Friday, 6 February 2015

A Tale of Two reports



We saw the publication of two reports this week, Care services for people with learning disabilities and challenging behaviour, National Audit Office and Actually improving care services for people with learning disabilities and challenging behaviour The JusticeforLB HERB Audit Office.

There could not be more of a contrast to two different approaches to bringing about change. We have been involved in both at the H&SA.



Since June 2011 when the Panorama story broke about Winterbourne View we were involved in developing the concordat, advising the government, advising the Winterbourne JIP and writing paper after paper of recommendations, figures and reports to make sure we could share our knowledge and skills in getting people out of hospitals and keeping them from going in in the first place, which is significant. We even wrote to every NHS & LA commissionerand MP in the country with a copy of Thereis an Alternative which set out real examples and costs of people who challenge living successfully in their communities. 

We were not contracted or paid to do any of this work except for a small amount of consultancy work on welfare benefits for the Winterbourne View JIP. We took our commitment to the concordat seriously and did everything we could.

So much of the NAO report filled me with rage and it makes difficult reading…

In December 2012, when agreeing the Concordat, the scope and the quality of data on patients with learning disabilities was poor.  
Yes this is a problem but you knew that there were way too many people in these places and this should not stop any other action

The government left it to mental health hospitals, NHS commissioners, and local authorities to decide how to meet the commitments.
Whilst the programme lacked any real co-ordination and leadership (and this was a problem), aren’t the local people responsible paid to do a job (some whopping salaries there)?  Aren’t they supposed to be skilled at what they do? They take public money to do their jobs and they still need to be nannied by the government? Really?
    
As funding did not follow the patient, there was no financial incentive for local areas to bring patients home.
This line made me feel nauseous. Why the hell do you need a financial incentive to get people out of places they shouldn’t be in the first place? Do people paid by the state really need a financial incentive to do what they are paid and directed to do?
I said at a WV concordat planning meeting in October 2011 that the programme would not work unless money followed the people. This was either ignored or written off as too difficult.

Joint work between health and social care commissioners is vital to make discharges from mental health hospitals sustainable
No s**t!  We’ve known this for years and there are plenty of examples where it is done and works. Just google it.

Developing robust community services for people with a learning disability and challenging behaviour takes time.
We told everyone that would listen that this was the case. There are only a limited number of providers that support people who challenge successfully in their communities. We wrote a report and offered help with this. We shouted, pleaded and wrote reports about the need for capital investment in housing. Only recently has there been action.
I dispute many of these excuses for not meeting the commitments in the concordat. I put it down to a lack of responsibility taken by commissioners, providers with vested interests and poor programme leadership and co-ordination. This has been underpinned by inertia and a simple refusal to listen and act by those who have power.  This week particularly, I have felt ashamed to be a professional working in this field.

Actually improving care services for people with learning disabilities and challenging behaviour, JusticeforLB report 

Alternatively, we have the #JusticeforLB  #LBBILL campaign and its painfully honest and direct approach to bringing about change.

We took one of the #107 days and decided to do something practical in Connor’s memory http://www.housingandsupport.org.uk/hsa-day-83-107-days  14 NHS commissioning teams were written to, tweeted and sent a follow up letter to offer help to get housing for people stuck in ATUs. 

Out of the 14 teams we approached, 5 responded and we have been actively helping them with getting housing. The remainder did not respond or request help. This did not surprise me, especially now given the NAO report and LD census figures that show how little has moved on.

It was liberating doing something practical to try and move things on and feeling part of a movement for change where people’s hearts are in the process.  During this process I was contacted by a senior person responsible for delivering change nationally and warned off from going through such a public process to challenge/help commissioners. I was asked “Who are you to tell commissioners what to do?” I replied that I had signed the concordat and made a commitment to do something and got the response,  “ Yes, but who ARE you?”  

This says it all for me. If we have to leave it to people like that to change things ,we will never get anywhere.  In less than a year we are heading for the second draft of the #LBBill on virtually no budget, great heads and big hearts of the @JusticeforLB team. Justice for Connor moves slowly but it is moving.  

I feel proud to be part of this. Had I been asked today “ Yes, but who ARE you?”  I would have responded proudly “ I am an LBBiller!”