‘Life-saving’ council service for adults with learning disabilities facing cut
Illustration: Sophia Checkley
“My sister was in freefall, and close to the end of her life. Without Concord Lodge to move to, I don’t know what would have happened to her.”
In 2021, Mary’s* sister’s mental and physical health had deteriorated after years in another Bristol care home that wasn’t meeting her needs. But then she was given a lifeline, a transfer to Concord Lodge, a council-run assessment centre for up to seven vulnerable adults in Horfield.
“When I say that her current placement at Concord Lodge has saved her life, it is no exaggeration,” Maria says.
But Bristol City Council is now considering cutting the service and outsourcing it to another provider in order to save £450,000 a year. Vulnerable people who would have gone to Concord Lodge would instead be supported by other council-commissioned services that cost less to run. The public consultation on the plans closed last week, with a final decision expected in the next few months.
The planned cuts to this service come two years after an independent report exposed a series of “shocking” failings in caring for vulnerable people with autism and learning disabilities in Bristol. At the time, the council accepted the findings and committed to action on recommendations by Sir Stephen Bubb, who previously called for change following the 2011 Winterbourne View care home abuse scandal.
And the wider context is that across the country adults with learning disabilities are ending up in hospital when they shouldn’t be. A recent review by NHS England of the care of almost 2,000 patients with learning disabilities and autism found many are still being detained in hospitals because there is nowhere else to go, and developing serious health problems due to poor diet and lack of exercise. The review was prompted by the death of three patients at a private hospital in Norfolk, just one of a number of similar scandals across the country.
How Concord Lodge made all the difference
After years in a Bristol care home, Maria says her sister’s wellbeing reached crisis point.
“She got iller and iller, more and more angry and then more and more medicated and then more and more docile,” Maria says. “After Covid she was in a state of total collapse. She was trying to kill herself by walking in front of cars.”
After going in and out of hospital, it was decided that she should be transferred to Concord Lodge. Maria says that this followed years of raising concerns about her sister’s care and feeling ignored, but the transfer was handled very skillfully: “When she first arrived, she just kept saying, thank God. I’m never going back to that place ever again.”
“Concord Lodge is specifically built to give people who have had a really rough ride and can only express themselves through really difficult behaviour,” Maria says. “It gives them a calm oasis of space for recovery and assessment in that process.”
It just strikes me as deeply wrong that Concord Lodge and what they do is not being recognised
Maria says that individual apartments for patients, personalised support from skilled staff and the healthier food provided have been transformational in improving her sister’s physical and mental health.
“She can’t harm herself. She’s in a very safe space,” she says. “The staff have got specialist training and understanding in how to hold boundaries.
“She has become my sister again. She’s gone from somebody at death’s door, very withdrawn… And now she is self-assured, quietly confident. She’s looking healthy. And she sleeps in her own bed.”
Typically, people stay in Concord Lodge for 24 to 36 weeks. Although it has taken longer to get her sister to that point, she is now ready to move onto a long-term placement that will meet her needs.
‘Staff working under a cloud of uncertainty’
As well as the impact on service users, cutting the council-run service will also affect the 40 or so staff who work at Concord Lodge, with no obvious replacement for the service.
“It’s a nightmare for the poor staff, who are extremely dedicated,” says Maria. “Of course, they’re doing their best not to give anything away, and to give their usual fantastic support to their residents. But they’re working under a cloud of uncertainty…”
A spokesperson from Bristol UNISON, who has members among the current staff, told the Cable: “The consequence will be the loss of a valuable service both for the adults using the service and their families and carers, together with the loss of 40 plus jobs. The skilled workers will be made redundant with the subsequent loss of expertise and experience. There are no plans to replace the service.”
“The result is the further reliance on the private sector who are focussed on profit and paying minimum wages.”
In the last year, the council has also closed two rehab centres in South and East Bristol to save money, which meant around 50 staff had to be made redundant or redeployed to new providers. The council said lessons were learnt after coming under fire from unions and opposition councillors for how they dealt with employees at South Bristol Rehab Centre before it shut last summer.
Jeff Sutton, the secretary of the local GMB branch, said Concord Lodge fits the pattern of these rehab centre closures. “Despite promises, staff are being shoehorned into jobs they don’t want in order to not pay them redundancy. Many have had years of service with the council, and have been through this a few times before.”
“The GMB, like its fellow unions, is working closely with its members to get them the best deal possible and also to see what can be salvaged for the clients who will be displaced,” he said.
“This is another example of Bristol City Council letting go of services it doesn’t have a statutory need to run but rather a moral one.”
Adults with learning disabilities still being locked up
Before Maria’s sister went to Concord Lodge, it was possible that she would go into a secure unit in a psychiatric hospital.
For years, examples have been exposed of adults with learning disabilities and autism being locked up in these settings. The government has acknowledged the need for change and pledged to halve the number of people with a learning disability and/or autistic people in mental health hospitals by March 2024.
But there are still around 2,000 patients in these hospitals, and analysis from disability charity Mencap revealed the government will miss their target by at least four years at the current rate of change.
Dan Scorer, head of policy and public affairs at Mencap, said: “For more than a decade, the government has repeatedly promised to ‘transform care’ for people with a learning disability and autistic people only to leave them languishing in mental health hospitals at increased risk of abuse and neglect because of a lack of the right social care support in the community.
“We’re calling on the government to urgently review their plan, which, considering our analysis, shows how worryingly off-target they are.”
The recent review by NHS England into the care of people with a learning disability and inpatient units revealed that 41% of patients assessed in 2022 could be supported in the community if appropriate support was in place.
What will happen next?
The Cable asked Bristol City Council for their response to Maria’s claims that they were cutting a life-saving service that could prevent vulnerable adults from ending up in inappropriate placements in psychiatric hospitals, as well as when the final decision would be made about Concord Lodge and what service would replace it.
A council spokesperson said: “We are now in the process of looking at how the necessary savings will be delivered alongside ensuring appropriate ongoing provision of this type of care and support.
“Concord Lodge provides accommodation for seven adults and there are high costs associated with operating such a small facility, of which staffing is the largest. We already commission this type of support from a range of different providers for most individuals who need it, and the average cost of the alternative provision is lower without any compromise to safe or adequate staffing levels.
“Our aim is to continue delivering care and support, which meets the needs of people who currently use Concord Lodge, whilst exploring alternative delivery models and in doing so reduce the costs to the council.”
We also asked what action is being taken in response to the recommendations by Stephen Bubb as part of the Building Rights report in 2021, but the council did not answer.
For Maria, she hopes her sister can thrive at her next placement, when an appropriate long-term setting has been found. But she worries about other vulnerable people in crisis not being able to access Concord Lodge in future.
“It just strikes me as deeply wrong that Concord Lodge and what they do is not being recognised,” she says.
“Why is our council not fighting for something more meaningful and more humane? Why do we just parcel things out to large companies as if the corporate world has the answers?”
*Not her real name
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