Central to the progress called for in the Department of Health plan for the next three years will be new, high-quality, community-based services. Hundreds of people with a learning disability and/or autism are expected to benefit from new, better care options in the community instead of hospitals, with more never being admitted in the first place.
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The plan predicts that, as these services are put in place, there will be a reduction of up to 50% in the number of inpatient beds, meaning that some units will close altogether.
Simon Stevens, chief executive of NHS England, who helped design the plans, said: “As good and necessary as some inpatient care can be, people with learning disabilities are clear they want to live in homes, not hospitals. We’ve seen some progress over the last few years, but now is the moment to grasp the nettle and build the excellent community-based support that will allow people to move out of hospitals."
Building the right support: A national implementation plan to develop community services and close inpatient facilities was produced by NHS England alongside the Local Government Association (LGA) and the Association of Directors of Adult Social Services (ADASS). The plans it contains have been developed with significant contribution and constructive challenge from people with learning disabilities and/or autism, their families and carers, and a range of commissioners, providers, voluntary sector and representative groups.
It represents a key milestone in the ongoing cross-system transforming care programme, which has seen a number of reforms including the roll out of Care and Treatment Reviews and an upcoming consultation response on strengthening the rights of individuals.
Meeting specific needs of people with learning disabilities
While local areas will be able to design bespoke services with those who use them, the plan sets out the need for:
• local housing that meets the specific needs of this group of people, such as schemes where people have their own home but ready access to on-site support staff;
• a rapid and ambitious expansion of the use of personal budgets, enabling people and their families to plan their own care, beyond those who already have a legal right to them;
• people to have access to a local care and support navigator or key worker, and;
• investment in advocacy services run by local charities and voluntary organisations so that people and their families can access independent support and advice.
To achieve the shift from inpatient to community-based services, Building the right support sets out three key changes:
• Local councils and NHS bodies will join together to deliver better and more co-ordinated services - 49 new local Transforming Care Partnerships will work with people with lived experience of these services, families, carers and key local stakeholders to agree robust implementation plans by April 2016, and then deliver on them over three years. They will be made up of clinical commissioning groups, NHS England’s specialised commissioners and local authorities, and will cover the whole of England
• Budgets will be shared between the NHS and local councils to ensure the right care is provided in the right place – A new financial framework will aim to speed up discharges, particularly for those who have been in inpatient care the longest, and make better use of resources so that services can be increased and improved. Central to the new framework will be the opportunity for local pooled budgets which encourage better use of resources for all people in a local area with learning disabilities and/or autism
• Funding guidance will also be reformed to enable swift discharges. For people who have been in hospital five years or more, specific payments will be made by the NHS to local authorities to enable their needs to be met in the community.
• National guidelines will set out what support people and families can expect, wherever they live – A new Service Model describes what good services should look like, framed around nine principles from the perspective of the people using them. It gives people a clear picture of what they can expect from the services they use, while at the same time allowing partnerships the flexibility to design and commission services that meet the needs of people in their area. The new model, which was co-produced by people using services, commissioners and health and social care system leaders, has been finalised using the feedback from early implementation by six ‘fast track’ areas.
NAS welcome plan but raise concerns
Commenting on the plans Mark Lever, Chief Executive of the National Autistic Society (NAS), said: "Following the abuse uncovered at Winterbourne View, the Government and NHS have been working to move people out of inappropriate in-patient units. But this has not happened fast enough.
"We therefore welcome this promising plan which provides guidance to local areas on how to develop suitable community provision that should enable up to 50% of inpatient beds in England to close in the next three years. We are also encouraged that NHS England has made £45 million available to support this transition.
"Now, it's for local authorities and the NHS in each of these areas to come together to put these plans into action. Success in practice will depend on commissioners setting up new community-based support, without which inpatient beds won't be able to close. It will also rely on NHS England making sure that the plan is being followed by local areas and to holding them to account if it's not. But we believe the progress measures set out by NHS England will need further development to meet this challenge and ensure that individuals' experiences and care improve as inpatient beds decrease.
"Where possible people with autism should be supported within communities of their choosing, not stuck in inappropriate care away from loved ones. This plan is an opportunity to make this a reality, but this can only happen with careful implementation by local areas and strong oversight from NHS England."