tag:blogger.com,1999:blog-10169047857769501212024-03-12T22:03:12.392+00:00Chris Hatton's blogChris Hattonhttp://www.blogger.com/profile/05299821560069281510noreply@blogger.comBlogger178125tag:blogger.com,1999:blog-1016904785776950121.post-75152508963616271312023-12-08T13:28:00.000+00:002023-12-08T13:28:10.014+00:00New evidence of ethnic inequalities in healthcare among people with learning disabilities - the Health and Care of People with Learning Disabilities dataset 2022/23As<a href="https://www.kcl.ac.uk/research/leder" target="_blank"> the LeDeR report </a>continues its yearly documenting of the shocking/not shocking health inequalities experienced by people with learning disabilities in England compared to other people, over the course of this year we've seen some attention beginning to be paid to some jaw-dropping health inequalities within the population of people with learning disabilities. In particular, <a href="https://raceequalityfoundation.org.uk/press-release/we-deserve-better-ethnic-minorities-with-a-learning-disability-and-access-to-healthcare/" target="_blank">a major review commissioned by the NHS Race and Health Observatory</a> , 'We Deserve Better', has magnified continuing LeDeR reports of grim health inequalities according to the ethnicity of people with learning disabilities. Most stark was the information on median ages of death from any cause - while this was bad enough for white people with learning disabilities (62 years). it was even worse for people with learning disabilities from 'other' ethnic groups (49 years), people from Black, Black British, Caribbean or African ethnic groups (40 years), people from Asian or Asian British ethnic groups (33 years) and people from 'mixed/multiple' ethnic groups (30 years).<div><br /></div><div>Yesterday (7th December 2023) NHS Digital/NHS England published the latest yearly information from over half of GP practices in England about the health of people with learning disabilities, relating to 2022/23. <a href="https://digital.nhs.uk/data-and-information/publications/statistical/health-and-care-of-people-with-learning-disabilities/experimental-statistics-2022-to-2023" target="_blank">'The Health and Care of People with Learning Disabilities' </a>is a brilliant source of information that deserves to be much more widely known and I hope is being widely used at both national and local levels. This year for the first time this dataset includes some limited information on ethnicity. While there will hopefully be more information to come in future years, it does provide some information that has been weirdly absent so far.</div><div><br /></div><div>First, it provides information on the ethnicity of people registered with their GP as a person with learning disabilities, compared to people not registered as a person with learning disabilities (because the dataset is geographically patchy, this is probably the fairest comparison rather than national Census 2021 data). The recording of ethnicity in GP records is better for people with learning disabilities than other people, with ethnicity not recorded for 2.9% of people with learning disabilities compared to 6.3% of people without learning disabilities, and 4.4% of people with learning disabilities compared to 6.5% of people without learning disabilities choosing not to have ethnicity information on their GP record.</div><div><br /></div><div>Of those people where there was ethnicity information:</div><div style="text-align: left;"><ul style="text-align: left;"><li>79.9% of people with learning disabilities compared to 74.8% of people without learning disabilities were from a white ethnic group</li><li>9.8% of people with learning disabilities compared to 13.4% of people without learning disabilities were from an Asian/Asian British ethnic group</li><li>5.7% of people with learning disabilities compared to 5.5% of people without learning disabilities were from a Black/African/Caribbean/Black British ethnic group</li><li>2.9% of people with and without learning disabilities were from a 'mixed/multiple' ethnic group</li><li>1.7% of people with learning disabilities and 3.5% of people without learning disabilities were from an 'other' ethnic group</li></ul></div><div><div>These are very broad ethnic categories putting very different communities together, and information from schools which uses more specific ethnic categories (and breaks down information according to whether children have been given labels of Moderate Learning Difficulty, Severe Learning Difficulty or Profound Multiple Learning Difficulty) shows that these specificities really matter (<a href="https://raceequalityfoundation.org.uk/wp-content/uploads/2023/07/RHO-LD-Appendices.pdf" target="_blank">a summary table is available in Appendix 2b of the 'We Deserve Better' report</a>). But just as we know that the deaths of people with learning disabilities from white ethnic backgrounds are disproportionately likely to be notified to the LeDeR programme, it's highly likely that people with learning disabilities from some communities are less likely to be recorded as such in GP registers. It's also important to say that the 'We Deserve Better' report found that much of the ethnicity coding in GP registers was outdated and unclear, so the accuracy of the findings reported here could be improved.</div><div><br /></div><div>As well as this, the 'Health and Care' dataset includes information on the percentages of people with learning disabilities getting annual health checks and having a flu vaccine, broken down by these broad ethnic categories.</div><div><br /></div><div>For annual health checks, overall in 2022/23 71% of people with learning disabilities were recorded by GPs to have had an annual health check in 2022/23. This conceals substantial differences between ethnic groups, where the figures were:</div><div><ul style="text-align: left;"><li>74% of people with learning disabilities from a white ethnic group</li><li>68% of people with learning disabilities from a Black/African/Caribbean/Black British ethnic group</li><li>68% of people with learning disabilities from an Asian/Asian British ethnic group</li><li>64% of people with learning disabilities from a 'mixed/multiple' ethnic group</li><li>62% of people with learning disabilities from an 'other' ethnic group</li></ul></div><div>Worryingly, there were particularly low rates of annual health checks among people with learning disabilities where ethnicity data were missing (48%) or the person had chosen not to have ethnicity information recorded (57%), perhaps showing a certain degree of disengagement on the part of GP practices.</div><div><br /></div><div><div>For flu vaccines the differences are even bigger. Overall in 2022/23 56% of people with learning disabilities were recorded by GPs to have had a flu vaccine in 2022/23. This conceals big differences between ethnic groups, where the figures were:</div><div><ul><li>61% of people with learning disabilities from a white ethnic group</li><li>46% of people with learning disabilities from an Asian/Asian British ethnic group</li><li>41% of people with learning disabilities from a 'mixed/multiple' ethnic group</li><li>38% of people with learning disabilities from an 'other' ethnic group</li><li>35% of people with learning disabilities from a Black/African/Caribbean/Black British ethnic group</li></ul></div><div>Worryingly, there were also low rates of flu vaccines among people with learning disabilities where ethnicity data were missing (41%) or the person had chosen not to have ethnicity information recorded (47%).</div></div><div><br /></div><div>These ethnic inequalities in rates of flu vaccination for people with learning disabilities mirror the most recent information we have (mid-2022) about COVID-19 vaccinations (<a href="https://chrishatton.blogspot.com/2022/08/pushing-rock-back-up-hill-autumn-covid.html" target="_blank">see this blogpost for details</a>, using information from OpenSafely). This reported that among 16-64 year-olds with learning disabilities who weren't judged to be 'Clinically Extremely Vulnerable', 73% of people in a white ethnic group had received 3 doses of the COVID-19 vaccine, compared to 53% of people in an 'other' ethnic group, 50% of people in a 'mixed/multiple' ethnic group, 47% of people in a South Asian ethnic group, and 40% of people in a Black ethnic group.</div><div><br /></div><div>This is one small corner of all the health information that could be broken down according to ethnicity, but it clearly shows big ethnic inequalities in getting something basic (like an annual health check, or a flu vaccine) that everybody with learning disabilities is entitled to. And these vaccines make a big difference. The 'We Deserve Better' report reported that before the COVID-19 pandemic, flu/pneumonia was the most common cause of death among people with learning disabilities from Asian/Asian British groups (17%) and from 'other' ethnic groups (16%), and the second most common cause of death for people from Black/Black British/Caribbean/African ethnic groups (16%) and from white ethnic groups (14%). During the COVID-19 pandemic, COVID-19 was by far the most common cause of death for people with learning disabilities across all ethnic groups, although there were big differences in the percentages of people within each ethnic group who had died from COVID-19:</div><div><ul><li>60% of people with learning disabilities from a 'mixed/multiple' ethnic group</li><li>38% of people with learning disabilities from a Black/African/Caribbean/Black British ethnic group</li><li>31% of people with learning disabilities from an Asian/Asian British ethnic group</li><li>29% of people with learning disabilities from an 'other' ethnic group</li><li>26% of people with learning disabilities from a white ethnic group</li></ul></div><div>The 'We Deserve Better' report documents the huge range of causes of the extreme ethnic inequalities in health amongst people with learning disabilities and provides clear recommendations for what needs to be done. This new information from the 'Health and Care' dataset, although limited, clearly points to a practical agenda for action on the part of health services in terms of proactively focusing on ethnic inequalities in people getting vaccines. Without action, data is nothing. But without data, action is clueless.</div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div></div>Chris Hattonhttp://www.blogger.com/profile/05299821560069281510noreply@blogger.com0tag:blogger.com,1999:blog-1016904785776950121.post-42572691116486763812023-10-20T09:55:00.000+01:002023-10-20T09:55:06.039+01:00What do the latest statistics say about social care and adults with learning disabilities? 8 key messages (and 0 graphs)<p>Every year NHS Digital (now absorbed into NHS England) publish statistics collected by councils related to social care and adults with learning disabilities in England. <a href="https://digital.nhs.uk/data-and-information/data-tools-and-services/data-services/adult-social-care-data-hub" target="_blank">Data tables for 2022-2023</a> were released on 19th October. Rather than inflict my usual graphalanche, here are 8 things that jumped out at me:</p><p>1) Since 2019/20 the number of adults with learning disabilities getting social care support has stalled. In 2022/23, 152,175 adults with learning disabilities got social care support at some point in the year, less than the 153,145 people getting social care support in 2019/20. </p><p>2) Using projections about the increasing number of adults likely to need social care support from 2014/15 to 2022/23, there are between 14,000 and 22,000 adults with learning disabilities who need social care support but are not getting it.</p><p>3) While the number of adults with learning disabilities aged 18-64 living in residential care and nursing care continues to decrease, the number of adults with learning disabilities aged 65+ living in residential care and nursing care has been increasing from 2020/21 to 2022/23.</p><p>4) 49,145 adults with learning disabilities aged 18-64 getting social care support were living with family (or friends) on a settled basis in 2022/23 - well over a third (37%) of all working age adults with learning disabilities getting social care support.</p><p>5) Council spending on social care for adults with learning disabilities was £6.3 billion in 2022/23, which might be keeping pace with or even outstripping inflation.</p><p>6) Council spending on social care for adults with learning disabilities is almost one third (32%) of all council social care spending.</p><p>7) For the first time in 2022/23, over half a billion pounds in social care spending (£513 million) for adults with learning disabilities was paid for by 'client contributions'. This is 8% of all council social care spending for adults with learning disabilities.</p><p>8) Among working age adults with learning disabilities getting council social care, the rate of people in any form of paid employment remained at 4.8% in 2022/23, a historic low, with the gender employment gap also remaining (5.2% for men; 4% for women).</p><p>There is much more in the statistics (and I have updated my graph stash), but I see no signs of 'recovery' or 'building back better' here. </p><p><br /></p>Chris Hattonhttp://www.blogger.com/profile/05299821560069281510noreply@blogger.com0tag:blogger.com,1999:blog-1016904785776950121.post-47787345090276205472023-09-15T08:36:00.007+01:002023-09-15T13:56:55.051+01:00Statutory homelessness statistics and people with learning disabilities 2023 - getting even worse<p>This short blogpost updates <a href="https://chrishatton.blogspot.com/2022/07/statutory-homelessness-statistics-and.html" target="_blank">a post from just over a year ago</a>, using <a href="https://www.gov.uk/government/statistical-data-sets/live-tables-on-homelessness" target="_blank">the latest statistics on statutory homelessness in England</a>, as they relate to households with a person with learning disabilities living within them. As far as I can tell (and others are better placed than me to know about this) <a href="https://onlinelibrary.wiley.com/doi/10.1111/jar.12815" target="_blank">we know relatively little about homelessness among people with learning disabilities</a> in the UK, although it looks like people with learning disabilities (often unrecognised) are <a href="https://homeless.org.uk/knowledge-hub/learning-disabilities-and-homelessness-toolkit/" target="_blank">more likely to experience homelessness</a>.</p><p>To quote this typically lucid <a href="https://researchbriefings.files.parliament.uk/documents/SN01164/SN01164.pdf" target="_blank">report from the House of Commons Library on statutory homelessness in England</a>, "Local authorities have a statutory duty to secure accommodation for unintentionally homeless households who fall into a 'priority need' category. There is no duty to secure accommodation for all homeless people". </p><p>There are a range of statistics presented in the live tables, one of which presents information on the number of households owed a homelessness duty broken down by whether anyone in the household has a list of particular support needs, which includes 'Learning disabilities'. Because of changes to the law in 2018, statistics are available for each quarter (three months) from April 2018 through to March 2023.