://losttransport.blogspot.co.uk/2015/02/simon-stevens-failure-is-not-option.html ) the question of funding yielded no satisfactory answers, and without this being addressed what’s going to be different from first time round?

[Perhaps what I can call the #justiceforLB part of my brain] 3) A really striking thing for me from the session is the technocratic language world that senior people seem to live in (see Mark Neary’s blogpost for more on this and other issues https://markneary1dotcom1.wordpress.com/2015/02/11/worlds-apart/ ), and that more ‘cleverness’ may not be what’s essential here to drive through fundamental change – now is the time for people with learning disabilities and families to be really in charge, with access to undoubted necessary cleverness that will work under their direction.

[#justiceforLB brain] 4 and last) These services are not going to give up without an almighty fight, and NHS England had better be ready for the streetfighting required…

Exhibit A: Findings from the Learning Disability Census show that they’re already digging in to defensive positions to protect themselves (see http://chrishatton.blogspot.co.uk/2015/01/unwrapping-first-ferrero-rocher.html ), for example the number of people ‘not dischargeable’ due to behavioural risks to self or others or mental illness increasing by a whopping 80% from 496 people in 2013 to 895 people in 2014.

Exhibit B: Reacting to a news story about the closure of Calderstones NHS Trust (partly on the back of a fairly damning CQC inspection report https://www.cqc.org.uk/location/RJX04/inspection-report/INS1-940186387 ), a story in the Lancashire Telegraph showed the range and scale of opposition to any potential closure (http://www.lancashiretelegraph.co.uk/news/11756016.CLOSE_IT_DOWN__Expert_advises_national_NHS_chiefs_to_shut_down_Calderstones_Hospital/ ), including:

•            the local MP Nigel Evans (“There is always going to be a need for secure units, so I don’t see how every patient can be released into the community quite frankly. And I don’t really see the benefit of moving patients to smaller units around the country, as I’d still say there’s a need for big and more centralised institutions so that economies of scale kick in. My belief is that Calderstones is essential.”)
•           the local councillor Terry Hills (“There have been concerns historically about patients ‘getting out’ of the site, but I don’t think there have been any issues for a while. I wouldn’t say Calderstones is an asset to the village, it’s just been there for many many years. Undoubtedly it would have a big impact were it to close, as they employ a lot of people, but my main concern is where would the patients go?”)
•           and the local Clinical Commissioning Group (“We are not aware of any plans to close the trust at all, however we are monitoring the situation very closely, noting that the trust is nationally recognised as a specialist forensic learning disability service”.).

Exhibit C: This week, the CQC published another damning report of a ‘specialist service’, this one private, St Andrews. For their services for people with learning disabilities and/or autism, every single area was rated as requiring improvement (see http://www.cqc.org.uk/sites/default/files/1-102643363_coreservice_services_for_people_with_learning_disabilities_or_autism_st_andrews_healthcare_scheduled_20150107%20%281%29.pdf ). The overall summary is shocking in the range and fundamental nature of the failures in these services.

St Andrews have, of course, ‘welcomed’ the CQC reports (see http://www.standrewshealthcare.co.uk/news/st-andrew%E2%80%99s-welcomes-care-quality-commission-report ). And Manjit Darby, Director of Nursing and Quality for NHS England (Central Midlands), said: “We welcome the CQC’s report into St Andrew’s Healthcare. We have been working actively with St Andrew’s and its health partners to ensure improvements to services and are pleased to note the areas of good practice and progress made to date. As the CQC identifies, there are some areas still requiring improvement and we will continue to work with St Andrew’s to address these for the benefit of patients.”

Calderstones Hospital started as “accommodation for imbeciles and epileptics”, with building starting in1907 (http://www.bbc.co.uk/history/domesday/dblock/GB-372000-435000/page/15 ). St Andrews started life as the Northampton General Lunatic Asylum in 1838 (http://en.wikipedia.org/wiki/St_Andrew%27s_Healthcare ). They’ve survived two world wars, the creation of the NHS and deinstitutionalisation. Cleverness is important, but people up for the fight are essential. If these providers will be singing this (https://www.youtube.com/watch?v=4zQQp_Fvn0k ) we need people who will sing this (https://whobyf1re.wordpress.com/2015/02/10/anthem-for-atus/  ) – written and performed by @KatharineChrome.