'This model of care has no place in the 21st century' 

The following is extracted from a message to TAC Bulletin from the Challenging Behaviour Foundation: 

As you may know the CQC has today published a report from a programme of 145 unannounced inspections and the Department of Health has published its interim report. Here we summarise these findings. 

Links to the full versions of all three reports can be found on the latest news page of our website: www.challengingbehaviour.org.uk 

CQC report

Today the CQC has published a report from a programme of 145 unannounced inspections. Almost half (48%) of the services inspected did not comply with the CQC standards, with moderate or major concerns. Only 24% of the services complied with the standards without any concerns, 28% complied with the standards but had minor concerns raised.  

IHAL report

The Improving Health and Lives (IHaL): Learning Disabilities Observatory has analysed data collected during the CQC review and produced a report. The report states that overall only one in seven of the residents in the 145 units were being supported in services compliant with both outcomes. Only 14% of people living in assessment and treatment units were in services that were fully compliant with both outcomes. 

The report highlights:

• the size of many of the services - the largest was supporting 97 people. Half of the units that were inspected were supporting 9 or more individuals and half of the individuals included in the inspection were living in services with 20 or more people. 
• the length of time people are spending in services. The majority (64%) of   assessment and treatment units were supporting at least one person who had been there for 3 years or more.
• that compliance with the CQC regulations does not necessarily indicate the presence of high quality care. It gives the example of an assessment and treatment unit which had five people living there for over seven years, and a further four people who had lived there for an average of four years with no discharge plans in place.

Emerson concludes "The disjunction between compliance and broader notions of quality in this, and other, instances may call into question the extent to which the current Regulations are fit for purpose for the inspection of Assessment and Treatment Units for people with learning disabilities." 

DH interim review

The Department of Health (DH) has published an interim report following the Panorama programme. The full report will be published after criminal proceedings and have been completed. The report is based on the CQC's inspection reports as well as information provided by people with learning disabilities, people with autism, family carers and various professionals and organisations. 

Although unable to cover what happened at Winterbourne View, the report highlights the fact that the health and care system isn't meeting the needs of people with learning disability or autism and behaviour which challenges. The report focusses on several initial findings from the review: 

• There are too many people with learning disabilities and behaviour perceived as challenging in assessment and treatment units and they are staying there for too long.
• This model of care has no place in the 21st century. People should have access to the support and services they need locally
• In too many services there is evidence of a poor quality of care, poor care planning, a lack of meaningful activities and an over-reliance on restraining people.
• The whole system has a role in improving standards of care and demonstrating zero tolerance of abuse. 

The report identifies 14 actions at a national level to drive good practice at a local level with the aim of more people being supported to live at home and far fewer people being sent away to hospitals. 

Links to the full versions of all three reports can be found on the latest news page of our website: www.challengingbehaviour.org.uk

'The findings were very positive, and showed that staff's attitudes had improved and that they had better empathy'  

Who's Challenging Who? is an 18 month knowledge transfer partnership developed in Wales between Mencap Cymru and Bangor University.  The project aims to improve learning disability services by helping social care staff develop positive attitudes towards challenging behaviour, and improve how they empathise with the people they support. 

Over the past months, volunteers Martin Banks and Claire Bowler (both of whom have displayed challenging behaviour in the past) helped project manager Lisa Hutchinson deliver 10 half-day pilot sessions to a total of 76 social care staff from a number of organisations. 

The content of WCW has been informed by findings from the academic literature (i.e. the perspectives of adult service users with challenging behaviour about the services they receive and perceptions of family carers), as well as Martin and Claire's own experiences.  The sessions measured attitudes and empathy by asking a series of questions at the beginning of the training, and the same questions at the end to see if there was any difference.  

The findings were very positive, and showed that staff's attitudes had improved and that they had better empathy.  Encouragingly, over 75% said that they thought training in this area was a good use of their time, and the same number said that they would apply what they learned to their job.  

Who's Challenging Who? will be developed over the coming months by Mencap with the hope of delivering it across the UK.  A conference was also organised by the project team in June to discuss the research findings, and give delegates the chance to discuss the themes.  Another conference will take place in Chester in September.

For more information please email This email address is being protected from spambots. You need JavaScript enabled to view it. or call 02920 747 588.

Both by Peter Limbrick, the originator of the TAC System for joint working. Both published for Kindle in 2012.

1. An Introduction to Keyworking and TAC in the Horizontal Landscape: Joint working in support of children and adults in need 

This essay is offered as an introduction to the multiagency keyworking model and the TAC System – and to their place in the horizontal landscape for service users of any age who require support from two or more agencies or services in the same time period. Readers are invited to relate its content to the needs and situations of the service users (babies, children, teenagers, adults or old people) they meet in their work or to categories of service users they belong to themselves or represent in some way.  

The appeal, and the solutions offered, are for improved joint working to remedy the great dangers of chaos and fragmentation that happen so commonly when agencies and the people working in them fail to co-ordinate and collaborate with each other. 

2. TAC for the 21st Century: Nine essays on Team Around the Child

The TAC system, accepted as good practice in several countries, offers opportunities to radically re-appraise how practitioners use time and resources in pursuit of effective support for the increasing population of infants who have multifaceted conditions and disabilities. TAC for the 21st Century will inform and inspire managers, practitioners and families in the struggle to match limited resources to increasing needs.   

The nine TAC essays show the evolution of TAC philosophy from its foundation in the early 2000s. TAC began as a straightforward approach to multidisciplinary joint working and has become the vehicle for genuine child and family-centred support.

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