</p><p>The graph below shows the number of households with a person with learning disabilities who were owed a homelessness duty in each quarter year. There are some fluctuations, but overall the number of households has rapidly increased. In Quarter 2 of 2018 (April-June) there were 2,670 households with a person with learning disabilities owed a homelessness duty - by the first quarter of 2023 (January-March) this had increased to 4,700 households, an increase of 76% in less than five years.</p><p><br /></p><p></p><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIyCkwifXm9_wUgzv16S0mCKIRRerX1dMYQrpJlOAW5Yr_X4wQK93bsogJr4CEqK2aeSbagTpsRaQqfgn7TMHeLp-4E_ujY1qhJJrXf6G2ll5REKmaAvSF5BK0yNRcz4al0KG77kkuPJwu6SmCTE-EY9VeJhJbdwkJ9r0XSryXtjavBf4kH_ikXYiEmNE9/s1864/Picture1.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1093" data-original-width="1864" height="376" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIyCkwifXm9_wUgzv16S0mCKIRRerX1dMYQrpJlOAW5Yr_X4wQK93bsogJr4CEqK2aeSbagTpsRaQqfgn7TMHeLp-4E_ujY1qhJJrXf6G2ll5REKmaAvSF5BK0yNRcz4al0KG77kkuPJwu6SmCTE-EY9VeJhJbdwkJ9r0XSryXtjavBf4kH_ikXYiEmNE9/w640-h376/Picture1.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div></div><p>How big a proportion of households owed a homelessness duty are households with a person with learning disabilities? The graph below shows trends in two percentages over time. </p><p>The first (the blue line) is the percentage of all households owed a homelessness duty by a local authority that are households with a person with learning disabilities. This shows that households with a person with learning disabilities represented 4.3% of all households owed a homelessness duty in Quarter 2 of 2018, increasing to 5.9% of all households in Quarter 1 2023.</p><p>The second, orange, line is the percentage of households with an identified support need owed a homelessness duty that are households with a person with learning disabilities. [Not all households owed a homelessness duty officially have a support need]. This shows that households with a person with learning disabilities represented 9.3% of households with a person with support needs owed a homelessness duty in Quarter 2 2018, increasing to 11.0% of these households in Quarter 1 2023.</p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGB8HvGruUMeTnqsuzBeRHjlma8u7Wk6vkMWp402-rL7YboKiUKwmIIRmz33CDSNbgM9FY_PACTLDkLF4cG0BSYDXBTCBcZbQXLT1PbW3hHY9ggux8ziFXXGxZvyQZy65lgHUMruvxNERbvVOpdjrk7UpXp8qRN2kcpsuZqvGRqCWJO9-zWg2FRymXw540/s1866/Picture2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1373" data-original-width="1866" height="470" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGB8HvGruUMeTnqsuzBeRHjlma8u7Wk6vkMWp402-rL7YboKiUKwmIIRmz33CDSNbgM9FY_PACTLDkLF4cG0BSYDXBTCBcZbQXLT1PbW3hHY9ggux8ziFXXGxZvyQZy65lgHUMruvxNERbvVOpdjrk7UpXp8qRN2kcpsuZqvGRqCWJO9-zWg2FRymXw540/w640-h470/Picture2.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><p>This is not an area I know about at all well, so there may be horrible errors of interpretation here. And these statistics will clearly miss out a lot of people with learning disabilities who are homeless, for a variety of reasons. But to me these look like highly worrying statistics which are getting worse quickly, for which there is virtually no policy attention or action.</p><p>Update: David Abbott has alerted me to an excellent research project with autistic people who experience homelessness completed by his colleague, Beth Stone - I've linked to a <a href="https://policystudies.blogs.bristol.ac.uk/2022/10/13/autism-and-homelessness/" target="_blank">blog describing the project</a>, which also has links to more in-depth descriptions of the research.</p><p>Update 2: David's sent me <a href="https://assets-global.website-files.com/59f07e67422cdf0001904c14/645a76da097c6dad33fcc423_CHI-disabilities-homelessness23.pdf" target="_blank">this link to a must-read, authoritative report</a> by Beth Stone and Emily Wertans for the Centre for Homelessness Impact on Homelessness and disability in the UK - published in May 2023. In fact - read this instead of my blogpost!</p><p><br /></p>Chris Hattonhttp://www.blogger.com/profile/05299821560069281510noreply@blogger.com0tag:blogger.com,1999:blog-1016904785776950121.post-77405625352230982202023-08-01T10:48:00.002+01:002023-08-01T10:48:45.191+01:00Winterbourne View 12 years on - 2023. Report card 4: leaving inpatient units<p><span style="font-family: times; font-size: large;">This blogpost is the final one of four looking at the Transforming Care programme through the prism of the national statistics regularly produced by NHS Digital/NHS England, updating a series of blogposts I last updated in 2022.</span></p><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><a href="https://chrishatton.blogspot.com/2023/08/winterbourne-view-12-years-on-2023.html" target="_blank">The first blogpost</a> looked at statistics on the number of people being admitted to inpatient services, and where they were being admitted from.</span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><a href="https://chrishatton.blogspot.com/2023/08/winterbourne-view-12-years-on-2023_1.html" target="_blank">The second blogpost</a> looked at how far people were from home and how long they were staying in inpatient services.<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><a href="https://chrishatton.blogspot.com/2023/08/winterbourne-view-12-years-on-2023_74.html" target="_blank">The third blogpost</a> looked at planning and reviews for people within inpatient services.<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">This final blogpost will focus on the number of people leaving inpatient services (charmingly called ‘discharge’) and what is happening leading up to people leaving. Getting people out of inpatient units has arguably been the major focus of activities under the Transforming Care/Building The Right Support banner. Again, at this point the impact of these programmes should be visible in the number of people getting ready to leave, how well people’s plans to do so are developing, and how many people are actually leaving to places outside inpatient services.</span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">The first and most obvious question is whether people in inpatient services have a planned date to leave. The graph below shows the proportion of people in inpatient services with a planned date for transfer, from March 2015 to March 2023 (according to Assuring Transformation data). There have been some fluctuations over time but there is an overall trend of things improving up to March 2019, and things worsening from then to March 2023 where the figures look in some ways slightly worse than in March 2015. In March 2023 there was no planned transfer date for 57% of people in inpatient units, compared to 50% of people in March 2015. In March 2023, 18% had a planned transfer date within 6 months, although for 10% of people their planned transfer was overdue.</span></div><div class="MsoNormal"><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><br /><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdKBPnF1u5t19J3f5-5yrobhTiZwZRvjKLe34V9bkzhcu3X-XXajrOgYI5cDa0MulEc7G-39V08rn5DmWKwGgLFksPALr6Lcw6ydGS3H1Evxz62oYIWR7ZOzmCIxW5I4_FsTr-16q-vIRC6iJLe8XY6BFoeEIL-aZ9w-I4gZUMltYdtydy1FR741niAPjB/s1012/AT%202023%201.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="603" data-original-width="1012" height="382" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdKBPnF1u5t19J3f5-5yrobhTiZwZRvjKLe34V9bkzhcu3X-XXajrOgYI5cDa0MulEc7G-39V08rn5DmWKwGgLFksPALr6Lcw6ydGS3H1Evxz62oYIWR7ZOzmCIxW5I4_FsTr-16q-vIRC6iJLe8XY6BFoeEIL-aZ9w-I4gZUMltYdtydy1FR741niAPjB/w640-h382/AT%202023%201.jpg" width="640" /></a></div><br /><br /><br /></div></div><span style="font-family: times; font-size: medium;">In addition to planned transfer dates, do we know anything about the plans themselves?<o:p></o:p><br /><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">Well, if people are leaving the inpatient unit to go home in some sense then my expectation would be that the person’s local council should be aware of the plan to leave. The graph below shows information from Assuring Transformation based just on those people with a plan to leave – for this group of people, are councils aware of the plan? Over time, the proportion of people with a plan that their council is aware of dropped substantially from 2015 to 2019, although this has improved again up to March 2023. Despite this recent improvement, by March 2023 the proportion of planned transfers where the council was aware (63%) was still lower than it was in March 2015 (69%). Of concern is that in March 2023 for 22% of people with a planned transfer it wasn’t known whether the council was aware of the plan or not, an improvement from 2019 but still worse than in March 2015 (7%). At the very least this suggests that the close working between health and social care envisaged as central to Transforming Care/Building The Right Support is less than universal.</span></div><div class="MsoNormal"><o:p></o:p></div><div class="MsoNormal"><o:p> </o:p> </div><div class="MsoNormal"><o:p></o:p></div><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIfRnrRyqKTEUuw5zATriEbcekcsj9KZs5VffCkMA19ll4nAilNL-x4Xd3pjqdMOPy5G4DJoNCVbS9W2HbdBsMODYWvIkk3cgUKKda2bVZI08o4_RCj4hMS7kwz6tErWKa6IL9363kgzloIsc4AVfnk4S_dDaZTOAH1kjQhWeV_bNX4rX5SEdimzrsYOxq/s1076/AT%202023%202.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="529" data-original-width="1076" height="314" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIfRnrRyqKTEUuw5zATriEbcekcsj9KZs5VffCkMA19ll4nAilNL-x4Xd3pjqdMOPy5G4DJoNCVbS9W2HbdBsMODYWvIkk3cgUKKda2bVZI08o4_RCj4hMS7kwz6tErWKa6IL9363kgzloIsc4AVfnk4S_dDaZTOAH1kjQhWeV_bNX4rX5SEdimzrsYOxq/w640-h314/AT%202023%202.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">There are other signs too of haste in planning for people to leave. The Assuring Transformation statistics report whether a range of people (the person themselves, a family member/carer, an advocate, the provider clinical team, the local community support team, and the commissioners) have agreed the plan to leave. For those people with a plan to leave, the graph below reports the proportion of their plans that have been agreed by different people, from March 2016 to March 2023. Over time, the proportion of plans agreed by anyone and everyone potentially involved has plummeted. Only 27% of plans had been agreed by the person themselves in March 2023, compared to over two thirds of people (69%) in March 2016. Similar drops are reported for the proportion of family/carers (from 60% to 23%) and advocates (from 64% to 26%) agreeing the plans.</span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">By March 2023, transfer plans had been agreed by a minority of provider clinical teams where the person was supposed to be moving to (from 83% in March 2016 to 31% in March 2023), a minority of local community support teams in the area the person was supposed to be moving to (from 69% to 28%) and a minority of those commissioners who are reporting the information the graph is based on! (from 83% to 31%). To what extent are these actually feasible and sustainable plans that will result in a better life at home for people in inpatient services, and what are their chances of breaking down?</span><o:p></o:p></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="mso-fareast-language: EN-GB; mso-no-proof: yes;"><!--[if gte vml 1]><v:shape
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</v:shape><![endif]--><!--[if !vml]--><!--[endif]--></span><o:p></o:p></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZiHrC1E2lzwXE5Ocs7ADfElXx4YxSt7_GGGc42BgFt-0T2EIv_DrsS-X4yrJyK-36JkVgqYm-5dN19b6QqSDVrUF_kfcffaU0XkklsvgavWVVdrAZ8OOkE5jC4lfcw6Zv0K9H2F-fxD_rVXb5Ajlo4HCik2oZvMyPjMElKcWMcXugFHQzficswe-Pft5k/s1091/AT%202023%203.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="631" data-original-width="1091" height="370" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZiHrC1E2lzwXE5Ocs7ADfElXx4YxSt7_GGGc42BgFt-0T2EIv_DrsS-X4yrJyK-36JkVgqYm-5dN19b6QqSDVrUF_kfcffaU0XkklsvgavWVVdrAZ8OOkE5jC4lfcw6Zv0K9H2F-fxD_rVXb5Ajlo4HCik2oZvMyPjMElKcWMcXugFHQzficswe-Pft5k/w640-h370/AT%202023%203.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">The final graph in this blogpost series is one of the most important – how many people have actually been transferred from inpatient services, and where have they gone? The graph below adds up monthly ‘discharges’ from inpatient services in the Assuring Transformation dataset in six yearly blocks, from October 2015 through to September 2022. It’s also one of the most complicated graphs in this series, so I’ll go through it in a bit of detail.</span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">The first thing to say is that overall the number of people ‘discharged’ from inpatient services increased from 2015/16 (2045 people) to 2017/18 (2,265 people), but has since decreased to 1,710 people in 2021/22 (although the COVID-19 pandemic undoubtedly had an impact on the number of people leaving inpatient units, this presumably isn't a continuing issue into 2022?).<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">Of the people who have been ‘discharged’, in 2021/22 almost one third of people (525 people; 31%) moved to independent living or supported housing. Another third of people (540 people; 32%) moved to their family home with support, making almost two thirds of everyone ‘discharged’ from inpatient services (63%). This is a big increase from the 41% of people 'discharged' to these living circumstances in 2015/16.<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">Where did everyone else go? For almost two fifths of people in 2021/22 (305 people; 18%) their ‘discharge’ was actually a transfer to another inpatient unit, confirming the picture of ‘churn’ of people passed around inpatient services found elsewhere in this series. Around one in six people (270 people; 16%) moved into residential care. Given that some inpatient services have re-registered themselves as residential care homes with the CQC and a panoply of 'step-down' and other services are registered as care homes, it is unclear to what extent people are leaving an inpatient service to move somewhere more local and homely, moving somewhere very similar to where they were, or not actually moving at all.<br /><o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">In 2021/22, there were also another 165 people (10%) who moved to an ‘other’ location – again it is unclear what these ‘other’ places are, but are they wildly different from where people were moving from?.