The Scottish Government’s Coming Home report, looking into the practice of placing people with learning disabilities and complex needs in homes out of their local area, often in “multi-bed” institutions or hospitals, found: “It is clear that the experience of people with learning disabilities being unable to receive support to live within their communities … is a denigration of their human rights.”
The report, by Dr Anne MacDonald, found that 705 people are being cared for away from their local area, potentially hundreds of miles from family and friends. More than half did not choose to be moved away. In the wake of the Scottish Government’s 2019/20 Budget, we need to consider how we invest in a health and social care system that supports our most vulnerable citizens.
In Scotland, the Government has long supported the hard-won rights of people with learning disabilities to live in their own home, in the community of their choice, supported by the people they choose, to live the life that they choose.
ENABLE Scotland, as the country’s largest charity fighting for the rights of people who have learning disabilities, has led the fight for these rights for 65 years.
The Coming Home report identified 109 people who need to be brought home as a priority but they are still supported away from home at a total cost of £16 million.
In fact, 15 people have been awaiting discharge from hospital for more than 10 years. That’s because our social care system is not yet always working well to accommodate their needs, either short or long-term.
It is vital that we resist any temptation to revert to building more multi-bed, residential units. This is not the answer to the challenges identified in Coming Home.
That would be a significant setback not only to the individuals themselves, but also to decades of campaigning and societal progress. Instead, we need collectively to look at how we can deliver a strategic response at an integrated health, social care and housing level to enable people to come home and receive excellent quality, personalised support.
One reason so many remain in unsuitable placements is because, quite simply, we don’t have enough adequately equipped, good quality homes to accommodate their needs and we have not considered developing this as part of local housing strategies or the commissioning of social care.
However, bricks and mortar alone won’t solve the problem. We need to see improved partnership working across the sector, linking commissioning of social care services with housing plans locally, especially around crisis planning, and possibly considering regional commissioning.
We need to ensure that, when people face a crisis, they have access to relevant services at the time of need, in their local area. There is a role for flexible support, to be used when the system is experiencing significant strain.
Of course, a well-trained and motivated workforce underpins all of this and how we reward and recognise it is a critical part of the strategic response to the challenges raised by this report.
It identifies that moving people with learning disabilities and complex needs out of their local area, away from everything they know, is a human rights issue.
As we work to welcome them home urgently, we need to ensure we have our house in order by delivering reform in the health and social care sector to ensure that it is fit for purpose and supports all who rely on it to live the lives they choose – and not the lives the system chooses for them.
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