I experienced something last night that felt very surreal indeed – I was sat in my second rush-hour related nightmare of the day and bored. I hadn’t heard proper news for some while so flicked off the music and put the radio on. To be honest, the intention was to escape into other people’s reality but I immediately found myself listening to news about the NHS England commissioned report into learning disabilities care. For those who are not aware, in 2012 the ‘Winterbourne View Review: Concordat Programme of Action‘ was published in which a whole host of organisations, including ACPO on behalf of the police service, committed to a range of things around Learning Disabilities and the report yesterday basically said that those organisations had collectively failed to deliver any real change.
After the broadcast piece, there was an interview with Norman LAMB MP, Minister of State for Care and Support. He informed the listeners how disappointed he was that despite signatory agencies to the Concordat committing to change, none had happened. Of course, if you listened to the news yesterday you will also notice that the Prime Minister made pronouncements about how important it was for more care to delivered in homes and in people’s own communities, after highlighting instances of people being afforded care hundreds of miles away from their families.
I don’t want to gloss over the issue of learning disabilities or the disgusting crimes that ocurred in places like Winterbourne View – these are important matters and when one hears the campaigns like ‘Justice for LB‘ and others, we can see the clear importance of these issues – but my here is not about learning disabilities or institutional care: it is about Concordats. The irony of this report is that it was published on the day immediately prior to the National Crisis Care Concordat Summit in London – I’m writing this on the train on the way to the event where I get to speak for ten minutes about what the College of Policing are contributing to this work and running a workshop and training. But listening to Norman LAMB talking yesterday, I couldn’t help but think it was a somewhat surreal foreshadowing of what we might hear if we’re not careful in 2016 after two years of talk and action plans.
The word concordat comes from the Latin, concordatum or ‘something agreed upon’. Therein lies one of the problems: it probably remains true that whatever the signatories to the 2012 concordat agreed upon, they still agree upon it. Agreeing on something that needs to happen doesn’t mean that anything changes in the real world. It is against this background that Norman LAMB stated that there will be a green paper on institutionalised care for people with learning disabilities in 2015 and that it may be necessary to legislate. This is the point where my irony-meter hit critical levels: because suggestions that on some issues we should legislate to give effect to change have previously been rejected on issues under active examination in the Crisis Care Concordat. For example, we could legislate to remove the words ‘police station’ from s135(6) of the Mental Health Act 1983, thereby making it illegal to use such places as a place of safety. Indeed, this proposal was put forward to Parliament in 2013 in a back-bench motion involving Paul BURSTOW MP, Mr LAMB’s predecessor as Minister of State. Despite suggesting a lead in time of 2017 for that legislative amendment taking effect, the proposal was rejected, in part because other methods of achieving this were preferred. Yet we have thirty years of history to show how hard this has been and there are various reasons to suspect that a lot of this stuff is too difficult for many to properly contemplate.
In recent years, whilst overall use of police custody as a place of safety has fallen, in some areas it has risen as place of safety services have been closed for one reason or another. In Cornwall, although a service has not been permanently cut, the mental health trust has transferred all PoS detentions to police custody after a mental health unit was temporarily closed for fire safety reasons. So paragraph 10.22 of the Mental Health Act Code of Practice and the implications of the Civil Contingencies Act 2005 don’t seem to apply there. (For clarity, the CCA does not apply to mental health trusts, but NHS England has told them to act as if it does. So where is the contingency that avoids the need for deliberate violation of the Code of Practice for these vulnerable people?
There is no reason at all why the Mental Health Crisis Care Concordat cannot succeed as a vehicle for driving proper change, but we always new the risks around this and why it therefore needs to be properly led: you can ‘go green’ on the Concordat without actually doing anything and whilst developing a local action plan which is basically a wish list if our broader crisis system won the lottery. That’s why I’ve argued for another colour to be introduced to the map of England on the Mind CCC website: we need blue for ‘deliver our action plan’ and a deadline by which to ‘go blue’. So ahead of a National Summit at which we find ourselves ten months into a process that finds some areas unable to yet agree on the very hypothetical task of delivering on the principles of the Concordat which would mean they can ‘go yellow’, we should refocus and double our efforts because some people are worrying that this time next year, we will have areas struggling to ‘go green’ and by then we’ll be nearly two years into a process that has lasted as long as the 2012 Learning Disabilities Concordat. Just to focus everybody’s attention on the importance: history suggests that by the time of next year’s summit, two people will have died in police custody / contact following the use of section 136 MHA and a further half-dozen people in police custody after arrests for alleged offences. That we progress some of the most complex issues is, literally, a matter of life and death for some people to whom we ALL owe a duty of care.
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