The number of people with learning disabilities living in institutions, who have a defined date to move back into the community, is still shockingly low – and that has to change.
NHS figures published last week revealed that of the 2,577 people with learning disabilities in in-patient hospital settings, only 260 have a transfer date to move back into the community. Of those, only 172 are set to move before June 1. Those statistics were saddening, but not a great surprise.
They were saddening because they means there are still more than 2,000 people stuck indefinitely in assessment and treatment centres, commonly miles away from their family and community, who often receive neither assessment nor treatment while resident.
But not surprising, since, from what I had heard from those on the ground, moving people back into the community was taking longer than expected, for a variety of reasons. These include the difficulty in finding appropriate placements in the community, and ‘clinical decisions’ keeping people in assessment and treatment centres – the NHS figures said that in more than 1,000 cases this was the reason for no transfer date being set.
After the Winterbourne View inquiry, NHS England agreed to “review all current hospital placements and support everyone inappropriately placed in hospital to move to community-based support as quickly as possible, and no later than 1 June 2014.” But it appears that NHS England is nowhere close to meeting that deadline.
Bill Mumford, who is now leading the Winterbourne View Joint Improvement Partnership (WVJIP), admitted as much in a blog, saying: “we are we faced with a significant failing in the discharge planning for June and, perhaps more importantly, the [NHS figures] raise a major question as to whether we will make significant progress in reducing reliance on in-patient care beyond June.”
Following the release of the NHS figures, Mencap and the Challenging Behaviour Foundation called for an urgent independent review of relevant clinical decisions, saying these are often made through the lack of a thorough understanding of learning disability and behaviour that challenges, and also a lack of confidence among professionals that the right services exist in local areas to support the people concerned.
This is a sensible call and could certainly help to quicken the pace at which people are moved back into the community, enabling a date to be set for a move, or, if not, finding the reasons why a person cannot transfer to the community, and then addressing them.
While this is a hugely complex area, there is no doubt that the pace of change has to quicken. I’m not advocating speed for the sake of it – which could lead to greater problems if someone is moved to a community setting that isn’t appropriate or can’t cope with the person’s needs – but the current rate of progress is unacceptable, especially given the commitments made after the Winterbourne View inquiry.
However, there are encouraging signs that things are starting to move in the right direction. Since Mumford took charge of the WVJIP earlier this year, he has been actively trying to re-energise the programme, and speed the pace of change.
NHS England has also committed to the development of a new and comprehensive action plan, which is being designed to help accelerate progress and set out a vision for future provision. While this is a good thing, you do have to ask why its previous plans didn’t work, and what will make this one different (i.e. successful).
But as Mumford cautioned, we have to be realistic – change isn’t going to happen overnight: “We always knew the job was not easy or quick; and far from making us give up, this needs a response which causes all to keep working even more collaboratively together and with renewed determination.”
He’s right, but now progress has to be seen on the ground. The NHS figures are now to be published every 3 months and the entire sector will be scrutinising the next sets, and will expect a marked decline in the numbers inappropriately placed in hospital. I’m hopeful that things will improve, because the current situation just cannot continue.