Ah, yesterday the ambassador has spoiled us with a veritable
pyramid of material relating to people with learning disabilities and/or autism.
This includes:
A first report of findings from the Learning Disability
Census 2014 – following on from the 2013 Census (but with some revised
questions), this gained information from providers about people with learning
disabilities in specialist learning disability inpatient services on 30th
September 2014 – available here http://www.hscic.gov.uk/catalogue/PUB16760
A report summing up in great detail what the ‘Transforming
Care’ programme has been doing over the two years since it started, it also
contains some information from the latest quarterly data collection from
commissioners about how many people with learning disabilities are in
specialist inpatient services. This also has an easy-read version https://www.gov.uk/government/publications/Winterbourne-View-2-years-on
A report setting out future plans for a rebooted ‘Transforming
Care’ programme, based partly on a response to the ‘Time for Change’ report
published last October - I’m trying to not give a certain person the oxygen of
publicity. This is available here (I couldn’t find an easy-read version): http://www.england.nhs.uk/ourwork/qual-clin-lead/ld/transform-care/
There are good summaries from David Brindle in The Guardian http://www.theguardian.com/social-care-network/2015/jan/29/winterbourne-view-two-years-on-report
and Andy McNicoll in Community Care http://www.communitycare.co.uk/2015/01/29/learning-disability-care-fines-providers-stronger-right-challenge-placements-among-latest-post-winterbourne-reforms/
.
Like a pyramid of Ferrero Rocher I’ve found this welter of
material hard to digest in one go, so this first post puts together some of my
initial reactions based on a quick read of the Learning Disability Census. By
saying this is the first post I’m not committing myself to when (or if!) there
will be another one around this subject!
The Learning Disability Census 2014 gives us better
information than we’ve had before. For me it highlights the unwillingness of
the providers of these inpatient services to give an inch without serious
pressure.
A major headline figure is that there were 3,230 people in
these inpatient units in 2014, compared to 3,250 people in 2013 (although in
2013 providers didn’t report 370 people that they should have done – these people
were still inpatients in 2014). This is hardly a transformative reduction in
the number of places, and is still weirdly higher than the 2,600 people in
inpatient units on 30 September 2014 reported in quarterly data collected from
commissioners by NHS England (a reduction from the, erm, 2,601 people on 30
June). Who are the 600 people in these units who are not known to
commissioners? From the Census it looks like they are being commissioned by NHS
Commissioners outside England, local authorities, commissioners from outside
the UK and funded privately – in any plans we need to make sure these people
are not forgotten.
By my reckoning (which involves some shuffling of the 370
people compared to the report), 1,275 people were in the same inpatient service
in 2013 but not 2014, 885 people were in the same inpatient service in 2014 but
not 2013, and 2,345 were in the same inpatient service in both 2013 and 2014.
The headline ‘length of stay’ figures in the Census report (an average length
of stay of 1,034 days – i.e. three years – virtually no change from the 1,065 days
in 2013) only ask about how long people have been in their current inpatient
unit. In revealing new questions in the 2014 Census, it turns out that 1,380
people (43% of all people in the Census) had been directly transferred from
another specialist inpatient unit. When time in previous services is taken into
account, the number of people who had been living in an inpatient unit for five
years or more increases from 565 people to 1,060 people (a third of everyone in
an inpatient unit).
So while there is some movement into and out of inpatient
services, much of it is movement within the inpatient service system. There are
signs in the Census that this movement is towards the independent sector: the
number of people in NHS services went down from 1,851 people in 2013 to 1,730
people in 2014, while the number of people in independent sector services went up
from 1,399 people in 2013 to 1,500 people in 2014. People also tend to stay
longer in independent sector vs NHS services – signs that the Transforming Care
programme is not really touching the independent sector and NHS services are
shuffling off their problem to the independent sector to deal with?
The 2014 Census shows that many of these services are
effectively putting up two fingers at any national policy attempts to drive
them towards better practices.
Why are there only 15 people subject to a Guardianship order
designed to support people to live as independently as possible, when there are
over 600 people (20%) in these services with an ‘informal’ legal status? When
another 635 people (20%) are subject to a Ministry of Justice restriction order,
how come over half of them are in general or low secure services?
Why are 43% of women and 21% of men on mixed-sex wards
despite the Department of Health wanting to eliminate these wards? Particularly
as providers rate 44% of men (as opposed to 16% of women) being at risk of
sexual behaviour that would harm other people and rate 61% of women (as opposed
to 45% of men) being at risk of injuring themselves?
Why aren’t services more local to the communities that
people have come from? (an average of 60.5km away in 2013 vs 59.5km away in
2014?)
Why has the number of children aged under 18 in inpatient
services (160) not changed from 2013 to 2014?
The percentage of people reported as experiencing self-harm
(26% in 2013 vs 25% in 2014) and physical assault (22% in 2013 vs 23% in 2014) in
the last 3 months has stayed static, with accidents (21% in 2013 vs 18% in
2014) reducing slightly. As, despite DH policy, have levels of hands-on
restraint (34% of people experienced this in the last 3 months in 2013 compared
to 33% of people in 2014) and seclusion (11% of people in 2013 and 2014).
Most shockingly, the already obscene percentage of people
getting antipsychotic medication in the last month has increased, from 68% of
people in 2013 to 73% of people in 2014 (with a big increase in people being
regularly prescribed them – bigger doses maybe?) – if you’re on antipsychotics
you’re also more likely to get rapid tranquilisation, restraint and seclusion.
Is this what you would expect for an average £3,426 per
week? (totalling up to £575 million per year)
There are also signs of belated adaptation to changing
circumstances, possibly as a defensive move to protect their position. For
example, in 2014 200 people were subject to Deprivation of Liberty Safeguards,
an increase of 512% (yes, this isn’t a typo) from 2013. And how else to explain
the number of people ‘not dischargeable’ due to behavioural risks to self or
others or mental illness increasing by a whopping 80% from 496 people in 2013
to 895 people in 2014?
Perhaps the Care and Treatment Reviews (according to ‘Transforming
Care’ 1,032 have been done so far (all with people in inpatient services at
April 2014 with no discharge plan or discharge date) with 566 people discharged
by January 2015) are the magic bullet that happened too late to show in the
Census? Perhaps the other measures in ‘Transforming Care’ will finally see
significant shifts by September 2015? I hope so – all I know is that this
Census suggests that the providers aren’t going to go quietly. For a sobering
reminder of the fights that are still ahead, I suggest you look at this article
in the Lancashire Telegraph about the apparent mooted ‘closure’ of Calderstones
(many apologies to the person who sent this link to me as I haven’t been able
to track back to who are you and to credit you, but thank you) http://www.lancashiretelegraph.co.uk/news/11756016.CLOSE_IT_DOWN__Expert_advises_national_NHS_chiefs_to_shut_down_Calderstones_Hospital/
If anyone ever thinks we’re post-Winterbourne, just read
that and weep.
An "independent expert", eh? I am weeping, as directed
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