People with learning disabilities facing long waits for care reviews

Health services are struggling to deliver care reviews designed to make sure learning disabled people are not being inappropriately kept in hospital units, a group of MPs has warned.

The public accounts committee found just 39% of the estimated 2,500 patients affected had received care and treatment reviews within the six month timescale stipulated by NHS England policy. One in five who were in hospital as of February 2017 had received no review at all, although this had improved from 47% in January 2016.

‘Known barriers’

The care and treatment reviews, introduced two years ago, are a key plank of the government’s Transforming Care programme to shift more learning disability support into the community. But the committee found that five years on from the Winterbourne View scandal, which triggered the Transforming Care programme, progress on moving care out of hospitals was still too slow and more needed to be done to tackle “known barriers”.

The MPs found just £1m of funding had shifted from NHS hospitals to community services in order to build out of hospital options for learning disability care, well short of the estimated £10.8m that could have been released.

The committee said advocacy support for learning disabled people was “patchy”, and warned forthcoming housing benefit caps posed a “real risk” that people would be unable to afford the specialist accommodation needed to support community care options.

The report also called for the Department of Health to launch a cross-government strategy to improve access to healthcare and employment for people with learning disabilities, after finding just 23% were registered with their GPs and 5.8% of those known to local authoritieswere in employment.

Rob Greig, chief executive of the National Development Team for Inclusion, welcomed the committee’s call to improve access to care and community participation.

“For the last seven years there has been no national policy focus,” he said. “Attention has been taken up entirely by Transforming Care, which hasn’t so far delivered what it’s supposed to and is only concerned with a fairly small number of people.”

Greig, national director of learning disabilities at the DH from 2001-8, described the problems around money not following patients out of hospitals and into local authorities as a “historical” one. “It could be resolved by central government if it so wished, which clearly it hasn’t done,” he added.

But the lack of mechanisms for moving funds are not the only issue, he said. “Care and treatment reviews are good innovations that are having a positive effect, but there’s a difficulty in ensuring people get services in place within realistic timescales,” he said.

The answer, Greig added, would be to initiate a programme of supporting commissioners around “knowledge and skills to do proper person-centred service design”.

‘Stop institutional placements’

Viv Cooper, chief executive of the Challenging Behaviour Foundation, which supports people with severe learning disabilities whose behaviour challenges and their families, backed Greig’s calls for better commissioning.

“Buying placements in institutional settings needs to be removed as an option – currently NHS England ‘specialist commissioners’ purchase places in institutions that are not in line with their own model of service provision,” Cooper said.

“Regulatory processes are currently unable to reliably scrutinise these ‘specialist’ services against the Transforming Care service model.”

Cooper added that the slow flow of money from the NHS to councils was causing a “general lack of investment in early intervention, prevention, and a range of local support and services”, meaning families can struggle to access the right support at the right time, ultimately leaving people vulnerable to being placed into inpatient care.

“The reliance on crisis placements in inpatient services has been shown to often fail to provide specialist care, and may focus on medication and restrictive practices, resulting in poor outcomes for people,” she said. “Getting out of inpatient provision can be very difficult for a range of reasons resulting from the lack of local funds, including the perverse financial incentives, a lack of suitable appropriate housing for individuals to move into and lack of skilled staff.”