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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