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27 Jun 2017
Dundee Stronger Together

National Guidance exists for the use of restraint on “looked after” children in Scotland but nothing similar covers children with special needs in schools.  This is a major oversight and means schools have no national standards on the appropriateness of restraint techniques, the use of de-escalation and the necessary levels of training. 

This means that is some circumstances, bad practice has arisen and parents have little recourse to challenge teaching and other support staff.  For more information see our stories on the events at Kingspark School in Dundee.  

Even more surprising is that there is no external supervision of the care regime in schools.  HMIE does not cover this in their inspections.    It is left up the same local authorities who employ staff and run the schools to monitor them.  This is a real concern and we are supporting a national petition to start  a national dialogue to improve this picture.

Sign the petition by clicking here

 

Dear Mr Hood,

 I refer to your recent email entitled “A return to institutional care for adults with learning disabilities in Glasgow?”. Your email raises two fundamental concerns regarding the current tendering process for the provision of residential accommodation for adults with learning difficulties which could cater for up to 20 individuals.

Firstly, can I emphasise that this in no way represents a reversal of the progressive, democratically established, learning disability policy of supporting individuals to live independently within the community. Specifically, there is no attempt to redirect anyone from the community into residential care.

This tender relates to a reconfiguration of a comparatively small level of provision of existing residential care to this client group; i.e. the individual service users in scope for this revised provision are, in the main, already in residential placements. The current provision is outwith the city boundary and there are significant benefits for the individuals concerned, as well as their family and friends, if they were supported within their home city.

It is also recognised that there will be future circumstances where as a result of, for instance, diminishing health and increasing needs that it is simply no longer appropriate for some individuals to be sustained in individual placements. This may be because the appropriate form of care cannot be provided in the person’s home (e.g. nursing) or that, following individual reviews which identify increasing need, the significantly increasing costs of supporting such placements does not provide best value to the council or to the individual.

The award of any contract of significant value requires Executive Committee approval; on the conclusion of this tender exercise, should an award be recommended, it will be brought to Executive Committee for a final democratic decision.

You also appear to suggest that every instance of group living/residential care is, by definition, a bad thing. Having worked as a Nursing Assistant at Ladysbridge Hospital near Banff, (the North East equivalent of Lennox Castle,) and having served on the Board of an organisation supporting adults with learning disabilities to live in the community, I have first hand knowledge and a deep personal commitment to independent living. You cite a number of examples of some of the terrible failures in institutional and group living. While I would fully support your condemnation of these failures I am also aware that there are circumstances and numerous exemplars of both the appropriateness and considerable success of group support for a small proportion of adults with learning disabilities.

The service envisioned under the current tender process does not equate to large scale institutions such as Lennox Castle nor should it be tarnished because of cases such as Winterbourne which, though thankfully rare, represent a failure of the service rather than the concept.

This council remains committed to supporting all our citizens, irrespective of age, disability or background to live as independently and freely as possible within the community. We are also committed to ensuring that, to the full extent of their capacity, people with whom SW engage have genuine choice. Neither of these commitments in any way precludes the provision of well run and properly provisioned group support in a small number of appropriate cases.

I trust you will find this clarification of the position helpful.

 Kind regards,

 Cllr Malcolm Cunning

Dear Councillor Cunning

 Last week following the publication of the Bubb report into plans to end institutional care following the Winterbourne scandal the UK government had to defend its failure to help people with learning disabilities leave institutional care and live in their local communities.    In England more people with learning disabilities are entering hospital and other forms of institutional care than are leaving.  In the year to September, 923 people were discharged but 1,306 were admitted.  Norman Lamb PM, the Minster for Care admitted on the radio that the problem is that local authority provision for people living in independently was falling behind.  But he insisted that money was not the problem, after all these places were funded by the NHS - surely the money could be used better in the community. 

 Scotland is not immune from this.  Many people with learning disabilities are still in institutional care north of the border and many more travel south to hospital and services in England.  But a new development worries us considerably.   It was with surprise that we found that Glasgow City Council Social Work Services are planning to commission a new 20 bed Care Home for people with learning disabilities so that people leave their local communities and live in institutional care. 

 We have looked through papers presented to the City Council's Health and Social Care Policy Development Committee for this year and can find no mention of this development or any subsequent discussion.  Neither can we locate any mention of it in the publicly available papers from the Personalisation Sub Committee.    I am sure that we must have overlooked some mention of this as surely such an important development cannot be taking place without some form of democratic oversight. 