<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">Overall, there are signs of some changes over time in where people are being ‘discharged’ to. Fewer 'discharges' are to other hospital inpatient units and residential care, and more 'discharges' are to people's families with support.</span></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="MsoNormal"><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWgrPwFymgKZwzNCXKMed3KP5MCTAQVatcXrjH-kb1TLQdUUCBDtIQR9UBpIrHo6fZpDi9PgiyLqaokURlemwWWG8LbZZegNkQUQCGOIbH-wOeJ1FbcDp0F3yUbMwXDq0gpglMgwIYiCofPQ0D9sJgcW9xVi7hfyGe8oaq1LS9uFExnSXRRwdPenlowUXn/s1483/AT%202023%204.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1026" data-original-width="1483" height="442" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWgrPwFymgKZwzNCXKMed3KP5MCTAQVatcXrjH-kb1TLQdUUCBDtIQR9UBpIrHo6fZpDi9PgiyLqaokURlemwWWG8LbZZegNkQUQCGOIbH-wOeJ1FbcDp0F3yUbMwXDq0gpglMgwIYiCofPQ0D9sJgcW9xVi7hfyGe8oaq1LS9uFExnSXRRwdPenlowUXn/w640-h442/AT%202023%204.png" width="640" /></a></div><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: times;"><span style="font-size: medium;">So in this final post in the series, there are definite signs that Transforming Care/Building The Right Support has not continued to support the 'discharge' of more people out of inpatient services, although almost two thirds of those people who are leaving are now moving to independent or supported living or back to the family home. There are real worries about the feasibility and sustainability of some of these plans, and the extent to which many people ‘leaving’ inpatient services are actually leaving for something radically different or being churned around a system that doesn’t call itself an inpatient service system but looks mighty similar to the people living within it. The fact that for around one in six people being 'discharged', they are actually being moved to another inpatient unit, is to my mind something of an indictment of the inpatient service 'system' and Transforming Care's lack of fundamental impact upon it.</span><o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><div class="separator" style="clear: both; text-align: center;"><br /></div></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">None of these past four blogposts gets to the heart of what this failure has done to countless people and those close to them since the BBC Winterbourne View programme was aired (and in the years and decades before then). </span><span style="font-family: times; font-size: large;">Surely the government must see that, after 12 years, something radically different is required?</span></div>Chris Hattonhttp://www.blogger.com/profile/05299821560069281510noreply@blogger.com0tag:blogger.com,1999:blog-1016904785776950121.post-69048806053444636632023-08-01T10:12:00.000+01:002023-08-01T10:12:11.680+01:00Winterbourne View 12 years on - 2023. Report card 3: Planning within inpatient units<p><span style="font-family: times; font-size: large;">This blogpost is the third of four looking at the Transforming Care/Building The Right Support programme through the prism of the national statistics regularly produced by NHS Digital/NHS England, and updating a series of blogposts I last updated in 2022 on the same issues.</span></p><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><a href="https://chrishatton.blogspot.com/2023/08/winterbourne-view-12-years-on-2023.html" target="_blank">The first blogpost </a>looked at statistics on the number of people being admitted to inpatient services, where they were being admitted from, and the legal status and ward security of people in inpatient units.</span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><a href="https://chrishatton.blogspot.com/2023/08/winterbourne-view-12-years-on-2023_1.html" target="_blank">The second blogpost</a> looked at how far people were from home and how long they were staying in inpatient services.</span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">This blogpost will focus on what the statistics are telling us about planning within inpatient services, using statistics from Assuring Transformation. If Transforming Care/Building The Right Support has made progress, its effects should be felt through whether people’s needs are being regularly reviewed, and whether people are having regular, effective Care and Treatment Reviews (CTRs).</span></div><div class="separator" style="clear: both; text-align: center;"><br /></div><span style="font-family: times;"><span style="font-size: medium;">For everyone in inpatient services, reviews should happen regularly. The graph below shows how long ago people in inpatient services had had their last review, from March 2015 to March 2023. The graph generally shows that things seem to improve at times when there is more government/NHS England attention or pressure, but without that pressure reviews begin to drift again. By March 2023, half of people (49%) had had a review in the past 12 weeks, and almost a quarter (22%) between 12 weeks and 6 months ago. However, a further quarter (13%) last had a review between 6 months and a year ago, and another 11% had last had a review over a year ago. The figures for March 2023 are a big improvement on March 2022, but figures do fluctuate from year to year.</span><br /></span><div class="MsoNormal"><span style="font-family: times;"><o:p></o:p></span></div><div class="MsoNormal"><o:p><br /></o:p></div><div class="MsoNormal"><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgoDHtZTNRYYrGjJBxJW8wZKlGUVv1TklgEdrHzoES8y2oULKxmfFie8YP0rjxccjYPz4VigYjmrlgwdwL5u8MJDQ6eWI12jnwnA6Xv56n5nZEScuB2KaQubaAF2tHDzLvkEICuLjeoU-gVpj0LL8rMlLbbpJr2IoUc143lPbi-W9Kk4aQSXidSPdf1o3xi" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="577" data-original-width="1030" height="358" src="https://blogger.googleusercontent.com/img/a/AVvXsEgoDHtZTNRYYrGjJBxJW8wZKlGUVv1TklgEdrHzoES8y2oULKxmfFie8YP0rjxccjYPz4VigYjmrlgwdwL5u8MJDQ6eWI12jnwnA6Xv56n5nZEScuB2KaQubaAF2tHDzLvkEICuLjeoU-gVpj0LL8rMlLbbpJr2IoUc143lPbi-W9Kk4aQSXidSPdf1o3xi=w640-h358" width="640" /></a></div></div></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">A particular form of review introduced by Transforming Care as a way to bring in independent voices to challenge inpatient services is the Care and Treatment Review (CTR), now extended to Care, Education and Treatment Reviews (C(E)TR) . The graph below reports the last time people in inpatient services had had a C(E)TR, from March 2017 to March 2023. The graph shows that the vast majority of people in inpatient services have had a C(E)TR at some point (90% of people in March 2023), and that this coverage has increased from 82% of people in March 2017. Perhaps one concern is that in March 2023 12% of people last had a C(E)TR more than a year ago, a proportion that has stayed fairly consistent over the last four years.</span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><o:p></o:p></div><div class="MsoNormal"><span style="mso-fareast-language: EN-GB; mso-no-proof: yes;"><!--[if gte vml 1]><v:shape
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</v:shape><![endif]--><!--[if !vml]--><!--[endif]--></span><o:p></o:p></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjzAH5nL5AKzbWjDLpo877obqY6rYVTOLovEu6g0Z7rpXr5k26q8D-SK2lF-oqu7H8_y6PxIrYbviCFdf3XuQ9aRJ2rcE7LaZFLJ5U91rqPY7jZ_mtvpwh3LqY8VejHecEXJRTxP2Jao6tuWKbyVfgUokBGnUvA02ikEyxAUBOvyhSjFoNcantfr-OwUw/s1949/AT%20data%20June%202022%20graph%203.3.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1011" data-original-width="1949" height="332" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjzAH5nL5AKzbWjDLpo877obqY6rYVTOLovEu6g0Z7rpXr5k26q8D-SK2lF-oqu7H8_y6PxIrYbviCFdf3XuQ9aRJ2rcE7LaZFLJ5U91rqPY7jZ_mtvpwh3LqY8VejHecEXJRTxP2Jao6tuWKbyVfgUokBGnUvA02ikEyxAUBOvyhSjFoNcantfr-OwUw/w640-h332/AT%20data%20June%202022%20graph%203.3.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">The graph below shows when people are next scheduled to have a C(E)TR. Again, there are improvements from March 2017 to March 2023, where the proportion of people with no scheduled future C(E)TR dropped from almost half (46%) to 8% of people. For a further 12% of people in March 2023 the date for their scheduled C(E)TR had passed without a C(E)TR happening.<o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="mso-fareast-language: EN-GB; mso-no-proof: yes;"><!--[if gte vml 1]><v:shape
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</v:shape><![endif]--><!--[if !vml]--><!--[endif]--></span><o:p></o:p></div><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEim8NSzJ3-x38rW_Cv4h8XuWOPE6JAeNmZr7shboG8JKgb8b_4I9lc9N1oK2P2WBFExf9abwmWJxazLUEbfZ5mQJRSdAKQ460mqjbswR-HfqfD4pKg_SI21VJlIBuuTUaArpXdep1IlxfwlsTqyRUXQ8hLHTc0UEsChLrwLpfJzerdUAcxNvDMp1qhy8E0x" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="456" data-original-width="897" height="326" src="https://blogger.googleusercontent.com/img/a/AVvXsEim8NSzJ3-x38rW_Cv4h8XuWOPE6JAeNmZr7shboG8JKgb8b_4I9lc9N1oK2P2WBFExf9abwmWJxazLUEbfZ5mQJRSdAKQ460mqjbswR-HfqfD4pKg_SI21VJlIBuuTUaArpXdep1IlxfwlsTqyRUXQ8hLHTc0UEsChLrwLpfJzerdUAcxNvDMp1qhy8E0x=w640-h326" width="640" /></a></div><br /><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">Overall there are signs that more people in inpatient services are having both regular reviews and Care and Treatment Reviews, although reviews often drift back to lower levels outside times of particular pressure being applied. There are still large numbers of people in inpatient services who have not had any sort of review for a long time, however. Care and Treatment Reviews are being done, but what difference are they making?</span></div>Chris Hattonhttp://www.blogger.com/profile/05299821560069281510noreply@blogger.com0tag:blogger.com,1999:blog-1016904785776950121.post-48264296646292333602023-08-01T10:00:00.002+01:002023-08-01T10:00:39.920+01:00Winterbourne View 12 years on - 2023. Report card 2: How far are people from home, for how long?<p> <span style="font-family: times; font-size: large;">This blogpost is the second of four, updating a series of blogposts on various aspects of Transforming Care/Building The Right Support I last updated in 2022.</span><span style="font-family: times; font-size: large;"> </span><a href="https://chrishatton.blogspot.com/2023/08/winterbourne-view-12-years-on-2023.html" target="_blank">The first blogpost in this updated series</a><span style="font-family: times; font-size: large;"> </span><span style="font-family: times; font-size: large;">looked at who was being admitted to inpatient units, where they were being admitted from, and the legal status and ward security of people in inpatient services. This second blogpost will focus on two aspects of what happens to people in inpatient services, how far people are from home and how long they are in inpatient services. They use information from</span><span style="font-family: times; font-size: large;"> </span><a href="https://digital.nhs.uk/data-and-information/publications/statistical/learning-disability-services-statistics" style="font-family: times; font-size: large;" target="_blank">the Assuring Transformation dataset</a><span style="font-family: times; font-size: large;">, provided by NHS Digital/NHS England.</span></p><div><div class="MsoNormal"><div class="MsoNormal"><span style="font-family: times; font-size: medium;">One of the main policies consistently trumpeted is having crisis and inpatient services close to home. The graph below reports information on the ‘distance from home’ of people in inpatient units, as reported in the Assuring Transformation dataset, from May 2017 to May 2023 (no data were published for May 2021). The graph firstly shows that the biggest change in how far people are from home, from May 2016 to May 2023, is the huge increase in the proportion of people whose distance from home is recorded as 'unknown' (from 15% of people in May 2017 to 28% of people in May 2023). This makes interpreting other apparent changes over time difficult, as we don't know how far these extra 'unknown' people are from home. By May 2023, a quarter (24%) of people were reported to be in inpatient units more than 50km from their home. </span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">How, many years on from the introduction of this dataset, information is not provided for almost a third of people on a supposed 'flagship' indicator, is beyond me.</span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgPc1moMXGplg5otUZLn9e-myELb64Stv1jWvA8sPI5sAQVMha4CSFM_4JjGphLpTWj4pzmcfLEjD2hzynjixfyNSlRMdxXjJkN_aTT2S3duUZY1s31zSiP0fRBFffGGuebqa1AjZhyETgsqH2xEhEA-Fl7UaYj7DJaOUvw-mgT8gpdItGLg857QiNyNhLH" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="558" data-original-width="929" height="384" src="https://blogger.googleusercontent.com/img/a/AVvXsEgPc1moMXGplg5otUZLn9e-myELb64Stv1jWvA8sPI5sAQVMha4CSFM_4JjGphLpTWj4pzmcfLEjD2hzynjixfyNSlRMdxXjJkN_aTT2S3duUZY1s31zSiP0fRBFffGGuebqa1AjZhyETgsqH2xEhEA-Fl7UaYj7DJaOUvw-mgT8gpdItGLg857QiNyNhLH=w640-h384" width="640" /></a></div><br /><br /></div></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">Another important policy aim of Transforming Care/Building The Right Support is to reduce the length of time that people spend in inpatient units. The graph below shows how long people have been in their current inpatient unit according to Assuring Transformation statistics, from March 2015 through to March 2023. There are very gradual trends towards a greater proportion of people being in their current inpatient unit for shorter lengths of time up to March 2018, although the picture has been pretty static since then. In March 2023 13% of people had been in their current inpatient unit for 5 years or longer.</span></div><div class="MsoNormal"><br /></div><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEghwHhBUVWXOxCLBI7z_NGfXnTjBZ7hILWDlVW_HJiV_thUKxIFliUqMIV6e3k9QS75fQLEoRed4EI7WbwUbkS3WewaSybvkGQNQfU0LUhX37uvlbBtp3D42BsRPCuRbcSXIHzZm7t9gniI775YoevAud5KT6zBbxxcVdlNPrUr5c_GQOV15igIz746Q_L7" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="527" data-original-width="1087" height="310" src="https://blogger.googleusercontent.com/img/a/AVvXsEghwHhBUVWXOxCLBI7z_NGfXnTjBZ7hILWDlVW_HJiV_thUKxIFliUqMIV6e3k9QS75fQLEoRed4EI7WbwUbkS3WewaSybvkGQNQfU0LUhX37uvlbBtp3D42BsRPCuRbcSXIHzZm7t9gniI775YoevAud5KT6zBbxxcVdlNPrUr5c_GQOV15igIz746Q_L7=w640-h310" width="640" /></a></div><br /><br /></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">As I mentioned in the previous post, these is a lot of evidence that substantial numbers of people are moved around different inpatient services without ever leaving the inpatient service system. Assuring Transformation also reports information on how long people have been continuously within inpatient services (not just how long they have been in their current unit). The graph below shows this information from March 2015 to March 2023. The impact of people being transferred around can be clearly seen; in March 2023 over a third of people (33%) had been continuously in inpatient services for 5 years or longer, a proportion that has hardly changed from March 2015.</span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><o:p></o:p></div><div class="MsoNormal"><span style="mso-fareast-language: EN-GB; mso-no-proof: yes;"><!--[if gte vml 1]><v:shape
