Lack of community care provision is making commissioners search for private beds

For many people with learning difficulties, the government’s
plan to close all long-stay NHS hospitals signalled the start of
life in the community.

Figures released last month by the Valuing People support team show
there are 350 people remaining in 14 long-stay hospitals, three of
which are due to close this month. The government wants all of them
to shut by next March.

But last November, then community care minister Stephen Ladyman
warned councils and health commissioners against
“reinventing” the long-stay hospital “by the
backdoor” by placing people in private sector institutions.
Now there is concern that the warning has not been heeded.

Last week private provider Care Principles said it was planning 70
new beds and that some patients had come from long-stay hospitals.
Another provider, Castlebeck, confirmed it was expanding
provision.

The news comes despite Department of Health guidance following
Ladyman’s warning, urging commissioners to provide services
“as far as possible in community rather than institutional
settings”.

So why are commissioners still failing to respond? Some draw a link
between the closure of hospitals and the expansion of private
institutions.

Professor Greg O’Brien, medical director at Northgate and
Prudhoe NHS Trust, Northumberland, blames a lack of alternative
provision.

He says primary care trusts have met their targets by closing their
long-stay beds, but are just buying more beds elsewhere.
“PCTs find it very hard to find alternatives.”

Simon Halstead, medical director of Care Principles, says that
although most long-stay hospitals have closed, some people’s
needs cannot be met in the community.

He says: “I reject the allegation that we are recreating old
institutions through the backdoor. We are providing for a group of
people who have been left behind and ignored.” He adds these
people are dangerous.

Others say it is difficult to plan community-based services for
these people because of volatility in numbers. Yvonne Cox, chief
executive of Oxfordshire Learning Disability NHS Trust, says:
“You could be planning for five people one year and none the
next.”

Cost has also been cited as a factor in commissioners’
decisions. One source quotes annual costs of about £200,000
for a private hospital bed compared with about £350,000 for
community provision. But the Learning Disability Taskforce’s
annual report, published this month, says big institutions and
long-stay hospitals “are not good value for
money”.

Rob Greig, director of the Valuing People support team, has less
sympathy for commissioners. He says: “The key issue for the
Valuing People programme is the skill and competence of local
commissioners in supporting those in the greatest
need.”

He also rejects Halstead’s view that those receiving
institutional care cannot be supported in the community.

Greig blames a “collective failure of services” for
inadequate planning, saying those needing occasional institutional
care are not given the resources and support to move back into the
community.

The Valuing People support team has identified poor access to
housing due to discrimination and a “lack of local
will” as barriers to moving people out of institutional
care.

But Halstead says: “If community care was good, the numbers
in institutions would not be so great.”

Cox says: “While the issue is beginning to hit the radar,
there is nothing around performance [accountability] that would
challenge commissioners to put a higher priority on community care.
They must start being proactive, not reactive.”