 Glasgow City Council tender documents (attached) call for

"a discrete unit dedicated to the care and accommodation of 20 adults with learning disabilities, staffed on a 24- hour basis, within the geographical boundary of Glasgow. It will compromise living spaces including dining areas, communal areas, and individual bedrooms. It will also have access to outside garden space for residents. The unit will have its own identity, and at very least a door separating the unit from other resources.

 "The unit will be staffed 24 hours per day and able to meet the needs of up to 20 individuals over the age of 18 years with Learning Disabilities whose needs are to a level of complexity that cannot be met within a mainstream elderly care home environment.

 "Maximum funding of £640(gross) per placement per week is available within this contractual arrangement.  Bidders will require to evidence that the service as described in the service specification will be fully operational by 7th January 2015."

 We are concerned because 

·         Large institutional settings disempower people with learning disabilities leaving them more vulnerable to abuse and neglect such as took place in Winterbourne

·         The creation of such large services can allow staff sub cultures to develop that devalue people with learning disabilities

·         Opening such a service in just 6 weeks after the award of contract runs the risk of unexpected problems such as making sure each individual has a proper personalised care plan

·         This service may end up replicating the problems in care home services already used by the City Council such as Collisdene Care Centre which has had a moratorium on placements for over a year.

 The Mental Welfare Commission has investigated the experience of people with learning disabilities in care homes of this size or larger. They found that

.       People lost their rights and were restricted more in movement and choice than they should be

.       Staff often did not understand how they should make sure people consented to medical treatment

.       People were often not taking part in their own reviews

.       Local authorities often didn't turn up for reviews or keep an active interest in people

.       Many of the homes were institutional in feel and look

.       Some people had very limited day activities

.       A significant number of people couldn't get out because of lack of transport

.       There was little effort to help people develop friendships outside the unit. 

 Developing a 20 bed care home is not an alternative way of looking after people with learning disabilities in the community.  It is a return to the old days of large segregated services that have the smell of Lennox Castle and other large hospital based services. 

 We would urge you to raise this matter within the democratic structures of Glasgow City Council and to find a way of putting this tender on hold before it is withdrawn completely.  

 Such a development is not what anyone expected as we moved into Self Directed Support.  It is the wrong direction of travel.

 All the best

Ian Hood

 

Coordinator

Dear Councillor Cunning

 

Thanks for your reply to my email.  It was indeed useful in understanding your approach.    It was also sent on to me from other councillors. 

In it you makes two points – first that there is no new policy and secondly what is being proposed is not institutionalisation. 

In the end, it is up to elected councillors such as yourself to judge whether a new policy has been adopted. 

We would suggest that there has been a clear policy across Scotland to move away from care homes and to support people to live in their own homes.  This has been the case in Glasgow more than anywhere else as you can see from the table below.

Care Homes for All Adult Groups bar Older People

Area

March 2003

March 2013

Scotland

37,947

34,933

Percentage fall over 10 years

 

-8%

Glasgow City

4,691

4,041

Percentage fall over 10 years

 

-14%

Number of people with learning disabilities in care homes in Glasgow

317

208

Percentage fall in 10 years

 

-35%

  Source for statistics - Scottish Care Home Census, 2013                               

Throughout Scotland there has been a shift but in Glasgow there has been a real move away from care homes.  In fact, over the period the number of care homes in Glasgow has fallen by 20%.  Care homes have been closing, rather than opening.

Not only have care homes been closing, they have been getting smaller.  In 2013 there were 233 care homes in Scotland for 1,588 long term residents with learning disabilities making the average size of care home 7 places each - one third of the proposed new service. 

It is slightly harder to get  current figures for separate local authority areas but information we collected a few years ago says that in 2011 the average size of care homes for adults with learning disabilities in Glasgow was only slightly higher 8 places and it may have come down since then. 

Such actions by Glasgow reflect a good policy of developing and supporting independent living where resources allowed and smaller care homes where it was harder to make progress

It was the type of policy that  Matt Kerr, former Executive Member for Social Care might have been endorsing when he said,  “However, with the self-directed support bill currently going through parliament, the landscape for social care in Scotland is shifting and we must move with the times.  .... By reforming now, we a have a huge opportunity to support more people to integrate more meaningfully into their local communities, which is a key principle of national policy."

Independent living and smaller care homes really do help integrate people more into their local communities. 

Councillors need to decide if the decision to tender for a 20 bedded care home, three times the size of the Scottish average is a change in the policy or not.   But I find it surprising that a decision which impacts on Glasgow’s sons and daughters does not need to be approved by a council committee, yet a paper contract between two corporate bodies does.  Does the value of contracts trump the value of individual men and women?