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</v:shape><![endif]--><!--[if !vml]--><!--[endif]--></span><o:p></o:p></div><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhFSoXbHe72QahkQr2GZh_UEqy7CZETJKtYcWExKwmpxG9dWl9gsL9wOhl4EKqn2g2VikZuNgi8jz2ds_-ChkMs0NB1WdQyL0-WOdCl9brI3AT_PLJ6C-TV2UWFNJxR7ZJ1DcveLV_MAUCsfBddlsPPpGXxyJIoJWJjMqLj8K4ondld87Y_m2W-Kg_rfBqX" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="536" data-original-width="1050" height="326" src="https://blogger.googleusercontent.com/img/a/AVvXsEhFSoXbHe72QahkQr2GZh_UEqy7CZETJKtYcWExKwmpxG9dWl9gsL9wOhl4EKqn2g2VikZuNgi8jz2ds_-ChkMs0NB1WdQyL0-WOdCl9brI3AT_PLJ6C-TV2UWFNJxR7ZJ1DcveLV_MAUCsfBddlsPPpGXxyJIoJWJjMqLj8K4ondld87Y_m2W-Kg_rfBqX=w640-h326" width="640" /></a></div><br /><br /></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">Finally, Assuring Transformation also reports the average length of time that people have been in their current inpatient unit, and continuously in inpatient services. The graph below shows that people were on average in their current inpatient unit for just under 3 years, with this length of stay hardly changing from March 2017 to March 2023. The total length of time people have been continuously in inpatient services showed a recent reduction from March 2022 to March 2023 but still stands at an average of well over 5 years, the same as in March 2015.</span><o:p></o:p></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="mso-fareast-language: EN-GB; mso-no-proof: yes;"><!--[if gte vml 1]><v:shape
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</v:shape><![endif]--><!--[if !vml]--><!--[endif]--></span><o:p></o:p></div><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgR3dD5Vwtdgy_hgvRTRX5Nck89Is2gjyG88nAS5WiG5lw1UMBVIM7uLe928H3P-QjxUUBgJvbMZmwBbCdJC8rgRL1I58ED5S95JnBL9U97tJn8VI1fZBlSPuLzJ9Uu5A_QLZ71anOR3VgFbI-LzgkI3MJ3K9QFnZ1WKXp_63nCUQMo9ckrfx6m4uebiG0p" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="496" data-original-width="1045" height="304" src="https://blogger.googleusercontent.com/img/a/AVvXsEgR3dD5Vwtdgy_hgvRTRX5Nck89Is2gjyG88nAS5WiG5lw1UMBVIM7uLe928H3P-QjxUUBgJvbMZmwBbCdJC8rgRL1I58ED5S95JnBL9U97tJn8VI1fZBlSPuLzJ9Uu5A_QLZ71anOR3VgFbI-LzgkI3MJ3K9QFnZ1WKXp_63nCUQMo9ckrfx6m4uebiG0p=w640-h304" width="640" /></a></div></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">What does this mean? First, it’s obvious that inpatient services have not become radically more local as Transforming Care/Building The Right Support has ‘progressed’, with Assuring Transformation reporting that a quarter of people are more than 50km from home and this information simply not being reported for almost a third of people. The information on how long people are staying in inpatient units reflects the continuing ‘churn’ of people between inpatient units without seeing the outside world, with people still on average spending well over 5 years continuously in some form of inpatient unit.</span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">Reducing distance from home and length of stay were both supposed to be central to Transforming Care/Building The Right Support – as far as I can tell, these have shown very little change since the data started being published.</span></div></div>Chris Hattonhttp://www.blogger.com/profile/05299821560069281510noreply@blogger.com0tag:blogger.com,1999:blog-1016904785776950121.post-16371976818330522922023-08-01T08:48:00.001+01:002023-08-01T08:48:14.971+01:00Winterbourne View 12 Years On - 2023. Report card 1: People being admitted to inpatient units, legal status and ward security<p><span style="background-color: white; color: #444444; font-size: 13.5pt;"><span style="font-family: trebuchet;">It is now more than twelve years since the BBC aired its programme about the horrendous abuse meted out to people with learning disabilities and autistic people at Winterbourne View, a ‘specialist’ inpatient unit.</span></span></p><div class="post-body entry-content" id="post-body-4349868429085908554" itemprop="description articleBody" style="background-color: white; color: #666666; line-height: 1.4; position: relative; width: 546px;"><p style="font-size: 13.2px;"></p><p class="MsoNormal" style="font-size: 13.2px; line-height: normal; margin-bottom: 0cm;"><span style="font-size: 13.5pt;"><span style="color: #444444;"><span style="font-family: trebuchet;">Has nothing really changed at all in this 12 years, with the panoply of policies, progress reports, rebranded initiatives when previous ones have not met their targets, meetings, deep dives, reviews, flow charts, workshops, more reviews, and days, weeks and years of people’s lives living in spaces beyond human rights and dignity (not to mention the amount of public money that must have been spent on officials to get a ‘grip’)?<o:p></o:p></span></span></span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><span style="color: #444444;"><span style="font-family: trebuchet;"><span style="font-size: 13.5pt;">There are many ways to try and answer this question. One thing I’ve been doing sporadically is to look at the official monthly statistics published by NHS Digital (now absorbed into the NHS England empire) about autistic people and people with learning disabilities in inpatient units, to see if they reveal any tangible evidence of change over time (or at least since 2015, when some of this information began to become available). The last time I went through a comprehensive ‘report card’ on inpatient units was in the summer of 2022, in a series of four blogposts (the link to the first one of these </span><a href="https://chrishatton.blogspot.com/2022/06/winterbourne-view-11-years-on-report.html" target="_blank">is here</a><span style="font-size: 13.5pt;">). I’m going to update this 'report card' in four similar blogposts.</span></span></span></p><p class="MsoNormal" style="font-size: 13.2px; line-height: normal; margin-bottom: 0cm;"><span style="color: #444444;"><span style="font-family: trebuchet;"><span style="font-size: 13.5pt;">I will not cover in detail the issue of the overall number of people in these inpatient units (I went through this record of failure against the succession of targets the government set for itself recently </span><a href="https://chrishatton.blogspot.com/2023/06/vanishing-point-when-will-targets-about.html" target="_blank">here</a><span style="font-size: 13.5pt;">. I want to look again at some of the other statistics that give us some clues about what has been happening with Transforming Care and its successors 12 years on from Winterbourne View. </span></span></span></p><p class="MsoNormal" style="font-size: 13.2px; line-height: normal; margin-bottom: 0cm;"><span style="color: #444444;"><span style="font-family: trebuchet;"><span style="font-size: 13.5pt;">These blogposts will focus on <a href="https://digital.nhs.uk/data-and-information/publications/statistical/learning-disability-services-statistics" style="color: #2288bb; text-decoration-line: none;">information produced publicly by NHS Digital</a>/NHS England from one of two datasets. It uses data from the</span><span style="font-size: 13.5pt;"> Assuring Transformation dataset – for this dataset, health service commissioners provide information (sometimes retrospectively) on the number of people with learning disabilities and autistic people in specialist inpatient services and on various aspects of what is happening with or to people. I’ve collected some of the information into yearly blocks, and some of the information I report for every year rather than every month (both you and I would not survive that amount of information…). This means that most of the information goes up to March 2023. </span></span></span></p><p class="MsoNormal" style="font-size: 13.2px; line-height: normal; margin-bottom: 0cm;"><span style="color: #444444;"><span style="font-family: trebuchet;"><span style="font-size: 13.5pt;">In this post I have not used information from the Mental Health Services Dataset (MHSDS), which reports information collected by mental health service providers concerning people identified by them as a person with learning disabilities or an autistic person – this has been published monthly starting more recently than the Assuring Transformation dataset and is less detailed about processes. In different ways both datasets are partial – Assuring Transformation does not include a lot of people in mainstream mental health inpatient units, and some big independent sector inpatient service organisations are not yet reporting aspects of their activity to the MHSDS. According to NHS Digital (now absorbed into the NHS England empire) provider organisations contributing information have been subject to a cyber-attack which means that data from the MHSDS has not been complete for almost a year.</span></span></span></p><p class="MsoNormal" style="font-size: 13.2px; line-height: normal; margin-bottom: 0cm;"><span style="color: #444444; font-family: trebuchet; font-size: 13.5pt;">As with the previous series, these four blogposts will focus on:</span></p><ul style="font-size: 13.2px; line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;" type="disc"><li class="MsoNormal" style="line-height: normal; margin: 0px 0px 0.25em; padding: 0px;"><span style="font-size: 13.5pt;"><span style="color: #444444;"><span style="font-family: trebuchet;">Who is going into inpatient services?<o:p></o:p></span></span></span></li><li class="MsoNormal" style="line-height: normal; margin: 0px 0px 0.25em; padding: 0px;"><span style="font-size: 13.5pt;"><span style="color: #444444;"><span style="font-family: trebuchet;">How far are people from home, and how long are people spending in inpatient services?<o:p></o:p></span></span></span></li><li class="MsoNormal" style="line-height: normal; margin: 0px 0px 0.25em; padding: 0px;"><span style="font-size: 13.5pt;"><span style="color: #444444;"><span style="font-family: trebuchet;">What planning and review is happening in inpatient services?<o:p></o:p></span></span></span></li><li class="MsoNormal" style="line-height: normal; margin: 0px 0px 0.25em; padding: 0px;"><span style="font-size: 13.5pt;"><span style="color: #444444;"><span style="font-family: trebuchet;">What is happening about people leaving inpatient services, and where are they going?<o:p></o:p></span></span></span></li></ul><p class="MsoNormal" style="font-size: 13.2px; line-height: normal; margin-bottom: 0cm;"><span style="font-size: 13.5pt;"><span style="color: #444444;"><span style="font-family: trebuchet;">So – much of the focus of the various iterations of the Transforming Care programme and its rebranded successors has been on getting people out of inpatient units, but the slower than planned reduction in the overall number of people in these units suggests that there are still substantial numbers of people coming into these units. What do the statistics tell us about this?<o:p></o:p></span></span></span></p><p class="MsoNormal" style="font-size: 13.2px; line-height: normal; margin-bottom: 0cm;"><span style="color: #444444;"><span style="font-family: trebuchet;"><span style="font-size: 13.5pt;">Every month, the Assuring Transformation statistics report how many people have come into an inpatient unit (called ‘admissions’) according to commissioners. The graph below adds these together across seven different years (each one October to September), so we can see the number of people coming into these units and whether they have changed over time.</span></span></span></p><p class="MsoNormal" style="font-size: 13.2px; line-height: normal; margin-bottom: 0cm;"><span style="color: #444444; font-family: trebuchet; font-size: 13.5pt;"> </span></p><div class="separator" style="clear: both; font-size: 13.2px; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhanG3POdXo-wU4fE_FKDp01WmxoQYY1kigEkesUMcMpgYK_XqIYJaoY4TALCqdD0xWHZ5HM1sEbOfxWKAvmvQ0boun8OFXFswApHdG7FPKq08TzogbN6B_JKMbkXKx1jbRy5RDLSZ6QNYJK_DeYU87ICuD0CPexvoTsNXLL_2xZDnrkh9ej8IiLJkZ4UWI" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="565" data-original-width="1046" height="346" src="https://blogger.googleusercontent.com/img/a/AVvXsEhanG3POdXo-wU4fE_FKDp01WmxoQYY1kigEkesUMcMpgYK_XqIYJaoY4TALCqdD0xWHZ5HM1sEbOfxWKAvmvQ0boun8OFXFswApHdG7FPKq08TzogbN6B_JKMbkXKx1jbRy5RDLSZ6QNYJK_DeYU87ICuD0CPexvoTsNXLL_2xZDnrkh9ej8IiLJkZ4UWI=w640-h346" width="640" /></a></div><br /><br /></div><p style="font-size: 13.2px;"></p><p class="MsoNormal" style="font-size: 13.2px; line-height: normal; margin-bottom: 0cm;"><span style="font-size: 13.5pt;"><span style="color: #444444;"><span style="font-family: trebuchet;">The first thing the graph shows us is, pre-COVID, the overall number of admissions to inpatient services was increasing, from 1,810 admissions in 2015/16 to 2,250 admissions in 2018/19. The total number of admissions dropped to 1,745 admissions in Oct 2019 - Sept 2020, when COVID-19 hit, increased in 2020/21 to 1,830 admissions, then dropped again in 2021/22 to 1,530 admissions. In total, there have been 13,170 admissions to these inpatient units in the last sseven years - we don't know how many of these are the same people being admitted more than once or different people being admitted.</span></span></span></p><p class="MsoNormal" style="font-size: 13.2px; line-height: normal; margin-bottom: 0cm;"><span style="font-family: trebuchet;"><span style="font-size: 13.5pt;"><span style="color: #444444;">The second thing to notice is that a large proportion of admissions (the red chunk) are actually transfers from other hospitals (mainly other inpatient services of various types), running consistently at 20% or more of all admissions. </span></span><span style="color: #444444; font-size: 13.5pt;">The third thing I want to mention is that more than one in six admissions (the lilac chunk) are re-admissions, where people had previously been in an inpatient service less than a year before. Finally, the purple chunk shows that getting on for two thirds of admissions to inpatient services (63% in 2021/22) are people who have not been in an inpatient unit for at least a year (or maybe never).</span></span></p><p class="MsoNormal" style="font-size: 13.2px; line-height: normal; margin-bottom: 0cm;"><span style="font-size: 13.5pt;"><span style="color: #444444;"><span style="font-family: trebuchet;"><br /></span></span></span></p><p class="MsoNormal" style="font-size: 13.2px; line-height: normal; margin-bottom: 0cm;"><span style="font-size: 13.5pt;"><span style="color: #444444;"><span style="font-family: trebuchet;">What kinds of places are people being admitted to inpatient services coming from? The graph below shows this information from the Assuring Transformation statistics, for five one-year blocks (starting in October 2016, through to September 2022).