Ministers will on Monday order a programme of action intended to remove up to 1,500 people with learning disabilities and autism from private hospitals such as the Winterbourne View unit where a regime of abuse and humiliation was exposed. Health chiefs will be told to review urgently the cases of all people placed in so-called “assessment and treatment” units and to deliver a “rapid reduction” in their numbers by planning more appropriate care and support.
The move comes as a report warns that the care sector risks slipping back into an institutional culture typified by the Victorian asylum system. It says strict, custodial practices are making a return in some modern care homes that are struggling with the effects of spending cuts.
Lord Best, a leading housing and care expert and president of the Local Government Association, said: “Unless organisations are vigilant, the older institutional culture can re-emerge anywhere.”
The crackdown on use of assessment and treatment units will come in the government’s final report on the scandal at Winterbourne View, near Bristol, where secret filming revealed routine physical abuse of patients by staff. Six former care workers at the unit have been jailed and five others given suspended sentences.
Although Winterbourne View has been closed by its operator, Castlebeck, and checks on similar units have raised no comparable concerns, ministers have agreed that the model of care is probably unsuitable for most of the people placed in them.
Assessment and treatment units are supposed to offer short-term care for people whose behaviour is seen as “challenging” and difficult to manage in the community. But evidence suggests patients are being left in the units for years on end – in one case, 17 years – at costs revealed in the Winterbourne View affair to be £3,500 a week.
The action plan will give local care commissioners two years to move people out of the units, ideally to other forms of accommodation in their home areas, unless there is a demonstrable clinical and time-limited case for them to remain.
To keep faith with the government’s commitment to localism, the plan will fall short of instructing commissioners to stop using the units, as demanded by pressure groups, but most such groups have signed up to a concordat of support for the programme.
Other measures will include new guidance on use of physical restraint strictly as a last resort in care homes and hospitals; provision for planning from childhood of the care and support needs of people with challenging behaviour; and enhanced powers for regulators to intervene in cases like Winterbourne View and, potentially, to hold directors of private care companies personally to account.
The warning on a drift back to institutionalism in the care sector comes in a report commissioned by Family Mosaic, a leading London housing association and provider of care and support, after it found abuse and poor practice in what it says was a small minority of its own services.
In two shared housing schemes, there were strict times set for getting up, eating and going to bed. In one scheme, access to the toilets was controlled by staff. In another, a woman who kept taking off her clothes had been dressed back-to-front to stop her doing so.
The report warns that, elsewhere, staffing cuts caused by reduced fees paid to care providers are causing residents to be left alone for hours at a time and are fostering excessive reliance on use of drugs and on physical restraint, “often for minor perceived misdemeanours”.
Brendan Sarsfield, Family Mosaic’s chief executive, said: “We would argue that if providers don’t believe this has ever happened in their services, it just may be that they haven’t looked hard enough.”