Bubb Report: Winterbourne View-style homes must be closed down

Patients with learning difficulties should be transferred to home and community care

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The NHS has been told to embark on the biggest overhaul of care for people with learning disabilities since the closures of Victorian asylums a century ago.

Institutions that have people with learning disabilities as live-in inpatients must be shut down and their residents looked after at home, a major NHS-commissioned report has said.

The demand comes in the wake of the disturbing BBC Panorama investigation that exposed staff at Winterbourne View hospital physically and psychologically abusing people with learning disabilities. 

Calling for a programme that would see most of the 104 facilities similar to Winterbourne close their doors, the report warns NHS leaders that the “evils” of institutional care must end.

In the wake of the abuse scandal, the Government pledged to move all people being “inappropriately” cared for in assessment and treatment units (ATUs) into community care by June this year. However, between 2,500 and 3,000 people with learning disabilities and autism are still living resident in institutions throughout England, and there are still more people being admitted than are being allowed to go home, Sir Stephen Bubb’s report reveals.

Sir Stephen, chief executive of charity leaders body ACEVO said there was “anger and frustration” at the pace of change and the NHS admitted that progress had been slow.

“The Winterbourne View scandal shocked the nation. People are still angry and frustrated that more people with learning disabilities are being placed in institutional care than moved into the community,” said Sir Stephen.

“We urge immediate action, to close all Winterbourne-style institutions and ramp up community provision.”

The report also calls for a new “Charter of Rights” for people with learning disabilities and their families, with a recognized right to challenge the system and request a review of whether they or their loved one should be cared for in an institution.

In the report, Sir Stephen writes that the NHS today needed to “recognize” that it should have as few institutional facilities as possible. 

“In 1851, the American physician and philanthropist Samuel Gridley Howe  wrote about the ‘evils’ of institutional care. He wrote: ‘all such institutions are unnatural, undesirable and very liable to abuse. We should have as few of them as possible…’”, Sir Stephen said.

“That essential truth underpins our proposals for change and we know they have widespread support. We recognised that as a nation when we closed the old mental health asylums and we must recognise it again here.”

The NHS has broadly welcomed the report but said that not all such facilities would close, with a small number allowed to remain open to provide inpatient beds for people with learning disabilities detained under the Mental Health Act. AVECO said that all institutions where there was a high risk of abuse must go.

NHS England’s chief nursing officer, Jane Cummings said that the switch from institution to community care was “fundamental”.

“A hospital and an inpatient bed is not a home,” she said. “Like every other member of society people with a learning disability deserve to choose where they live and to call wherever they live their home.”

However, patients and charities representing the rights of disabled people have been calling for an overhaul of the current system for years.

Liz Kendall, Labour’s shadow care minister said that people with learning disabilities would want “action, not another review.”

“After the appalling scandal at Winterbourne View, ministers promised to move people out of ATUs and into the community by 1st June 2014.  Yet almost three and a half years later there has been barely any change,” she said.

“Ministers should now set a clear, two year deadline for shutting ATUs and moving people out of hospital and into the community.”

Care minister Norman Lamb said that he welcomed “the thrust” of Sir Stephen’s report.

“The horrors of Winterbourne View exposed serious failures in the care of people with learning disabilities and autism and this report makes clear commissioning needs to change radically if services are to improve,” he said.

“It is unacceptable for people with learning disabilities and autism to be left in institutions if they can live in their own home or in the community. I am going to consult on changing the law to speed up delivery of the Winterbourne View commitments - to see people living in the community wherever possible and able to challenge decisions about their care.”

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