  The second charge is that we are over egging the proverbial pudding on the charge of institutionalisation.    The point of the Bubb Report is about institutionalisation generally.   It didn’t deal with the causes of the Winterbourne scandal but instead looked at why more people with learning disabilities were still ending up in large institutional settings rather than less. 

The Bubb report was clear it was not just “the setting” that was the problem but “the concept”.  Bubb quotes ‘“the  1851 American physician and philanthropist Samuel Gridley Howe wrote about the “evils” of institutional care. He wrote, “all such institutions are unnatural, undesirable and very liable to abuse. We should have as few of them as possible, and those few should be kept as small as possible. The human family is the unit of society.”’ (p7)

It is not true as you claim that “it is simply no longer appropriate for some individuals to be sustained in individual placements.”   Since Urquhart’s “Study of the Balance of Care” in the 80’s, it has been clearly demonstrated that every person living in an institution has their equivalent person living happily in a community setting.  You may choose not to use resources to support people in the community but it is a choice. 

We would prefer that no adult with a learning disability had to live in a group setting unless they chose to do so.  However we do recognise that this is the reality in Scotland (and the rest of the UK).  We and many others are working with Scot Excel to ensure that those homes that do exist are properly supported, supervised and regulated.

But there is a point when quantity transforms into a qualitative change.  The Mental Welfare Commission report referred to in my first email “A Home Of My Own” investigated homes of 20 or more residents with learning disabilities.  

These larger homes are of particular concern.   Particular issues of institutionalisation are likely to occur and even with active management it can be impossible to prevent.    Two of the large Lanarkshire care homes (40 & 26) that Glasgow City Council uses to place adults with learning disabilities are no longer able to accept new placements because of poor grades being judged as “weak” in performance by the Care Inspectorate.   The one large care home in Glasgow that is currently used by the Council for people with learning disabilities has only earlier this year left behind its 5 year record of “adequate” or “weak” performance. 

While many of the staff and people who worked in long stay hospitals were undoubtedly committed and caring like yourself, many others were not and the bigger the unit, the more the opportunity for abuse and neglect. 

At Ladysbridge Hospital which you refer to, serious concerns of ill treatment of patients with learning disabilities were raised by the Scottish Health Advisory Service in 2001.  They said that people with learning disabilities and some staff were afraid to report abuse at the hospital.  Twelve incidents were investigated during the 1999-2001 period and there may have been many more that didn’t come to light.  As a result of this NHS Grampian accelerated the closure programme at the hospital. 

But this isn’t just about abuse or neglect although these are more likely to happen in large services.   Institutionalisation is where the needs of the service are put ahead of the individual -  regimes are set for the smooth running of services rather than the needs of individuals.  The bigger the home, the more likely this is meant to happen. 

James is 66 and spent 30 years in Lennox Castle.  For the last 15 years he has lived in his own home and made his own choices.  But he still has nightmares about his treatment in the Castle.  Partly about the abuse he suffered but also just about the control that was exerted over his life – when he was allowed out, meals at set times, shared clothes, cups of tea premixed with milk and sugar.   Now at his next assessment, his carers will be asked to justify why he shouldn’t move into a care home, perhaps this new one.  Most people would accept that James has served his time already. 

The decision on the future of care for people like James lies in the hands of yourself and the other councillors of Glasgow City. 

Yours Sincerely

Ian Hood

 

Coordinator

Glasgow City Council Social Work Services are currently tendering for a new 20 bed Care Home for people with learning disabilities.

In Scotland we like to think of ourselves as being more forward thinking than the rest of the UK.  But in November, shocked that more people were entering institutional care than leaving it in England, Norman Lamb MP, the UK Minster for Care admitted on the radio that the problem is that local authority provision for people living in independently was falling behind. And he promised action to deal with it.  The money was there, he insisted.  

ITS NOT THE SAME IN SCOTLAND

Glasgow City Council is seeking "a discrete unit dedicated to the care and accommodation of 20 adults with learning disabilities, staffed on a 24 hour basis, within the geographical boundary of Glasgow. It will comprise living spaces including dining areas, communal areas, and individual bedrooms. It will also have access to outside garden space for residents. The unit will have its own identity, and at very least a door separating the unit from other resources.

"The unit will be staffed 24 hours per day and able to meet the needs of up to 20 individuals over the age of 18 years with Learning Disabilities whose needs are to a level of complexity that cannot be met within a mainstream elderly care home environment.”

The service has to be fully up and running  by 7th January 2015.

REAL CONCERNS

We are concerned because