Learning disability units to close in £45m plan to shift care into community

The NHS will close up to half its hospital beds for people with learning disabilities or autism, under plans drawn up in response to the Winterbourne View scandal.

Around 2,600 people with learning disabilities remain in hospital. That number will be cut by between 30% and 50% by April 2019, and community support options expanded, under a national plan to modernise care published today by NHS England, the Association of Directors of Adult Social Services and the Local Government Association (LGA).

England’s only remaining specialist learning disability hospital, Calderstones, will also be closed as part of the changes.

Improved community support

The bed reduction will be achieved by providing more options to treat people out of hospital, the plan’s authors say. This will be delivered by 49 ‘transformation partnerships’ of councils and NHS commissioners, and backed by £45m of NHS England funding.

Partnerships will be expected to pool health and social care budgets in a bid to speed up discharges. The NHS will also pay a life-long dowry to councils for some long stay hospital patients who become the responsibility of social services. The dowry will apply to patients who have been in hospital for over five years on 1 April 2016. It is estimated around a third of current inpatients will qualify.

The BBC’s Panorama exposed the abuse and neglect of patients at the now closed Winterbourne View hospital in 2011. Six care workers were jailed and five given suspended sentences.

The scandal led to a series of failed attempts to reform the learning disability system, most notably the government’s missed target to end inappropriate hospital placements for people with learning disabilities by June 2014.

The NHS concedes people with learning disabilities have been failed for decades. Simon Stevens, NHS England’s chief executive, said it was time “to grasp the nettle” and deliver the community improvements needed to move people out of hospitals.

Reaction to the plan

Rob Greig, chief executive of the National Development Team for Inclusion and a former national director for learning disabilities, welcomed today’s report as the most “well thought through” response to Winterbourne View produced by policymakers so far. But he raised concerns over how it would be implemented.

“The stated reduction in bed numbers should be a measure of success in developing community services, particularly new, skilled social care providers – and not a target in itself. If it becomes the target, then people will still be receiving poor support, but in the community instead,” he said.

Another issue was the plan’s lack of focus on the needs of young people with learning disabilities, said Greig. And the decision to limit NHS ‘dowry’ payments to patients who’d been in hospital for more than five years also risked undermining efforts to shift more care into the community.

“Unless local authorities receive funds to meet the costs of people in hospital for shorter periods, including those funded through specialised commissioning, the current pressures on the social care system will mean those people will not leave the hospitals.”

Funding fears

Learning disability charities also questioned the amount of funding for the reforms.

“New money has been announced today but there is no indication as to whether this is sufficient to rapidly mobilise the new housing and care services needed, whilst also up skilling local area teams,” Mencap and the Challenging Behaviour Foundation said.

“NHS England and the government must adequately fund local areas to deliver this change, as well as hold them to account, and intervene where change is not happening.  People with a learning disability, families and carers need to see change on the ground before they will believe progress is being made.”

Councillor Izzi Seacombe, the LGA’s community and wellbeing lead, said: “Councils want people with learning disabilities to have access to the right care and support they need in the right place, at the right time.

“The LGA is fully committed to supporting this programme but at a time when councils are facing continued financial pressures, it is vital that the government properly funds the changes needed in the social care system so that people who need support get the vital help that they deserve.”