When we wrote the serious case review that resulted from Panorama’s Undercover Care: The Abuse Exposed, broadcast on BBC One in May 2011, we had little sense that this obsolescent model of specialist service provision would be so defiantly durable. The broadcast received national news coverage due to the cruelties and distress revealed at a private hospital that was being paid, on average, £3,500 per patient, per week from NHS coffers. Although it had an annual turnover of £3.7m, the Care Quality Commission’s light-touch regulation did not notice that it had strayed far from its mandated purpose of assessment and treatment, or even notice a whistleblower’s three alerts.
Politicians’ promises to transfer more than 3,000 patients out of assessment and treatment units (ATUs) by July 2014 could not be kept, primarily because there is no incentive for commercially provided inpatient care to discharge patients and retain empty beds. There remain more than 2,000 people in these services. We believe that a progressive and long-term solution is necessary from which ATUs are excluded altogether. If people with learning disabilities and autism require a mental health service, the default commissioning response should not reside in ATUs.
We regret giving undue coverage to the recommendations of the contributing organisations 10 years ago, since this obscured the “commissioning challenge” recommendation concerning the 51 former patients at Winterbourne View hospital: “… commissioners ought to use their best endeavours in relation to ex-patients to return them home or to suitable placements in their local communities. This will require more than keeping tabs on where they are now – political support, the engagement of generic mental health services … capable managers and staff are essential if competent and humane forms of local provision are to develop.”
During sustained austerity, children and young people have been locked up in ATUs because there are no local support services willing to work with them. Ordinary lives require suitable accommodation and extraordinary support from skilled professionals. These change over time and are emphatically unavailable in ATUs. Homes are needed, not hospital beds.
Margaret Flynn and Vic Citarella