</span></span></span></p><p class="MsoNormal" style="font-size: 13.2px; line-height: normal; margin-bottom: 0cm;"><span style="font-size: 13.5pt;"><span style="color: #444444;"><span style="font-family: trebuchet;">In 2021/22, almost half of people (755 people; 49%) were admitted from their ‘usual place of residence’ and 43% of people (655 people) were admitted from other inpatient and/or hospital services. A further 75 people (5%) in 2021/22 were admitted from ‘penal establishments’ and 15 people (2%) were admitted from residential care services. In line with the overall decline in the number of admissions when comparing 2016/17 to 2021/22, the number of people being admitted from most types of place has also dropped. There are two exceptions: people being admitted from temporary places of residence (5 people in 2016/17; 20 people in 2021/22), and people being admitted from general hospitals/A&E wards (170 people in 2016/17; 295 people in 2021/22).</span></span></span></p><p class="MsoNormal" style="font-size: 13.2px; line-height: normal; margin-bottom: 0cm;"><span style="color: black; font-size: 13.5pt;"><span style="font-family: trebuchet;"> </span></span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: black; font-size: 13.5pt;"><span style="font-family: trebuchet;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjPbKCPSSKKb1Mt2GD1XLi-T7POXPQiDm-nPZketFfJR19wgJIGAg3Owrd7lZ77Vil46GhfFlsyBp2KiB8M3uu5CUYqbdvylR4Nw2aZzV48Avh6or5Mpxq2gxQ9T6oVduCrq6NSXM_ezVHY8CMxnoj1SxYjzkKwIB206A3oBoQANlWITwBsQDWI6b4tSzGW" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="556" data-original-width="1027" height="346" src="https://blogger.googleusercontent.com/img/a/AVvXsEjPbKCPSSKKb1Mt2GD1XLi-T7POXPQiDm-nPZketFfJR19wgJIGAg3Owrd7lZ77Vil46GhfFlsyBp2KiB8M3uu5CUYqbdvylR4Nw2aZzV48Avh6or5Mpxq2gxQ9T6oVduCrq6NSXM_ezVHY8CMxnoj1SxYjzkKwIB206A3oBoQANlWITwBsQDWI6b4tSzGW=w640-h346" width="640" /></a></span></span></div><span style="color: black; font-size: 13.5pt;"><span style="font-family: trebuchet;"><br /></span></span><p></p><div class="separator" style="clear: both; font-size: 13.2px; text-align: center;"><br /></div><p class="MsoNormal" style="font-size: 13.2px; line-height: normal; margin-bottom: 0cm;"><span style="font-size: 13.5pt;"><span style="color: #444444;"><span style="font-family: trebuchet;">Overall, the number of people admitted to inpatient services have, with some fluctuations, been consistently lower since the COVID-19 pandemic started. However, there are signs that the promises of </span></span></span><span style="color: #444444; font-family: trebuchet; font-size: 13.5pt;">Building The Right Support in 2015 about effective community support for people have not been kept. The number of people being readmitted within a year of leaving hospital has hardly changed in six years, and the number of people being admitted from general hospitals/A&E wards in particular has risen sharply and stayed high. The AT dataset is also bad at recording people with learning disabilities and autistic people who are in general hospital mental health inpatient wards - the MHSDS is much better at including people in these circumstances but we don't have comprehensive national information from this dataset at the moment.</span></p><p class="MsoNormal" style="font-size: 13.2px; line-height: normal; margin-bottom: 0cm;"><br /></p><p class="MsoNormal" style="font-size: 13.2px; line-height: normal; margin-bottom: 0cm;"><span style="font-size: 13.5pt;"><span style="color: #444444;"><span style="font-family: trebuchet;">Have any changes in admissions resulted in changes to the legal status or the ward security of people with learning disabilities and autistic people in inpatient units? A persistent argument has been that people on MHA Part III sections (particularly those with legal restrictions) and people in higher security places are more likely to need to remain in inpatient services, so the number of people in these categories should not change much even if the number of people in inpatient units reduces overall. </span></span></span></p><p class="MsoNormal" style="font-size: 13.2px; line-height: normal; margin-bottom: 0cm;"><span style="font-size: 13.5pt;"><span style="color: #444444;"><span style="font-family: trebuchet;">The graph below shows the number of people in inpatient units at the end of March each year from 2016 to 2023, broken down by the legal status of people in inpatient units according to Assuring Transformation data.</span></span></span></p><p class="MsoNormal" style="font-size: 13.2px; line-height: normal; margin-bottom: 0cm;"><span style="font-size: 13.5pt;"><span style="color: #444444;"><span style="font-family: trebuchet;">The most common legal status for people in inpatient units is a Part II section, where the number of people has dropped by 14% from 2016 to 1,135 people in March 2023. The next most common legal status is a Part III section with restrictions, where the number of people has dropped by 24% from 2016 to 545 people in March 2023. Less common are people with Part III sections without restrictions (which dropped by 46% from 2016 to 220 people in March 2023), people not subject to the Mental Health Act (which dropped by 38% from 2016 to 200 people in March 2023), and people in other sections (which dropped by 18% from 2016 to 45 people in March 2023). It is clear that reductions in the number of people in inpatient units have reduced for people with almost all types of legal status from 2016 to 2023.</span></span></span></p><p class="MsoNormal" style="font-size: 13.2px; line-height: normal; margin-bottom: 0cm;"><span style="font-size: 13.5pt;"><span style="color: #444444;"><span style="font-family: trebuchet;"><br /></span></span></span></p><p class="MsoNormal" style="font-size: 13.2px; line-height: normal; margin-bottom: 0cm;"><span style="font-family: trebuchet;"><span style="font-size: 13.5pt;"></span></span></p><div class="separator" style="clear: both; font-size: 13.2px; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjxQuNIMneSO1RHZau_w-MgtK7jKNvewSIhCiDy5UKnKNduWX_jpH7F5QQito7-OZv_Ny_pK5un-73CpGwwFw8QFbC65tT2knea1V9NHgINzrk8gtrwVUPEcEJRi5NAikM_cS8Cz82elpiuYP9HedPvBxwHKaWRG9lR6tSPTcolXV552IYbLj9INU7GfnMW" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="524" data-original-width="944" height="356" src="https://blogger.googleusercontent.com/img/a/AVvXsEjxQuNIMneSO1RHZau_w-MgtK7jKNvewSIhCiDy5UKnKNduWX_jpH7F5QQito7-OZv_Ny_pK5un-73CpGwwFw8QFbC65tT2knea1V9NHgINzrk8gtrwVUPEcEJRi5NAikM_cS8Cz82elpiuYP9HedPvBxwHKaWRG9lR6tSPTcolXV552IYbLj9INU7GfnMW=w640-h356" width="640" /></a></div><br /><br /></div><span style="font-size: 13.5pt;"><span style="font-family: trebuchet;"><span style="color: #444444;">The picture is similar when looking at ward security, as the graph below shows. The most common level of ward security is 'general', where the number of people in 'general' ward security dropped by 15% from 2016 to 1,145 people in March 2023. The next most common level of ward security is 'low secure', where the number of people dropped by 35% from 2016 to 550 people in March 2023. Together, people in 'general' and 'low secure' places were 79% of all people with learning disabilities and autistic people in inpatient units in March 2023. </span></span></span><p style="font-size: 13.2px;"></p><p class="MsoNormal" style="font-size: 13.2px; line-height: normal; margin-bottom: 0cm;"><span style="font-size: 13.5pt;"><span style="color: #444444;"><span style="font-family: trebuchet;">The number of people in medium secure inpatient units also dropped by 38% from 2016 to 320 people in March 2023, with smaller numbers of people recorded in high secure units (65 people) and Psychiatric Intensive Care Units (70 people - an increase of 56% from 2016).</span></span></span></p><p class="MsoNormal" style="font-size: 13.2px; line-height: normal; margin-bottom: 0cm;"><span style="font-family: trebuchet;"><span style="font-size: 13.5pt;"></span></span></p><div class="separator" style="clear: both; font-size: 13.2px; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiLh6LV5_DRnWIL9h9zAoFKbnYRWJyqX1QWhAUkd3ZUyYwdkW_bXp33X3SvNUXb-XQOAz2fStbmKQ82UMaHvD9a2kc17Um8aZYVro31I-klPlTBV3LAKfagp74jLIdIu30qebTPE5Rwci2MJcZLi46wqr2DBDJfL1Pyhw-ttHLqhfLK1gGs3dsfPESTGCQ_" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="524" data-original-width="916" height="366" src="https://blogger.googleusercontent.com/img/a/AVvXsEiLh6LV5_DRnWIL9h9zAoFKbnYRWJyqX1QWhAUkd3ZUyYwdkW_bXp33X3SvNUXb-XQOAz2fStbmKQ82UMaHvD9a2kc17Um8aZYVro31I-klPlTBV3LAKfagp74jLIdIu30qebTPE5Rwci2MJcZLi46wqr2DBDJfL1Pyhw-ttHLqhfLK1gGs3dsfPESTGCQ_=w640-h366" width="640" /></a></div><br /><br /></div><span style="font-size: 13.5pt;"><span style="font-family: trebuchet;"><span style="color: #444444;">Clearly, reducing the number of people in inpatient units does not need to exclude people on Part III sections or people on low or medium secure wards.</span></span></span></div><div class="post-body entry-content" id="post-body-4349868429085908554" itemprop="description articleBody" style="background-color: white; line-height: 1.4; position: relative; width: 546px;"><br /></div><div class="post-body entry-content" id="post-body-4349868429085908554" itemprop="description articleBody" style="background-color: white; line-height: 1.4; position: relative; width: 546px;">Since the start of the COVID-19 pandemic, it looks like consistently fewer people are being admitted to the kind of inpatient wards/units covered by AT, and that these reductions aren't confined to people with a particular legal status or wards with particular levels of security. There are real questions about the extent to which these figures suggest a lack of the kind of support outside hospitals that has been promised for over a decade. People are still being moved between inpatient units, and more people are coming into inpatient units from hospital A&E departments and temporary accommodation. We don't know whether more people with learning disabilities and autistic people are going in and out of general hospital mental health inpatients and what people's experiences are in these places. We also don't know how many people are getting any sort of support outside of hospital, and how good that support is. </div><div class="post-body entry-content" id="post-body-4349868429085908554" itemprop="description articleBody" style="background-color: white; line-height: 1.4; position: relative; width: 546px;"><br /></div><div class="post-body entry-content" id="post-body-4349868429085908554" itemprop="description articleBody" style="background-color: white; line-height: 1.4; position: relative; width: 546px;">In the next blogpost I'll look at a couple of consequences of this - how far people from home are people being sent, and how long people are staying in these places.</div><div class="post-body entry-content" id="post-body-4349868429085908554" itemprop="description articleBody" style="background-color: white; line-height: 1.4; position: relative; width: 546px;"><p style="color: #666666; font-size: 13.2px;"></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><br /></p></div>Chris Hattonhttp://www.blogger.com/profile/05299821560069281510noreply@blogger.com0tag:blogger.com,1999:blog-1016904785776950121.post-62835587620346387112023-07-03T15:54:00.006+01:002023-07-03T17:20:11.062+01:00Disability benefits, people with learning disabilities and autistic people - 2023 update<p><span style="background-color: white; color: #666666; font-family: verdana; font-size: 13.2px;">This is a quick blogpost about disability benefit statistics, people with learning disabilities and autistic people, <a href="https://chrishatton.blogspot.com/2021/01/disability-benefits-people-with.html" target="_blank">updating one from early 2021</a>, with figures mainly up to November 2022. All these figures are obtained from the excellent</span><span style="background-color: white; color: #666666; font-family: verdana; font-size: 13.2px;"> </span><span style="background-color: white; color: #666666; font-family: verdana; font-size: 13.2px;"><a href="https://www.gov.uk/guidance/dwp-benefit-statistics-dissemination-tools#stat-xplore" style="color: #2288bb; text-decoration-line: none;" target="_blank">DWP Stat-Xplore online tool</a></span><span style="background-color: white; color: #666666; font-family: verdana; font-size: 13.2px;">. I’m going to talk about three disability benefits here:</span></p><div class="post-body entry-content" id="post-body-1460427604672433241" itemprop="description articleBody" style="background-color: white; color: #666666; font-size: 13.2px; line-height: 1.4; position: relative; width: 546px;"><div class="MsoNormal" style="font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif;"><span style="font-family: verdana;"><br /></span></div><div class="PHEBodycopy" style="font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif;"><span style="font-family: verdana;"><span lang="X-NONE">1) </span>Disability Living Allowance. <span lang="X-NONE">The Disability </span>L<span lang="X-NONE">iving Allowance (DLA) is a tax-free benefit for disabled people who need help with mobility or care costs. Disability Living Allowance (except for those born before 9 April 1948 and those aged under </span></span><span style="font-family: verdana;">16 at the time of application) is</span><span style="font-family: verdana;"> b</span><span style="font-family: verdana;"><span lang="X-NONE">e</span>ing<span lang="X-NONE"> replaced </span></span><span lang="X-NONE" style="font-family: verdana;">by </span><span style="font-family: verdana;">P</span><span lang="X-NONE" style="font-family: verdana;">ersonal</span><span lang="X-NONE" style="font-family: verdana;"> </span><span style="font-family: verdana;">I</span><span lang="X-NONE" style="font-family: verdana;">ndependence </span><span style="font-family: verdana;">P</span><span lang="X-NONE" style="font-family: verdana;">ayments. </span><span lang="X-NONE" style="font-family: verdana;">The </span><span style="font-family: verdana;">DLA </span><span lang="X-NONE" style="font-family: verdana;">consists of two components which are assessed and paid separately, a Care Award (paid at higher, middle and lower rates) and a Mobility Award (paid at higher and lower rates).</span></div><div class="PHEBodycopy" style="font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif;"><span style="font-family: verdana;"><br /></span></div><div class="PHEBodycopy" style="font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif;"><span style="font-family: verdana;"><span lang="X-NONE">The Department for Work and Pensions</span> (DWP)<span lang="X-NONE"> provides</span><span lang="X-NONE"> </span>quarterly<span lang="X-NONE"> information on Disability </span>L<span lang="X-NONE">iving </span>A<span lang="X-NONE">llowance (DLA)</span>, <span lang="X-NONE">that can be disaggregated for adults with ‘learning difficulties’ in England. The DWP definition of ‘learning difficulties’ includes ‘learning difficulties’’ (an old generic code still used for pre-2008 cases before more detailed sub-categories were introduced), ‘Down’s </span>s<span lang="X-NONE">yndrome’, ‘Fragile X </span>s<span lang="X-NONE">yndrome’, ‘</span>l<span lang="X-NONE">earning disability – Other/type not known’, ‘Autism’, ‘Asperger </span>s<span lang="X-NONE">yndrome’, and ‘Retts disorder’</span><sup>2</sup><span lang="X-NONE">. This definition is much broader than other government departments’ definitions of the population of people with learning disabilities.