Learning disability care: The move towards a community-based service

In February 2015 NHS England publicly committed to a programme of closing some inpatient facilities in a bid to establish stronger support in the community for those with a learning disability and/or autism, promising further details later in the year.

A report published at the end of October by the Local Government Association, ADASS and NHS England is the product of this commitment. It has outlined plans to develop community services whilst closing inpatient facilities for people with a learning disability and/or autism. This is a new national plan that aims to radically improve learning disability services in the UK in order to support people with learning disabilities to lead more independent lives and have a greater say in the support they receive. The plan predicts a reduction of up to 50 per cent of inpatient beds.

The report outlines that key to the success of this plan will be for three key changes to take place: local councils and NHS bodies to join together to deliver better and more co-ordinated services, budgets to be shared between NHS and local councils and national guidelines to set out what support people and families can expect.

This announcement should be cautiously welcomed by most health and social care stakeholders. According to NHS England, in too many cases inpatient care is used as a long-term option due to a historic lack of community-based services, and do not deliver the best outcomes for these people. They are also expensive, costing the health and care system on average over £175,000 per year. Reducing the number of inpatient beds by 50% should free up hundreds of millions of pounds for investment in community-based support, as well as improve the quality of remaining inpatient units.

However doubts have been raised as to the realities of putting this plan into practice. The announcement has also reignited concerns that not enough has been done since the 2011 Winterbourne View, since when pressure for a solution has been building.

Jan Tregelles, chief executive of Mencap and Vivien Cooper, chief executive of the Challenging Behaviour Foundation said: “This report comes over four and a half years after the abuse scandal at Winterbourne View was exposed by the BBC and shocked the nation. Despite numerous reports and missed targets… Whilst this report has strong ambitions which we welcome, significant questions remain unanswered. At this stage we were expecting a proper analysis of why there has been a lack of progress to date, alongside a well thought-through, costed and robust implementation plan. This report presents some good ambitions but it is unclear how they will translate to the right outcomes for people. We are concerned about whether sufficient resource and investment is being made available up front to develop the local support and services required.”

However these plans are put into practice, it is vital amongst all else that the best interests of the patients are met. The service the patients received at the various hospitals must not just be matched but also improved, and not simply replaced with a completely different service. In addition, generalising this approach to all patients currently in inpatient care may not be the right solution. Some patients may be better suited to inpatient care, and these cases must be identified before the plans are applied to anyone and everyone.

While this report highlights the potential value of integrated care in providing a cost-effective solution to a health care crisis, it does not recognise the complex funding environment in which this would take place. How the NHS and local authorities will join up to deliver more community-based services in this increasingly complex and challenging environment remains to be seen.