‘Lack of action’ on moving people out of Winterbourne-style institutions cannot continue, warns Lamb

‘The lack of action’ on moving people with learning disabilities or autism out of hospitals into community-based care cannot continue, care minister Norman Lamb has warned after NHS England figures exposed the lack of progress.

Despite a government target to move all patients placed inappropriately in hospitals into community settings by 1 June 2014, as part of its response to Winterbourne View, just 7% were due to move before this date, according to NHS England.

And though the figures date from 31 December 2013, the head of the programme charged with supporting commissioners to make the changes, Bill Mumford, said there was likely not to have been much change between then and now.

Data submitted by 169 of the 211 clinical commissioning groups and the ten NHS England specialised commissioning teams identified 2,577 relevant patients with learning disabilities or autism and additional mental health problem, in hospitals as of 31 December 2013. Of these, 260 were due to transfer out of inpatient care, and 172 had a transfer date before 1 June.

Of the others, 1932 did not have a transfer date and, for the remaining 385, an inexact response was provided by commissioners to NHS England about their transfer plans. The biggest reason for the lack of a transfer date – in 1108 cases – was a clinical decision.

‘Lack of action cannot continue’ – Lamb

Lamb, who has made the programme a personal priority, said: “I realise that for some people, doctors have decided that the best thing for them is to stay where they are and for some who are subject to Ministry of Justice restrictions [relating to criminal justice], it would be inappropriate to move. Making sure the right care is provided is a complex process.
“However, assessment, care plans and transfer dates are key and it’s taking some commissioners too long to do them. This lack of action cannot continue.”

“What we have is extremely disappointing,” said Mumford, director of the Department of Health-funded Winterbourne View Joint Improvement Programme (WVJIP), in a blog published yesterday. “In summary we are we faced with a significant failing in the discharge planning for June and, perhaps more importantly, the returns raise a major question as to whether we will make significant progress in reducing reliance on in-patient care beyond June.”

NHS England has been asked to produce these figures on a quarterly basis to enable the WVJIP and the Department of Health to track progress against their objectives. Mumford, who said this month said some commissioners were ‘complacent’ about making progress on this issue, said he was “realistic” that there is unlikely to have been significant progress between December and March.

The data also showed that:

• More patients (247) were admitted to inpatient settings than transferred out of them (124) from October to December 2013;
• Over a quarter of patients were not recorded as being on a register of people with learning disabilities or autism and mental health conditions in NHS-funded care, despite the NHS having had to have developed registers covering this population by April 2013;
• More positively, 2315 of the patients (90%) had a care co-ordinator and 2408 (93%) had access to independent advocacy.

Progress slowest in secure settings

The lack of progress was greatest for placements commissioned by specialised NHS England commissioners, which tend to be in secure settings, rather than those purchased by local CCGs. Just 31 people of the 1407 patients whose placements were commissioned by NHS England had a transfer date. While some of this group are in medium and high secure settings and are prevented from leaving by a court order, most were in low secure settings.

“This is despite a generally accepted understanding that there are likely to be high numbers of people currently in low secure settings who could safely be discharged to appropriate community settings,” said Mumford, whose programme is governed by NHS England and the Local Government Association.

In response to the figures, Lamb said he had asked NHS England to develop “a clear plan to move things forward quickly, and to look closely at individual cases to make sure we make the best decision for everyone”. This was welcomed by Mumford.

As part of this, NHS England said it would establish, for those without a transfer date, those who could move to community-based settings and those for whom the complexity of their needs meant they would need to stay in inpatient care.

Moving to community-based care ‘can take several months’

However, in a statement, it added: “Where it is agreed that a person should move into the community, it can take several months to find the right accommodation and ensure all the necessary arrangements are in place to support them.

“For example, patients sometimes require a period of assimilation, with transition to the community phased over a period of months. In addition generic and specialist community based support needs to be in place to support individuals. Commissioners may not be able to set a transfer date until these issues have been resolved.”

There are an estimated 3,200 relevant patients in England, and the difference between this and the 2,577 published by NHS England appears is accounted for by the lack of data from 42 CCGs in this week’s figures.