Fines for providers and right to care reviews among latest post-Winterbourne View reforms

NHS-commissioned learning disability providers could be fined for failing to implement a new set of national standards being developed to help cut the number of inappropriate inpatient placements.

The proposal is one of a set of measures to ‘transform’ learning disability care post-Winterbourne View set out in a report by the government, NHS England and council leaders.

The report also commits to giving every person with a learning disability or autism and their families the right to request an independent review of inpatient placements and says that the government will consider several changes to the law to strengthen the rights of people with learning disabilities. Details on law reform are likely to be set out in a green paper that care minister Norman Lamb has promised will appear before the general election in May.

Past failures

The plans were published as new figures from the second annual learning disability census highlighted the poor progress in reducing the use of inpatient units. The census found that 3,230 people with learning disabilities or autism were in inpatient settings on 30 September 2014, compared to 3,250 inpatients in 2013. The average length of stay was 547 days in 2014, compared to 542 days in 2013. The government failed to meet its target to end inappropriate use of such placements by June 2014 – its key response to the Winterbourne View scandal.

Today’s report is the latest attempt to address that failure and is the official response to recommendations published last November by a steering group commissioned by NHS England and headed up by Sir Stephen Bubb, the chief executive of the Association of Chief Executives of Voluntary Organisations.

The new plans

Key plans announced today include:

• National standards for admission and discharge will be introduced in April 2015 after being written into NHS England’s standard contract to be used by local commissioners;
• A consultation on the standards will be launched shortly and are likely to place two key demands on services: that they use a robust ‘admissions gateway’ being developed and piloted by NHS England to ensure hospital admission is only used as a last resort; and that discharge plans are in place from the point of admission;
• Compliance with the standards will be closely monitored in 2015-16 and NHS England will consider introducing ‘financial sanctions’ linked to them from April 2016;
• NHS England plans to give people with learning disabilities and/or autism and their families the right to request a ‘care and treatment review’ from independent experts. The reviews will involve a clinician, an expert by experience and the responsible commissioners;
• The plan to introduce the right for review is based on NHS England’s verdict that they are an ‘effective lever for change’. The agency has used the process to review more than 1,000 long-stay patients as part of a targeted programme in recent months. By mid-January, 566 of the patients reviewed had been discharged;
• A taskforce will be deployed to focus specifically on services in the north of England, where progress in cutting hospital placements has been poorest;
• A study will be conducted into the feasibility of Bubb’s call for a social investment fund to develop community services as alternatives to inpatient units.
• Delivery of the changes will be led by a board chaired by NHS England. The board’s deputy chair will come from the Association of Directors of Adult Services.

Reaction

Bubb’s report had recommended that NHS England set out a closure programme for ‘inappropriate’ units. However, today’s report stops short of a firm commitment on closures and says that there are cases where “admission will be necessary in some cases – including, in the immediate term, where there is currently an absence of the required community-based services.”

In response, Mark Lever, chief executive of the National Autistic Society, said that the right to challenge placements was a positive step but warned that reforms to funding and commissioning systems were badly needed.

“We won’t see real change until community providers, local clinicians and in-patient services are enabled to work effectively together to ensure there is properly supported and timely transition between in-patient and community care. While the report includes proposals to address this, the challenge of getting funding and commissioning structures right needs to be tackled with increased urgency and a readiness to make radical changes,” he said.

“Norman Lamb hopes to set out proposals shortly. Whoever forms the next government must, as a priority, take up the complex challenge of getting the right legislation and practice in place to prevent vulnerable people from being marooned in inappropriate services.”