The danger of knee-jerk closures of NHS units

Picture of John Sharich House, a brick one-storey building with flowerpots outside, with an NHS name plate to the leftA couple of weeks ago, a Care Quality Commission report was published that revealed that two NHS units for people with learning disabilities on the same site in Oxford were dreadful — they failed on every area of assessment, including the maintenance and quality of equipment and safeguarding of patients from danger and abuse (the full PDF is here) and “selected lowlights” can be read on a blog run by the mother of an autistic man who died there last July here. The young man, known as LB, was 18, was autistic and had epilepsy, and drowned in the bath while unsupervised, which people with epilepsy, let alone learning disabilities too, should never be (see earlier entry); the tragedy is mentioned briefly in the report. The unit has already been closed to new admissions and there are now rumours that the unit where LB died (the Short Term Assessment and Treatment Team [STATT] unit, but not neighbouring John Sharich House) is going to close, much as Winterbourne View did after their dreadful abuse of patients was revealed on national TV. (Update: the unit did close on 16th December.)

Closing a unit may seem like the easy response to this kind of scandal, but we should consider what happened to the people who were displaced when Winterbourne closed down. There is a shortage of suitable units where people need them; some people, including children, with severe needs related to autism in particular have to go to residential units sometimes hundreds of miles from home if there is no unit nearby (this was discussed on the BBC’s You and Yours programme on Friday, 13th Dec 2013). Going away to an unfamiliar institution that is full of strangers is frightening, as I know as this happened to me at age 12; for someone assessed as having a mental age of much less, it must be even more so (particularly if it happens several times). There is a young boy called Joshua Wills who comes from Cornwall, but is currently in a residential unit in Birmingham as there is nowhere nearer that can handle his needs; he has not seen his home or his whole family together for several months. Another family in Oxford saw their 16-year-old autistic son sent to a unit in East Anglia where he suffered abuse, as well as being given medication that made him unable to care for himself. In the case of Winterbourne View, some of the patients were able to return home but the young woman featured, named Simone, was subsequently moved to a unit in Norfolk where her parents (who live in Salisbury) cannot visit her as they are too infirm, so they can only speak on the phone.

Closing a unit down means that the people there have to go somewhere. Yes, some can go home, and some of them are only there to weather a crisis and to arrange support for them to live at home again (which is what LB’s family wanted for him). Some simply shouldn’t be in the unit in the first place. But others still need the intensive support that these units are meant to provide, and if they close the only NHS unit in Oxfordshire, they will have to go somewhere else. As LB’s mother Sara pointed out when I mentioned this on Twitter, “there won’t be the public scrutiny of the ongoing placement of STATT patients as there is for Winterbourne” as the media interest has been rather low-key and there is a misplaced but widely-held belief that things have changed a lot since Winterbourne. Surely it would be a better idea to open up a new unit, on the same site, with a new name and new staff, and put an outside agent in charge of initial hirings to make sure that only nurses and carers with impeccable histories work there. The people there have suffered enough already, having spent months in a rotten unit and experienced the death of a friend. They do not need a traumatic move far from home.

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