</span><o:p></o:p></span></div><div class="PHEBodycopy" style="font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif;"><span style="font-family: verdana;"><br /></span></div><div class="PHEBodycopy" style="font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif;"><span style="font-family: verdana;">2) Attendance Allowance<span lang="X-NONE"> (AA)</span>, which is <span lang="X-NONE">paid to disabled people over the age of 65 to help with personal care. </span>This can be paid at two rates to reflect the level of care required, and in the statistics uses the same broad definition of ‘learning difficulties’ as the DLA statistics.<o:p></o:p></span></div><div class="PHEBodycopy" style="font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif;"><span style="font-family: verdana;"><br /></span></div><div class="PHEBodycopy" style="font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif;"><span style="font-family: verdana;">3) Personal Independence Payment (PIP); a benefit for adults with sickness and/or disability replacing the DLA, but with some important differences. Information on the PIP is available on a monthly basis for adults with learning disabilities, under the category ‘Main Disabling Condition/Psychiatric Disorders/Learning Disability Global’, and for autistic people under the label ‘Main Disabling Condition/Psychiatric Disorders/Autistic Spectrum Disorders’.<o:p></o:p></span></div><div class="PHEBodycopy" style="font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif;"><span style="font-family: verdana;"><br /></span></div><div class="PHEBodycopy" style="font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif;"><span style="font-family: verdana;">In this blogpost I’m trying to get a sense of how many people with learning disabilities and autistic people (I’m assuming that the broader category of ‘learning difficulties’ is mainly these two groups of people) have been getting some form of disability benefit over time. To help with this, I’ve looked at four broad age groups: children and young people (age 0-15 for DLA); younger working age adults (age 16-44 for DLA and PIP); older working age adults (age 45-64 for DLA and PIP); and older adults (age 65+ for DLA, PIP and AA). The graphs include people getting payment for the benefit concerned, and are either people with ‘learning difficulties’ (DLA and AA) or, separately, people with learning disabilities and autistic people (PIP).<o:p></o:p></span></div><div class="PHEBodycopy" style="font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif;"><span style="font-family: verdana;"><br /></span></div><div class="PHEBodycopy" style="font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif;"><span style="font-family: verdana;">What do we find? The first graph shows how many children and young people with ‘learning difficulties’ received DLA (the only one of these three benefits where children and young people are eligible), from May 2012 to November 2022. The graph shows a steady increase in the number of children and young people with ‘learning difficulties’ getting DLA, with if anything a faster rate of increase in recent years, up to 267,436 people in November.</span></div><div class="PHEBodycopy" style="font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif;"><span style="font-family: verdana;"><br /></span></div><div class="PHEBodycopy" style="font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif;"><span style="font-family: verdana;"><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhYJqgQLaEcDKG0X5WJriDnb6GuyOq6bzahmhJl5xYLJM00vpDEGui7qyXeg57oEUnbkwEYvhUka1v_kGrm5Rfq1_r9MkK5oG7AUzmR8DsbWxxTb5O52fIpTy6XFDiTgbC5hXzQ8CQZvB-rd2Ht4lDmsXpbSO-BtkViWpaqMQbWONm-0N_LniIKqntDBELp" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="438" data-original-width="886" height="316" src="https://blogger.googleusercontent.com/img/a/AVvXsEhYJqgQLaEcDKG0X5WJriDnb6GuyOq6bzahmhJl5xYLJM00vpDEGui7qyXeg57oEUnbkwEYvhUka1v_kGrm5Rfq1_r9MkK5oG7AUzmR8DsbWxxTb5O52fIpTy6XFDiTgbC5hXzQ8CQZvB-rd2Ht4lDmsXpbSO-BtkViWpaqMQbWONm-0N_LniIKqntDBELp=w640-h316" width="640" /></a></div><br /><br /></div></span></div><div class="PHEBodycopy" style="font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif;"><span style="font-family: verdana;">The next graph below shows information for younger working age adults (aged 16 to 44), from May 2012 to November 2022, and includes both the DLA and the introduction of the PIP. As more and more people transferred from DLA to PIP there was a rapid decrease in the number of younger working age adults with ‘learning difficulties’ getting the DLA up to May 2020, after which numbers have stayed fairly stable. There have been similar rises over time in the number of people with learning disabilities and autistic people getting a PIP, although May 2020 increases for people with learning disabilities have been smaller than for autistic people. The grey line in this graph shows the combined total of people getting one of these disability benefits. This shows some fluctuations over time, with year-on-year increases punctuated by a dip in 2016, no real change from 2018 to 2020, and a steady increase from 2020. By November 2022 258,777 younger working age adults with learning difficulties, learning disabilities, or autistic younger working age adults, were getting either DLA or PIP.</span></div><div class="PHEBodycopy" style="font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif;"><span style="font-family: verdana;"><br /></span></div><div class="PHEBodycopy" style="font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif;"><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgyeT2ZzfLOBqcjVcZjsLb8xiYoH6fFsOEpzV1TafldiGxrAAcn8bGgb_CarpMQsiC9SA4KddqBYvlrIyZLqNTW8nI1-m6_2QxKAZVbP5cYVCRpbz5lUM-8fpsHLHTqf3jqN3d77iRUWyCkRODRgGkrifYZwkVA9cLDpypfE7Swy2DE8jAbHCX7F8KX8Q8o" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="467" data-original-width="890" height="336" src="https://blogger.googleusercontent.com/img/a/AVvXsEgyeT2ZzfLOBqcjVcZjsLb8xiYoH6fFsOEpzV1TafldiGxrAAcn8bGgb_CarpMQsiC9SA4KddqBYvlrIyZLqNTW8nI1-m6_2QxKAZVbP5cYVCRpbz5lUM-8fpsHLHTqf3jqN3d77iRUWyCkRODRgGkrifYZwkVA9cLDpypfE7Swy2DE8jAbHCX7F8KX8Q8o=w640-h336" width="640" /></a></div><br /><br /></div></div><div class="separator" style="clear: both; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; text-align: justify;"><span style="font-family: verdana; text-align: left;">The third graph, below, has the same information for older working age adults with learning difficulties aged 45-64 (note that the vertical scale for this graph is different to the previous ones, as the overall numbers are smaller). This graph also shows a rapid decrease in the number of people getting DLA from 2012 to 2020, and staying fairly stable since. There was a sharp rise in the number of people with learning disabilities getting PIP up to 2020 but numbers have stayed fairly stable since, with relatively few but gradually increasing numbers of autistic people getting PIP. The combined total for this age group shows a much slower rate of increase for people getting either disability benefit, with fluctuations but no clear trend over time from 2018 onwards. By November 2022 61,327 older working age adults with learning difficulties, learning disabilities, or autistic older working age adults, were getting either DLA or PIP.</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif;"><span style="font-family: verdana;"><br /></span></div><div class="separator" style="clear: both; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; text-align: center;"><br /></div><div class="separator" style="clear: both; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiKtRgIcEyvtJN0TpZRry1-SV2vhwTupGxuMYV1g9PvXagEjyfvzGtwlWECl-t0gaPsujbIiXiuFq2u-vkTFGpqmeDaMZh7CZTXuqCKmGUk1f1NgNK95czApsvCzA-PCuOAW_VRN0fjoiqVFtypPBhPIkoGz-_w367ri1MwEjBoGuCDidjvyJ7WdsU3R3o4" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="438" data-original-width="890" height="314" src="https://blogger.googleusercontent.com/img/a/AVvXsEiKtRgIcEyvtJN0TpZRry1-SV2vhwTupGxuMYV1g9PvXagEjyfvzGtwlWECl-t0gaPsujbIiXiuFq2u-vkTFGpqmeDaMZh7CZTXuqCKmGUk1f1NgNK95czApsvCzA-PCuOAW_VRN0fjoiqVFtypPBhPIkoGz-_w367ri1MwEjBoGuCDidjvyJ7WdsU3R3o4=w640-h314" width="640" /></a></div><br /><div class="separator" style="clear: both; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; text-align: center;"><br /></div><div class="MsoNormal" style="font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif;"><span style="font-family: verdana;"><span face=""trebuchet ms" , sans-serif">The final graph (again with a different vertical scale as the number of people is much smaller) has information on the number of older people with ‘learning difficulties’ (DLA, AA) or older people with learning disabilities or autistic people (PIP) getting one of these disability benefits. The number of older adults with learning difficulties getting AA is relatively small and has gradually declined from 2012 to 2022. As with older working age adults, sharp decreases in the number of older people getting DLA is accompanied by a sharp increase in the number of older adults with learning disabilities getting PIP but relatively few older autistic adults getting PIP. Overall, the number of older adults with learning difficulties, learning disabilities or autistic older adults getting one of these disability benefits has steadily increased from 2012 to 2022, but the rate of increase has slowed over time. <o:p></o:p></span><span face=""trebuchet ms" , sans-serif">By November 2022 20,269 older adults with learning difficulties, learning disabilities, or autistic older adults, were getting either DLA, AA or PIP.</span></span></div><div class="MsoNormal" style="font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif;"><span style="font-family: verdana;"><br /></span></div><div class="separator" style="clear: both; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjekjYT1Gp0cDbXckc5DU5ZH5sc7U63qR0O1KIbsr9lM--a5bMicRpEu-DhBF6y5RUOrweNuOfOVBDphFP9gEMDFxvtYnsgPK7838ds1zfciANQ84qP5xUNd8YnbPQ1CGRG4-46H9F6gYdCMzW8lTl3sLOPEQM8CwR6gstbeTKTOnGS6JUDFNfAizIwTW7Q" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="436" data-original-width="891" height="314" src="https://blogger.googleusercontent.com/img/a/AVvXsEjekjYT1Gp0cDbXckc5DU5ZH5sc7U63qR0O1KIbsr9lM--a5bMicRpEu-DhBF6y5RUOrweNuOfOVBDphFP9gEMDFxvtYnsgPK7838ds1zfciANQ84qP5xUNd8YnbPQ1CGRG4-46H9F6gYdCMzW8lTl3sLOPEQM8CwR6gstbeTKTOnGS6JUDFNfAizIwTW7Q=w640-h314" width="640" /></a></div><br /><br /></div><div class="MsoNormal"><span style="font-family: verdana;">Overall, the number of children and young people with 'learning difficulties' and the number of younger working age adults (particularly autistic adults, but also to a lesser extent younger adults with learning disabilities) getting disability benefits has continued to increase over time, even (after a blip) with the introduction of PIP. This is in contrast to older working age adults, when there have been no real increases in the number of people getting disability benefits for some years. For older people aged 65+, there was a very gradual but steady increase in the numbers of older people with learning disabilities and autistic people getting some form of disability benefit. For me, a few questions come out of this.</span></div><div class="MsoNormal"><span style="font-family: verdana;"><br /></span></div><div class="MsoNormal"><span style="font-family: verdana;">For the younger age groups, most of the increase in the number of people getting disability benefits may be largely being driven by an increase in the number of autistic people getting a disability benefit, which is not happening in the older age groups - is this perhaps a function of diagnostic services prioritising children and young people? </span></div><div class="MsoNormal"><span style="font-family: verdana;"><br /></span></div><div class="MsoNormal"><span style="font-family: verdana;">Where people with learning disabilities are identifiable (all the adult age groups), from May 2020 onwards there has been little or no increase in the number of people with learning disabilities getting a disability benefit, which is particularly pronounced in the older working age adult group (45-64 years). Is this some combination of a continuing tightening of eligibility criteria for adults with learning disabilities, combined with the impact of the COVID-19 pandemic on the lives and deaths of middle-aged and older people with learning disabilities where 55-64 years was the peak age of death for people with learning disabilities?</span></div><div class="MsoNormal"><span style="font-family: verdana;"><br /></span></div><div class="MsoNormal"><span style="font-family: verdana;">Finally, if the increases that are evident among young groups of people (particularly autistic people) are sustained, and move through into older age groups, what will this do to the already tightening eligibility criteria for any sort of support for people?</span></div></div>Chris Hattonhttp://www.blogger.com/profile/05299821560069281510noreply@blogger.com0tag:blogger.com,1999:blog-1016904785776950121.post-51723883962474359792023-06-29T18:05:00.001+01:002023-06-29T18:05:49.002+01:00Children with learning disabilities in schools in England: 2023 update<p> </p><h2 style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 22px; margin: 0px; position: relative;"><span style="font-weight: normal;"><span style="font-family: helvetica; font-size: small;"><a href="https://explore-education-statistics.service.gov.uk/find-statistics/special-educational-needs-in-england" target="_blank">The Department for Education has released its latest annual statistics</a> concerning children and young people identified within the English education system as children/young people with learning disabilities, recorded in an annual census of schools that takes place in January each year.</span></span></h2><h2 style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 22px; margin: 0px; position: relative;"><span style="font-family: helvetica; font-size: 13.2px;"><br /></span></h2><h2 style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 22px; margin: 0px; position: relative;"><span style="font-family: helvetica; font-size: 13.2px;"> </span></h2><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;">In the Special Educational Needs (SEN) statistics there are a number of mutually exclusive categories of SEN, three of which concern children with learning disabilities – Moderate Learning Difficulties (MLD), Severe Learning Difficulties (SLD) and Profound & Multiple Learning Difficulties (PMLD). There are a number of other SEN categories recorded within these statistics (Specific Learning Difficulties; Speech, language and communication needs; Social, emotional and mental health; Autistic spectrum disorder; Visual impairment; Hearing impairment; Multisensory impairment; Physical disability).