Ban institutions from detaining people with autism or learning disabilities, MPs say

Last week, the Health and Social Care Select Committee published its report into the treatment of autistic people and people with learning disabilities in inpatient units, finding that the current system of community support in England is “broken”.

The report is the fifth report on the treatment of autistic people and people with learning disabilities, and one of many since the Winterbourne View scandal in 2011 which has called for an end to the use of “inappropriate and outdated institutions” to detain autistic people and people with learning disabilities.

MPs on the influential Select Committee argued that autistic people and people with learning disabilities have the right to live independent lives in the community and that it is an unacceptable violation of their human rights to deny them the chance to do so. They further argued that it is more expensive to detain people in inpatient settings and this takes up resources that are not then available for more humane community care.

“We are therefore deeply concerned that community support and provision for autistic people and people with learning disabilities, and financial investment in those services, is significantly below the level required to meet the needs of those individuals and to provide adequate support for them in the community,” the Committee’s report said. “Fixing this must be a greater priority for both the Department of Health & Social Care and NHS England & Improvement.”

The Committee is now asking the Department of Health and Social Care to deliver a complete assessment of the cost of providing community support for all autistic people and people with learning disabilities currently in inpatient units, and a cost assessment of how this could be funded by the NHS and local authorities.

“Once the costs of moving care and support to the community for these individuals currently detained in inpatient units are identified, we expect the Government to provide investment which matches these costs, including initial funding for double running if needed,” the committee said.

Since the Winterbourne View scandal, successive governments have committed to reducing the number of autistic people and people with learning disabilities in inpatient settings and prioritising community support for these individuals. However, the committee said missed and delayed policy targets “suggest a more radical approach to unlocking funding for community provision is urgently needed.”

“Too often autistic people and people with learning disabilities are assessed as needing to stay in an Assessment and Treatment Unit (ATU) not for temporary assessment or treatment but simply because appropriate community provision is not available, as evidenced by the shocking six year average length of stay.

“We also recommend that the Department then needs to redesign the financial incentives in the healthcare system so that local authorities do not seek to ‘offload’ autistic people and people with learning disabilities onto the NHS or place these individuals in inpatient facilities. The Department must instead offer a credible alternative and provide additional support so that autistic people and people with learning disabilities can live independent and fulfilled lives in the community.”

Writing in Politics Home, Barbara Keeley, Labour MP for Worsley and Eccles South and member of the cross-party committee, said: “Over the past decade, we have had a string of promises and targets from the government but every time they have failed to match their ambitions with actions.”

“A decade on from David Cameron’s promise to end the use of these units, there are still more than 2,000 autistic people and people with learning disabilities detained in them.”

Minister for Social Care Helen Whately, giving evidence to the committee, said she was “frustrated” by the lack of progress and that the Government had made, and that she had established a Delivery Board called The Building the Right Support, chaired by herself.

The committee questioned the effectiveness of the board, saying the work and output of The Building the Right Delivery Support Group is unclear at present and risks repeating the previous “mistake” of focusing on a voluntary approach, rather than addressing the “fundamental flaws in funding flows” that prevent community provision being adequately provided.

The committee instead recommended the ‘Trieste model of care’, which uses simplified and quicker admissions to and discharges from inpatient facilities, limited numbers of individuals in inpatient facilities for lengthy durations and places an emphasis on well-resourced community support.

“[The Trieste model] presents a clear and better alternative to supporting autistic people and people with learning disabilities than is currently in place in England,” the report said, adding: “Crucially, the Trieste model demonstrates that, when legislated for and well-resourced, autistic people and people with learning disabilities can be effectively supported in the community and without unnecessary and lengthy stays in inpatient facilities.”