Plans to return people with learning disabilities and ‘challenging behaviour’ home from Winterbourne View-style hospitals are being held back by a lack of pooled funding between health and social care.
This was the “biggest single area that requires support and development” in meeting the government’s target to end inappropriate hospital placements for this group by June 2014, said a stocktake of progress published last week.
The people concerned are typically funded by NHS commissioners in hospital settings, such as assessment and treatment units, but by moving back to their communities their needs, besides those for healthcare, would predominantly be met by local authorities.
The Department of Health’s review into Winterbourne View – which set the June 2014 target – said councils should not be financially disadvantaged by the process, adding: “The NHS should agree locally how any new burden on local authorities will be met, whether through a transfer of funding or as part of a pooled budget arrangement.”
However, the stocktake found “considerable concern” that many councils and NHS clinical commissioning groups had not yet developed a joint commissioning approach because of difficulties in pooling budgets or using resources flexibly. This had “an inevitable negative impact on progress across local programmes”.
The June 2014 target is the headline pledge in a raft of commitments signed up to by 51 national health or social care organisations in a concordat published last December to transform care for people with learning disabilities or autism and ‘challenging behaviour’. All people in NHS-funded hospital placements should have had their needs reviewed by June this year and a personal care plan for their future developed.
The stocktake was carried out by the Winterbourne View Joint Improvement Programme, set up with DH funding by the Local Government Association and NHS England to help commissioners deliver on the concordat. It was based on a self-assessment answered by councils and CCGs in every part of the country.
The stocktake found that 30% of areas had a pooled budget covering the Winterbourne client group, while in just under 40% of areas, funding contributions had been agreed from both councils and CCGs. In just over 60% of areas there was a shared understanding across councils and NHS partners of the total costs of current services.
Winterbourne SCR author warns Hunt
The situation has sparked concern from the adult safeguarding expert who wrote the serious case review into the abuse at Winterbourne. In a question to health secretary Jeremy Hunt at last week’s National Children and Adult Services Conference, Margaret Flynn said: “The biggest barrier to supporting people to move is the intention of NHS commissioners to cease funding them in the expectation that local authorities will pick up the bill.”
In response Hunt said: “I will take what you say on board and make sure this is understood by NHS commissioners.”
The situation is complicated by the fact that about half the relevant hospital placements are commissioned by specialist commissioners within NHS England and half by CCGs.
The stocktake found a “very mixed picture” about how far specialist commissioners were engaged in local planning of services for Winterbourne clients, with 40% of respondents saying that such planning was inclusive of specialists.
However, it added: “A number of places report either lack of clarity or continuing dialogue about the role and engagement of specialist commissioners and, in some places, very significant frustration about the lack of engagement – or reported lack of responsiveness – from specialist commissioning.”
A spokesperson for the joint improvement programme said it would be publishing good practice advice on financial planning next month to support commissioners to improve in this area.
“The issue isn’t necessarily about releasing a particular chunk of money from one part of the system but rather being clear about the ongoing responsibility of the NHS to fund community based care,” he added.
Action to support improvement
Overall, 57% of areas requested support from the joint improvement programme. It will offer bespoke packages of support to individual areas, and will also provide resources to regional local government and NHS networks to support improvement.
Some local areas will undergo a “deep dive”, in which programme staff will carry out an in-depth assessment of progress, either to identify good practice or to explore areas of concern, such as an area having significant numbers of challenging placements.
In addition, an enhanced quality assurance team, consisting of nurses and social workers, has been set up to review the cases of patients formerly placed at Winterbourne View, others in providers about which there are concerns and a sample of cases from around the country.
Joint improvement programme lead Chris Bull said the team’s role was to ensure that reviews of needs carried out already have taken into account “the totality of someone’s needs and identify a clear plan for that person’s future”. “It’s about checking back on the robustness of that process and, where appropriate, putting a bit of challenge into the system,” he added.
The stocktake also identified over 340 examples of good practice, which will now be analysed by the Social Care Institute for Excellence before being disseminated.
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