News & Views

20th April 2015

Time for a new generation of adult learning disability services

There are still too many people with learning disabilities living in assessment and treatment units, but there are increasing numbers of providers delivering the housing and services people need to live successfully in the community, says Barry Carpenter

It is ‘time for change’ and to end inappropriate institutional inpatient facilities for people with autism and the closure of Winterbourne View-style institutions. That’s what in November 2014 Sir Stephen Bubb headlined in his NHS England report into the care of people with learning disabilities. Such change is well overdue.

June last year saw the passing of the government’s self-imposed deadline for progressing people out of assessment and treatment units (ATUs) and other similar institutions into community services. Sadly, the deadline was more than missed – since then more people have been admitted into ATUs than transferred out.

In the meantime, however, some providers have been creating innovative services on the ground. I’ve been advising Mariner Care on the health and care delivery of its four new purpose-built bungalows in the Burbank area of Hartlepool.

These ground-breaking services, with highly trained staff, will provide therapeutic and supportive care for up to 12 adults with learning disability and autism.

Mariner Care is all set to provide care for exactly those people whom, post-Winterbourne View, the government wants to see transferred out of ‘inappropriate’ hospital settings and back into the community. The organisation is not the only provider ready to deliver either.

They need to be ready too, as while NHS England’s chief executive Simon Stevens admitted last November that “progress has been slow” to move people out of ATUs he did reveal that figures show an increase in the number of people with a set transfer date from hospital back to the community. Plus, commissioners are increasingly sitting down with providers and discussing what’s needed. That’s what happened with Mariner Care.

So change is starting to unfold. And, in this context, Sir Steven’s report should provide that final push to ensure that people are finally moved out of inappropriate settings.

But what is vital is that this new generation of adult learning disability services has at its core an emphasis on providing ‘housing with care’. They should, in essence, be homes in the purest sense – a place to live and enjoy. To have neighbours, be part of a community and to have a good quality of life.

Such services should not only look and feel like a home that you and I might live in – Mariner Care has excelled on this front – but provide authentic links and engagement, if people want it, with the community.

One of my children has Down’s syndrome and she lives in this kind of genuine home with another person with a learning disability. She shops, catches the bus, as well as attending church and drama groups – ordinary, everyday things that anybody should be able to do. This is the standard we should be aspiring to for the 2,500 adults who currently still live in institutions.

On the commissioning side, for many years the sector has been applauding the goal of integrated commissioning of local authorities and the NHS where health, social care and housing budgets are pooled.

It now has to happen, and there are compelling reasons for it. Again – if it ever did need emphasising – ‘housing with care’ as opposed to institutions results in better communication and social ability of all people, including adults with autism and so results in fewer mental health problems. This means less spending on healthcare. In other words, it’s less costly to the taxpayer.

In addition, last year’s Care Act enshrined the principle that a person receiving residential care from a provider arranged by a council will now be covered by the Human Rights Act. This is legal clout to deliver quality personalised care.

When Mariner Care undertook training of its staff, one man who’d worked for 30 years with people with a learning disability told me he’d never received such intensive and high-quality social care training.

This shows that organisations are on the ground ready with progressive, innovative services. So let’s deliver. There are no reasons not to.


Barry Carpenter advised Mariner Care on the development of its Hartlepool services for people with a learning disability and autism, and is chair of the advisory board of Montreux Healthcare, which provides specialist care services in England. He has received an OBE for services to children with special needs.


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