Dismantling the right support

Today (6^th March 2018) @NHSBenchmarking held an event releasing the findings from their most recent round of data collection concerning NHS/health services for people with learning disabilities. This is a project that’s been going for a few years, where volunteer organisations (mainly NHS Trusts) across the UK help NHS Benchmarking collect information about health services for people with learning disabilities. I think 47 organisations took part in 2015/16, and 49 organisations took part in 2017.

I think this project is really important, because it tries to collect information that isn’t available in any other way (although there is a strong case to be made that much of this information should be routinely collected nationally). It also tries to collect information about some of the kinds of community-based health services that the NHS England strategy Building The Right Support says are needed, if people with learning disabilities or autistic people aren’t going to keep being unnecessarily shunted into inpatient units.

Thanks to live tweeters at the event (hashtag #NHSBNLD ) I was able to see some of the findings from this project. NHS Benchmarking also produced a handy summary for 2017 which you can see here, which they also produced in exactly the same format (thank you!) for 2015/16, which I found here and is also shown below. Although the number of organisations taking part changed from 2015/16 to 2017, some of the tweets from the event showed NHS Benchmarking making comparisons over time so I’m assuming this is OK to do.

This post is just a quick, instant reaction to some of the information presented today by NHS Benchmarking. I personally think it makes pretty gloomy reading – rather than building the right community-based support, these figures generally suggest that this support is being dismantled.

Specialist inpatient services

The NHS England Transforming Care programme has set great store on trying to reduce the number of people using inpatient units and reducing the number of these units that exist. The NHS Benchmarking data (from NHS Trusts, I think, so it doesn’t include independent sector organisations that now run inpatient units for half of all people using them in England) shows that the average length of stay for people in a unit has dropped slightly from 244 days to 230 days. This includes some general mental health inpatient units where people stay for much shorter periods of time, and can be contrasted with the national Assuring Transformation data. For January 2018, this dataset reported that people spent an average 987 days in their current inpatient unit, and 1,949 days continuously in inpatient units where they had been transferred directly between units.

More worryingly, the number of places in these units seems if anything to be increasing. In 2015/16, there were 4.8 places in these units per 100,000 of the general adult population – in 2017 this increased to 6.4 places per 100,000 population.

The nursing workforce in these units also changed slightly – in 2015/16 34% of the staff were registered nurses (66% were support workers), compared to 32% of staff in 2017 (and 68% support workers).

Across services for people with learning disabilities, in both 2015/16 and 2017, 14% of the total pay bill was spent on Bank staff. The percentage of the pay bill spent on agency staff increased, from 5% in 2015/16 to 7% in 2017.

Taken together, this suggests a continuing drift towards more inpatient services, with a progressively less skilled and stable workforce working within them.

Community teams for adults

The NHS Benchmarking project also reported some information on community teams for adults with learning disabilities that I don’t think is available anywhere else.

First, the number of contacts with adults with learning disabilities made by community health services has increased, from 2,688 contacts per 100,000 adult general population in 2015/16 to 2,756 contacts per 100,000 population in 2017. But there are signs that community health services are ‘doing more with less’, and are creaking under the strain.

For example, the waiting time from referral to assessment has increased for ‘routine’ referrals from 34 days in 2015/16 to 41 days in 2017. As with inpatient services, the skills of these community teams are also changing – 61% of staff in these services were registered nurses in 2015/16, compared to 53% of staff in 2017.

Community teams for children

The NHS Benchmarking project also reports a couple of bits of information on community services for children with learning disabilities, and here the trends look pretty catastrophic. In 2015/16 there were 2,289 contacts with children with learning disabilities made by community health services per 100,000 general child population – a figure already lower than the equivalent for adult teams. By 2017 this had dropped to 1,471 contacts with children per 100,000 population, a drop of over a third (36%). Over the same year, the average waiting time for a routine appointment for children with learning disabilities increased from 32 days to 72 days.

Dismantling the right support

The ambition and work of the NHS England Transforming Care programme (due to finish in a year’s time), particularly in terms of building decent community-based support services for people and families, is coming up against the brute reality of disinvestment and cuts to exactly the types of services specified as needed in Building The Right Support. These cuts aren’t confined to one year either – the NHS Benchmarking report for 2016 found that in two years from 2014 to 2016 the number of service contacts with people with learning disabilities had dropped by 18% and the spend on these services had dropped by 23%. These cuts seem particularly savage in services for children with learning disabilities, which is where, if anything, support needs to be front-loaded.

From an inadequate base, the right support is being further dismantled.