It’s unlikely that embryonic clinical commissioning groups are thinking about the needs of people with learning disabilities.
It’s a safe bet that other priorities are way ahead on the agenda: getting CCG members to talk to each other, working out where they are going to get commissioning support and how they can pay for it, casting spells to turn GPs into leaders, that sort of thing.
But commissioning care for people with learning disabilities is one of about a million things that could catch clinical leaders with their corduroys down if they’re not careful.
Remember Winterbourne View? You may have seen it on Panorama becoming another one of those things that must never happen again.
Minimising the chances of a repeat of these depressing events is not just a regulatory issue but a commissioning one. Some of the people in the “care” home should never have been there in the first place and would not have been if adequate local services had been available.
The investment in more suitable local provision would be modest and the savings more than enough to pay for it.
It cost £3500 a week to keep an individual at Winterbourne. On the basis of that figure alone it would be hard not to make a business case for better accommodation.
But will business cases like this be made? The numbers of people involved are relatively small and viewed from the perspective of a local GP or commissioner may not appear terribly significant. One of the drawbacks of scaling down commissioning units is the loss of the bigger picture. A couple of people on the practice list, a few tens at CCG level maybe. That’s where the business case starts to fall apart.
Examples like this will test the ability of CCGs to scale up on their own account, and work together on a risk sharing basis to provide services it may be uneconomic or otherwise impractical to commission individually.
Given where most of them are today, it is difficult to believe that these thoughts will appear on the radar any time soon.
Of course, until the NHS Commissioning Board is running at full steam, we don’t even know where decisions like this will sit. Commissioning for people with learning disabilities falls into the too difficult zone between the CCGs, the board and the local authority along with children’s services and others.
So it may not turn out to be a problem for CCGs. But until the gap between the commissioning board and local commissioners is closed, it will be nobody’s job to consider these issues until another one of the things that must never happen again happens again.
Before angry commissioners write in to rail against the hopeless oversimplification of articles like this, there is another cost to consider. It is not just the damage to the reputations of the NHS, local authorities, regulators and the individual managers who find themselves in the firing line when things go wrong. Nor is it the much more serious damage to the individuals who find themselves, through no fault of their own, in the wrong kind of care.
Low level commissioning issues that turn into high profile news stories have an unpleasant effect on politicians, turning mild mannered ministers into bloodthirsty vigilantes.
They also result in endless rounds of reviews and enquiries and reports and recommendations, the cost of which runs into millions of pounds – money that could have been invested in avoiding the problem in the first place.
Thanks to Moley for their contribution LGF