</span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;"><o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;">Within the annual census, a child can be classified as having a ‘primary need’ in one of these categories, and optionally classified as having an additional, ‘secondary need’ in another category. Most importantly in terms of how children are supported, children may have a special educational need that has been judged to require specific support in the form of an SEN statement (historically) or now an Education, Health and Care (EHC) plan. Beyond that, DfE statistics now only report an additional much larger number of children at a level of ‘SEN support’, which has no requirements to specifically support a child.<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;">This blogpost simply updates <a href="https://chrishatton.blogspot.com/2022/06/children-with-learning-disabilities-in.html" target="_blank">a post I did last year</a> on Department for Education (DfE) statistics, and goes through what some of these statistics say about the education of children and young people with learning disabilities, as identified within the education system. For a brilliant analysis of what these statistics say and what they mean for children with SEND generally, I highly recommend <a href="https://www.specialneedsjungle.com/send-2023-numbers-increase-sen-no-idea-what-type-new-moderate-learning-difficulties/" target="_blank">the Special Needs Jungle analysis</a>, and I would urge you to read it.<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><o:p><span style="font-family: helvetica;"><br /></span></o:p></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;">The first question is simply – how many children and young people with learning disabilities are recorded in DfE statistics?<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;">The first graph below shows the number of children with a statement/EHC plan with a ‘primary SEN need’ of MLD, SLD and PMLD, from 2010 to 2023 (apologies for the acronyms).<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;">The graph shows that in 2023, over 74,000 children in England had a statement/EHC plan and were identified as children with learning disabilities. For children with MLD this was 32,898 children in 2023, with a large decrease of 31% from 2010 to 2018 but an increase of 16% from 2018 to 2023.<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;">In 2023, there were 31,322 children with a statement/EHC plan and identified with a primary need of SLD, an increase in numbers of 24% from 2010 to 2021 but no increase from 2021 to 2023. Finally, in 2023 there were 10,120 children with a statement/EHC plan and identified with a primary need of PMLD, an increase of 16% from 2010 to 2018 but with fluctuating numbers since.<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><o:p><span style="font-family: helvetica;"> </span></o:p></div><div class="separator" style="background-color: white; clear: both; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjiSDI8kDAZikdYe8zudh8E3pWkJK6rMy87apy9QEKW8undAWIP7wYpSD74tW1j3KRFkhtiHvWUFPTwSz3GL88Uojz-LELVBP7h3JxKv6ghU6l0Swxqf9eeP1j_kRCQCHfLRYpidfJXN2FB4V25CJQIVS4XT0MMkyhbbVI8AiTirro3mJwrYoQULKLDCXKW" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="710" data-original-width="1066" height="426" src="https://blogger.googleusercontent.com/img/a/AVvXsEjiSDI8kDAZikdYe8zudh8E3pWkJK6rMy87apy9QEKW8undAWIP7wYpSD74tW1j3KRFkhtiHvWUFPTwSz3GL88Uojz-LELVBP7h3JxKv6ghU6l0Swxqf9eeP1j_kRCQCHfLRYpidfJXN2FB4V25CJQIVS4XT0MMkyhbbVI8AiTirro3mJwrYoQULKLDCXKW=w640-h426" width="640" /></a></div><br /><div class="separator" style="background-color: white; clear: both; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px; text-align: center;"><div class="separator" style="clear: both;"><br /></div></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><br /></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;">The second graph below shows the number of children with a ‘primary SEN need’ of MLD, SLD and PMLD at the level of SEN Support, from 2015 to 2023 (the reporting of statistics changed in 2015).<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;">The graph shows that in 2023, over 190,000 children in England were identified as children with learning disabilities at the level of SEN Support. For children with MLD this was 189,375 children in 2023, with a large increase from 2015 to 2016 and a decrease from 2016 onwards.<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;">In 2023, there were 2,277 children with a primary need of SLD at the level of SEN Support, with numbers fairly steady until 2020 but decreasing after then. Finally, in 2023 there were 824 children at the level of SEN Support with a primary need of PMLD, again with a recent decrease.<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><br /></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgpfBRHQfOIw9YD4ZjWk5cJOPD_5snpoKxEJBDTQaqxyk3ngXeH8JS50E1kvwE-WI_EIcXAqI7Cgd5IP2Zqpff7NWiuKoXfUN8m8nS-31cAs9ZduInX_qknmiEp7J3jx66eHiHa02SG8ZSyy_AbVCkgujkobRkWMTiHMlLGTuFN5pllyZwNg58r1guO-a9i" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="617" data-original-width="1067" height="370" src="https://blogger.googleusercontent.com/img/a/AVvXsEgpfBRHQfOIw9YD4ZjWk5cJOPD_5snpoKxEJBDTQaqxyk3ngXeH8JS50E1kvwE-WI_EIcXAqI7Cgd5IP2Zqpff7NWiuKoXfUN8m8nS-31cAs9ZduInX_qknmiEp7J3jx66eHiHa02SG8ZSyy_AbVCkgujkobRkWMTiHMlLGTuFN5pllyZwNg58r1guO-a9i=w640-h370" width="640" /></a></div><br /><br /></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;">How many children with learning disabilities are being educated in mainstream schools or special schools? The graph below shows the number of children with a statement/EHC plan and primary needs of MLD, SLD and PMLD being educated in mainstream schools and special schools in England, from 2010 through to 2023. These figures don’t include potentially substantial but often not really known numbers of children not in school (including those being educated at home), or in places like residential special schools or specialist inpatient units.</span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;">The graph has quite a lot of stuff in it, so let’s take it bit by bit. The lilac lines are for children with MLD in mainstream schools (diamonds) and special schools (circles). As we know from earlier on the number of children with statements/EHC plans associated with MLD decreased from 2010 to 2018 but increased from 2018 to 2023. This graph shows that the number of children with a statement/EHC plan and a primary need of MLD in special schools declined steadily from 2010 to 2023; the number of children in mainstream schools declined rapidly from 2010 to 2017 but has been rapidly increasing since then.<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;">For children with statements/EHC plans associated with SLD (the blue lines), the number of children with SLD in mainstream schools slightly decreased, with fluctuations, from 2010 to 2023, while the number of children with SLD in special schools rapidly increased up to 2022 but decreased slightly in 2023.<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;">For children with a statement/EHC plan associated with PMLD (the purple lines), the numbers of children with PMLD in both mainstream and special schools has very gradually increased from 2010 to 2018 but has fluctuated since.<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><br /></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><br /></div><div class="separator" style="background-color: white; clear: both; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px; text-align: center;"><div class="separator" style="clear: both;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhxVRPKXk9hy88qTm2Xs0IDhG90yhMPQflrpIrWmzi2xueEJ4hMv2HbX0z8eoZdJ4ie9ClA_nZoU1OfrrC3F_3RcZ1sF25VhFWMO6Daeck584_iCD_LanxlVE5hHBUT25qzXaNeokvq-EUKuvQ5v9Huto_VHnnohXQ9UAqDfUBGYOAegMsW5l0UfrLQXz_j" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="991" data-original-width="1502" height="422" src="https://blogger.googleusercontent.com/img/a/AVvXsEhxVRPKXk9hy88qTm2Xs0IDhG90yhMPQflrpIrWmzi2xueEJ4hMv2HbX0z8eoZdJ4ie9ClA_nZoU1OfrrC3F_3RcZ1sF25VhFWMO6Daeck584_iCD_LanxlVE5hHBUT25qzXaNeokvq-EUKuvQ5v9Huto_VHnnohXQ9UAqDfUBGYOAegMsW5l0UfrLQXz_j=w640-h422" width="640" /></a></div></div><br /><br /></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;">Another way of looking at this is to look at the percentage of children in mainstream vs special schools. The graph below shows this from 2010 to 2023 for children with a statement/EHC plan. As the graph shows, the percentage of children with a primary need of MLD and a statement/EHC plan in mainstream school dipped from just over 50% in 2010 to 43% in 2017, with the percentage returning to above 50% from 2021 onwards. For children with a statement/EHC plan and a primary need of SLD, the percentage of children in mainstream schools decreased from 17% in 2010 to less than 12% from 2018 onwards. For children with a statement/EHC plan and a primary need of PMLD, the percentage of children in mainstream school has remained fairly consistent around 14%-16%.</span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;"></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;"><o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEh-1ykaGDhbxGcf-u8QBKrzOHieaU2Q-89j6HH7sGvHfBx7fCebEhQBepzNpR7lhToJG_edvGdZFlfzIOpeTxgf80lfvpD-Kb9NyHf4nj6zUy_sws_ntpqOTxUGstYalb4w7TQ00NC37gwomuibvP3C_e8wZ9aI8FRXPE0CNkVxhYLIcueDwXAurW5adYze" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="620" data-original-width="1061" height="374" src="https://blogger.googleusercontent.com/img/a/AVvXsEh-1ykaGDhbxGcf-u8QBKrzOHieaU2Q-89j6HH7sGvHfBx7fCebEhQBepzNpR7lhToJG_edvGdZFlfzIOpeTxgf80lfvpD-Kb9NyHf4nj6zUy_sws_ntpqOTxUGstYalb4w7TQ00NC37gwomuibvP3C_e8wZ9aI8FRXPE0CNkVxhYLIcueDwXAurW5adYze=w640-h374" width="640" /></a></div><br /><br /></div></div><div class="separator" style="background-color: white; clear: both; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px; text-align: center;"><br /></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;">For children identified at the level of SEN Support (I haven’t included a graph on this), in 2023 almost all the children with a primary need of MLD (99.97%) and the vast majority of children with a primary need of SLD (92.3%) or PMLD (85.3%) were in mainstream schools.</span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;">Although it’s not an ideal marker of the financial circumstances of families, eligibility for free school meals is collected within DfE statistics. The graph below shows the proportion of children with statements/EHCPs associated with MLD, SLD and PMLD eligible for free school meals compared to the proportion of all children eligible for free school meals in 2023. For all children on the school roll, 23.8% of children in 2023 were eligible for free school meals. For children with a PMLD label the proportion of children eligible for free school meals is higher (36.2% for children with a statement/EHC plan), then higher again for children with an SLD label (43.5% for children with a statement/EHC plan), and highest for children with an MLD label (46.9% for children with a statement/EHC plan). It is worth mentioning that the proportion of children in all groups eligible for free school meals has increased in recent years.<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><br /></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhlAjy0GLGfs6b_zdeKh1U1gpLuivtGexoMkga_415cGc8ej7eY9hWGbcuKx3xdj7urVSwIc3nH-zIurA8RHUVbt_aIL_BWXJlc8IlWO8_D3I95AIAzCqOLd6U7JVG1dVsszhcxnlSs8mImUOcwL3_R7lMrj4Lc8bXAm1zc3pgJd0266ijxvgsqbpVD4LXM" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="707" data-original-width="1066" height="424" src="https://blogger.googleusercontent.com/img/a/AVvXsEhlAjy0GLGfs6b_zdeKh1U1gpLuivtGexoMkga_415cGc8ej7eY9hWGbcuKx3xdj7urVSwIc3nH-zIurA8RHUVbt_aIL_BWXJlc8IlWO8_D3I95AIAzCqOLd6U7JVG1dVsszhcxnlSs8mImUOcwL3_R7lMrj4Lc8bXAm1zc3pgJd0266ijxvgsqbpVD4LXM=w640-h424" width="640" /></a></div><br /><br /></div><div class="separator" style="background-color: white; clear: both; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px; text-align: center;"><div class="separator" style="clear: both;"><br /></div><br /></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;">A brief summary of the main points:<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px; margin-left: 18pt; text-indent: -18pt;"><ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;"><li style="margin: 0px 0px 0.25em; padding: 0px; text-indent: 0px;"><span style="font-family: helvetica;"><span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span><span style="text-indent: -18pt;">While the number of children identified as having special educational needs associated with severe learning difficulties or profound and multiple learning difficulties and needing statements or EHC plans have changed gradually over time, the number of children identified as having a special educational need associated with moderate learning difficulties has been plummeting but for the last five years has increased rapidly.</span></span></li><li style="margin: 0px 0px 0.25em; padding: 0px; text-indent: 0px;"><span style="text-indent: -18pt;"><span style="font-family: helvetica;">There are slightly different trends for different groups of children with learning disabilities in terms of the proportion of children in mainstream vs special schools, but some earlier trends towards special education seem to be starting to reverse for children with MLD in the last few years. Less than 20% of children with an EHCP/statement and a label of SLD or PMLD are being educated in mainstream schools.</span></span></li><li style="margin: 0px 0px 0.25em; padding: 0px; text-indent: 0px;"><span style="text-indent: -18pt;"><span style="font-family: helvetica;">Children with learning disabilities are much more likely to be eligible for free school meals than children generally.</span></span></li></ul></div>Chris Hattonhttp://www.blogger.com/profile/05299821560069281510noreply@blogger.com0tag:blogger.com,1999:blog-1016904785776950121.post-46042101541936718802023-06-23T09:12:00.001+01:002023-06-23T09:12:35.216+01:00Vanishing point: When will targets about the number of people with learning disabilities and autistic people in inpatient units be met?<p> "<a href="https://www.theguardian.com/lifeandstyle/2013/jul/20/john-cooper-clarke-q-and-a" target="_blank">Happiness is the target one only has to aim at in order to miss</a>" John Cooper Clarke</p><p>There are myriad ways to bring to light the abject failure of governments and services to make good on their promises after the Panorama programme on Winterbourne View, over 12 years ago in 2011. The most important are direct accounts of people's experiences in these places, and how life can be so different with decent support. A small way to add to the picture is to examine, on the government's own terms, whether they are achieving what they say they've set out to do, most obviously in terms of the number of people still in inpatient units.</p><p>To keep this blogpost relatively short I won't go over again what has happened, and more especially what has failed to happen, since the Winterbourne View programme first aired. I will just focus on a set of targets that the government has set about the maximum number of children and adults there should be in inpatient units, by the end of March 2024. With less than a year to go until this deadline, how close is the government to meeting the targets they've set? </p><p>
