Coming Home Implementation: report from the Working Group on Complex Care and Delayed Discharge

2. Underpinning Principles

All of the recommendations in this report are based upon the foundation that people with learning disabilities have the same human rights and should have the same opportunities as anyone else to live satisfying and valued lives and to be treated with the same dignity and respect. This by definition is irrespective of any complex care need or behaviour that challenges, either present or historic. Everyone living in Scotland has a right to a home within their local community, to be able to develop and maintain relationships, and to get the support they need to live a healthy, safe and fulfilling life.

Being placed in an inappropriate out-of-area placement, in a poor-quality institutional setting, or being admitted to hospital for an inappropriate reason (e.g. due to behaviour that challenges) is an excessive restriction on liberty and the right to home life.

The core commitment made here is a zero-tolerance approach to inappropriate placements for people with learning disabilities.

This report recognises that although progress has been made in many local areas, more could be done to prevent delayed discharge and inappropriate out-of-area placements for people with learning disabilities. Many people with learning disabilities continue to be failed by the current system, and for people with complex care needs these failures often begin early in life, with a lack of early intervention and minimal support around communication needs or behavioural challenges.

The framework outlined in this report is an indication of the fact that change is required for people with learning disabilities and complex support needs. The range of reports written on this issue, the concerns raised over many years about inappropriate and institutional placements, and a number of scandals in relation to the treatment of people with learning disabilities in institutions, provide a wealth of evidence to support the need for change and for additional mechanisms to achieve it.

A Well-being model, based on GIRFEC:
for physical, social, educational, emotional, spiritual and psychological lifelong development

How I grow and develop

• Communicting/being understood
• Participating in community life
• Learning to be responsible
• Enjoying family and friends
• Confidence in who I am
• Lifelong learning
• Being healthy

What I need from the people who look after me

• Understanding my family’s history, culture, beliefs
• Knowing what is going to happen and when, to reassure me
• Play, fun, encouragement, exercise
• Bering there for me: commitment
• Understanding my language
• Support to make good choices
• Everyday expert care & help
• Keeping me safe

My wider world

• Support from family, friends, wider community
• Comfortable, suitable housing
  
• Belonging
• Committed, skilled carers
• Enough money
• Local resources