The response to the Winterbourne View case promises to improve care

The abuse at Winterbourne View is likely to prompt a historic change in the care of people with learning difficulties

Ever since the 1969 inquiry into Ely hospital in Cardiff, improvement in the care and support of people with learning disabilities has been spurred by scandals. The most recent progress came five years ago, following revelations of abuse and neglect in Cornwall and in Sutton and Merton, south London, and, separately, Mencap’s devastating Death By Indifference report on the deaths of six learning disabled people failed by NHS healthcare.

Another lurch forward will come next week, when the government is due to release its final response to the Winterbourne View affair, and hopes are high that the widespread disgust triggered by the case will prompt a historic change in the way we treat people with what is termed “challenging” behaviour.

The closure of NHS learning disability hospitals in the last decades of the 20th century did not, we now know, put an end to long-stay institutional care for this group. Slowly and subtly, the private sector moved in to open facilities where many unimaginative care commissioners were only too happy to park people who proved difficult to settle in the community. Charges of £3,500 a week, as at Winterbourne View, were no deterrent.

Research by the Tizard Centre at the University of Kent in 2007 found that these so-called “assessment and treatment units” were typically less than 10 years old, demonstrating that they had been developed just as the last of the NHS hospitals disappeared.

Quite how much assessment and treatment has been undertaken in the units is open to question. Although they are supposed to offer short-term interventions, such as stabilising difficult behaviour, a recent survey by the Care Quality Commission (CQC), found patient stays of five to seven years were not uncommon and that one individual had been in a unit for 17 years. The abuse filmed secretly for last year’s BBC Panorama programme on Winterbourne View, for which six former care workers at the unit near Bristol have been jailed and five others given suspended sentences, was in part the product of a regime where little organised activity, clinical or otherwise, took place.

It is estimated that 1,500 people in England may be in units like Winterbourne View, which was closed shortly after the scandal broke. Although the CQC has found no comparable levels of abuse elsewhere and some units no doubt do deliver effective, short-term care, the overwhelming opinion in the learning disability sector is that the “assessment and treatment” model has been perverted beyond remedy and that people with challenging behaviour should be supported in other ways, usually in the community.

Ministers are expected to endorse this next week, calling for a rapid reduction over the next two years in the number of people with learning disabilities or autism in hospital-type units, and the closure of large-scale in-patient services in favour of personalised and local provision.

Commissioners will be given six months to prepare individual care plans for people in the units and a further 12 months to bring back to their communities all those placed inappropriately. By 2014-15, all the new NHS commissioning groups and councils across England should have agreed strategic plans covering a variety of services for adults and children with challenging behaviour. A wide range of organisations involved in the care and support of people with learning disabilities will sign up to a concordat setting out this ambition. It will describe the Winterbourne View affair as “horrifying” and say that the placing of people in hospital units for prolonged periods must stop.

For a government committed to localism, the report will be as close to a central directive as you are likely to get. Winterbourne View was a truly shocking episode, and no one would want to see vulnerable people hurt and ridiculed in that way, but good may yet come of it.