</p><p class="MsoNormal">The <a href="https://www.gov.uk/government/publications/building-the-right-support-for-people-with-a-learning-disability-and-autistic-people/building-the-right-support-action-plan" target="_blank">Building the Right Support for People with a Learning Disability and Autistic People Action Plan (2022)</a> restates the <a href="https://www.longtermplan.nhs.uk/" target="_blank">NHS Long Term Plan</a> target that “by March 2024 mental health inpatient provision for people
with a learning disability and autistic people will reduce to less than half of
2015 levels (on a like for like basis and taking into account population
growth). This means that for every 1 million adults, no more than 30 people
with a learning disability and autistic people will be cared for in an inpatient
unit. For children and young people, no more than 12 to 15 autistic children
and young people and children and young people with a learning disability per 1
million children, will be cared for in an inpatient unit.” </p><p class="MsoNormal">So, these targets (themselves a watering down of targets set in the original Building the Right Support in 2015, and puny in comparison to the aims of the government immediately after Winterbourne View) are expressed in a relatively straightforward way. What's actually happening?</p>
<p class="MsoNormal"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Targets for
children<o:p></o:p></span></p>
<p class="MsoNormal">The first graph below shows the number of children (aged less than 18
years) in inpatient units over time, from March 2015 to March 2023 for AT data,
and from March 2018 to March 2022 for MHSDS data. </p><p class="MsoNormal">Without going over this again at great length, AT stands for Assuring Transformation, a set of data collected by health service commissioners and reported every month, which tends to focus on people with learning disabilities and autistic people in 'specialist' inpatient units. MHSDS stands for the Mental Health Services DataSet, which is collected in real time by mental health service providers and reported monthly, which additionally to AT tends to include people with learning and autistic people in mainstream mental health inpatient units. Unfortunately, according to NHS Digital (now being absorbed into NHS England), many mental health service providers have been subjected to a 'recent' cyber attack, meaning that there has been no national MHSDS information since July 2022. You can find all this information <a href="https://digital.nhs.uk/data-and-information/publications/statistical/learning-disability-services-statistics" target="_blank">here</a>.</p>
<p class="MsoNormal"><u>Number of children (aged less than 18 years)
with learning disabilities and autistic children in inpatient services in
England</u></p>
<p class="MsoNormal"><o:p> </o:p><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgbPXUcPKSCU8Jb1yeJpX0pyZz4VvVWeFADKMJSOfHJDByuOsRsZFoNK62YzHv8paGb6Ns30q9JGQlSlN8paD4fOX6yhneXocKCxdAePCExna_l-g2tcjYVIGJDRCsLyD_suRlsYbYycj4ZVXyeyXuO9D6A3odT9vMtJWlvANn6sjrbBeDP5jdafnTPOfsI" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img alt="" data-original-height="444" data-original-width="752" height="378" src="https://blogger.googleusercontent.com/img/a/AVvXsEgbPXUcPKSCU8Jb1yeJpX0pyZz4VvVWeFADKMJSOfHJDByuOsRsZFoNK62YzHv8paGb6Ns30q9JGQlSlN8paD4fOX6yhneXocKCxdAePCExna_l-g2tcjYVIGJDRCsLyD_suRlsYbYycj4ZVXyeyXuO9D6A3odT9vMtJWlvANn6sjrbBeDP5jdafnTPOfsI=w640-h378" width="640" /></a></p><p class="MsoNormal"><br />The second graph below shows the rates per million population (aged less
than 18 years) of children with learning disabilities and autistic children in
inpatient services. <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/bulletins/annualmidyearpopulationestimates/latest" target="_blank">ONS mid-year population estimates were used from 2015-2020</a>
– more recent population estimates were calculated by applying the annual population growth
rate from 2015 to 2020<span style="font-family: Calibri, sans-serif;"><span style="font-size: 14.6667px;">.</span></span></p>
<p class="MsoNormal"><u><br /></u></p><p class="MsoNormal"><u>Rate per million children population of
children with learning disabilities and autistic children in inpatient services
– England</u></p>
<p class="MsoNormal"><o:p> </o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhY2L9Hus6Ada-FLX7VONbhsLY-1y0C-OSqow32VB1z5GZjiI73RXxA094OgxFp125FIzFqR_mP_qYHWYmovUSitm8DuUunyY4UIIpDBC_kNlXc49YBAFJRj3KSa_W3YA42oYu33F0Ll0TpGedLc3bVNd4ZcF9hee9sO1nZWSwQRt18JcKSoHvtJQSfNOXg" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="443" data-original-width="902" height="314" src="https://blogger.googleusercontent.com/img/a/AVvXsEhY2L9Hus6Ada-FLX7VONbhsLY-1y0C-OSqow32VB1z5GZjiI73RXxA094OgxFp125FIzFqR_mP_qYHWYmovUSitm8DuUunyY4UIIpDBC_kNlXc49YBAFJRj3KSa_W3YA42oYu33F0Ll0TpGedLc3bVNd4ZcF9hee9sO1nZWSwQRt18JcKSoHvtJQSfNOXg=w640-h314" width="640" /></a></div><br /><p></p>
<p class="MsoNormal">The first graph shows that according to the AT dataset, 170 children in
March 2015 (when the BtRS Action Plan states that the number of children in
inpatient services were undercounted) through to 240 children in March 2023 were in inpatient services. There is no clear trend over time, certainly not of reducing numbers of children in inpatient services.
The second graph shows that in March 2023 the rate per million of children in inpatient
services was 19.4, above the target for 2023/24 of 12-15. On current population
figures, the number of children in inpatient services needs to reduce to around
185 children to be within the upper target band and under 150 children to be
within the lower target band.</p>
<p class="MsoNormal"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><o:p>T</o:p></span>he MHSDS reports smaller numbers of children in inpatient services
than AT, from 175 children in March 2018 to 180 children in March 2022. Given
that MHSDS figures are usually higher than AT figures, this direction of
discrepancy is unusual. It may be that children are less likely to have an
already existing health system learning disability or autism flag, which would
result in the MHSDS undercounting this group. Again there is no clear trend
over time, with recent rates per million child population according to the
MHSDS at the level of the upper target band.</p>
<p class="MsoNormal"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Targets for adults<o:p></o:p></span></p>
<p class="MsoNormal"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><o:p>The third graph</o:p></span> below shows the number of adults (aged 18+ years) in
inpatient units over time, from March 2015 to March 2023 for AT data, and from
March 2018 to March 2022 for MHSDS data.</p>
<p class="MsoNormal"><br /></p>
<p class="MsoNormal"><u>Number of adults (aged 18+ years) with learning
disabilities and autistic children in inpatient services in England<o:p></o:p></u></p>
<p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEidH6Di3vm9Yj0ZgigqZfyB2bjZwqr2wlgoxwvR7sxVEmkG29AkgOStRP2IocJS_Tw4X0OGSr2z9xGIYPGpn8Jnmoo3eJRkJggAHExLIqDDalo1WG-H0_K_HNSFImHfN07sfNIo-ozlFcygsZDA3k8s2TWtKOWPjqw58O60J9lhjwYyH1lnvQEnpWEFaP_L" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="444" data-original-width="752" height="378" src="https://blogger.googleusercontent.com/img/a/AVvXsEidH6Di3vm9Yj0ZgigqZfyB2bjZwqr2wlgoxwvR7sxVEmkG29AkgOStRP2IocJS_Tw4X0OGSr2z9xGIYPGpn8Jnmoo3eJRkJggAHExLIqDDalo1WG-H0_K_HNSFImHfN07sfNIo-ozlFcygsZDA3k8s2TWtKOWPjqw58O60J9lhjwYyH1lnvQEnpWEFaP_L=w640-h378" width="640" /></a></div><br /><br /><p></p><p class="MsoNormal">The fourth and final graph below shows the rates per million population (aged 18+
years) of adults with learning disabilities and autistic adults in inpatient
services. </p>
<p class="MsoNormal"><u>Rate per million adult population of adults
with learning disabilities and autistic adults in inpatient services – England<o:p></o:p></u></p>
<p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjBdbk4KAToCBtcn-4gQzXw5gQeFHWiVDxHFeCIKT_EfCtFxj1YXM0nZVSV1pQhfz9IojaG07_j5gtRDP_Cah7EhSirel5n9ajDZPUKxErkPhk0tPBD2wVwcRj8P-504yhWjGvfOQMxuH9XfubwPM5ReUyUep-G_yk3wBcOtZ_fop-drKFRlerOBmlRql6I" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="443" data-original-width="902" height="314" src="https://blogger.googleusercontent.com/img/a/AVvXsEjBdbk4KAToCBtcn-4gQzXw5gQeFHWiVDxHFeCIKT_EfCtFxj1YXM0nZVSV1pQhfz9IojaG07_j5gtRDP_Cah7EhSirel5n9ajDZPUKxErkPhk0tPBD2wVwcRj8P-504yhWjGvfOQMxuH9XfubwPM5ReUyUep-G_yk3wBcOtZ_fop-drKFRlerOBmlRql6I=w640-h314" width="640" /></a></div><br />The third graph shows that, according to the AT dataset, 2,735 adults in
March 2015 through to 1,890 adults in March 2023 were in inpatient services
(although as the March 2023 data is relatively recent it is likely to be a
slight underestimate). There is a downward trend over time, at an average
compound rate of a 4.5% reduction per year. The fourth graph shows that in March 2023 the
rate per million of adults in inpatient services was 41.7, above the target for
2023/24 of 30. On current population figures, the number of adults in inpatient
services needs to reduce to 1,360 adults to be within the target band.<p></p>
<p class="MsoNormal">Applying the average reduction of 4.5% a year to the 1,890 adults in
inpatient units in March 2023, it would take seven years (to March 2030) to reach
the Building the Right Support target of 30 per million for March 2024. The
downward trend has slowed over time: it was faster for 2015-19 (average compound rate -5.6% per year)
than for 2019-2023 (average compound rate -3.6% per year). Applying the more recent
-3.6% rate, it would take nine years (to March 2032) to reach the target for March 2024. </p>
<p class="MsoNormal"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">The MHSDS reports higher numbers of adults in inpatient services
than AT, with 3,395 adults with learning disabilities and autistic adults
reported to be in inpatient services at the end of March 2022. There is no
clear trend in numbers over time according to the MHSDS, with lower numbers in
March 2020 and March 2021 likely to be related to the COVID-19 pandemic. The
rate per million of adults in inpatient services according to the MHSDS was
75.4 in March 2022, very similar to the 75.6 reported in March 2018, compared
to the Building the Right Support target of 30 per million. </span>Because there is no existing downward trend over time, there is no future date at which the target rate would be met.</p><p class="MsoNormal"><br /></p><p class="MsoNormal">Even on the progressively less demanding terms that the government has set for itself, this is abject failure.</p>
<p class="MsoListParagraph" style="text-indent: -36.0pt;"><b><span style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><o:p> </o:p></span></b></p>
<div style="mso-element: footnote-list;"><br /></div><p></p>Chris Hattonhttp://www.blogger.com/profile/05299821560069281510noreply@blogger.com0tag:blogger.com,1999:blog-1016904785776950121.post-56437341998810720992023-05-31T14:09:00.015+01:002023-05-31T16:21:10.037+01:00Not giving a shit<p>This is a quick post in response to the heartbreaking inquest for Sally Lewis, which George Julian has been assiduously reporting on in her blog https://www.georgejulian.co.uk/ Sally died as a result of the consequences of prolonged constipation, which despite Sally's 'support' service Dimensions knowing was an ongoing issue for her (and her GP flagging this up to people in the service), almost no-one working with Sally on a daily basis bothered to take seriously. The coroner reported a conclusion of gross neglect, which as those following George's reporting work will know is all too rare when it comes to the deaths of people with learning disabilities.</p><p>A final insult to the family is that they are having to crowdfund to pay for legal representation at Sally's inquest, while Dimensions have the funds to pay for lawyer after lawyer - if you have the resources, please consider a contribution https://www.crowdjustice.com/case/justiceforsally/ </p><p>In this post I'm just going to provide a short set of links to relevant evidence about constipation and people with learning disabilities, which has been around for some years now. </p><p><br /></p><p>1) At least <a href="https://www.tandfonline.com/doi/full/10.3109/13668250.2017.1310829">one third of adults with learning disabilities</a> are likely to be experiencing long-standing constipation at any one time, based on research directly assessing constipation.</p><p>2) In 2021/22, only <a href="https://digital.nhs.uk/data-and-information/publications/statistical/health-and-care-of-people-with-learning-disabilities/experimental-statistics-2021-to-2022">13.1% of people with learning disabilities in England</a> registered with a GP were recorded by their GP to have had diagnosed or treated long-standing constipation in the previous five years - this figure has hardly changed from 2017/18 (13.3%).</p><p>3) <a href="https://www.georgejulian.co.uk/inquests/richard-handley/">Richard Handley died from the consequences of chronic constipation in 2012</a> - his inquest did not take place until 2018. <a href="https://static1.squarespace.com/static/62ea37b2f412d231ae2c2f35/t/639871934b733a229d3531e6/1670934931279/Factors-James-and-Amy-For-Website.pdf">He is by no means the only person with learning disabilities to have died as a result of constipation</a>.</p><p>4) Amongst people with learning disabilities, <a href="https://www.ndti.org.uk/assets/files/IHAL-2013-02_Hospital_admissions_that_should_not_happen_ii.pdf">long-standing constipation is one of the most common causes of being taken to hospital in an emergency</a>.</p><p>5) <a href="https://pubmed.ncbi.nlm.nih.gov/17244427/">Research has reported that over 25% of people with learning disabilities received a repeat prescription for laxatives in one year</a>, compared to 0.1% of people without learning disabilities.</p><p>6) Beyond laxatives, <a href="https://pubmed.ncbi.nlm.nih.gov/29168259/">there is little research on how to effectively help people with learning disabilities with long-standing constipation</a>, and the evidence there is says that laxatives aren't always that helpful.</p><p>7) There is virtually nothing on how supported living and residential care services can support people with learning disabilities to live lives that reduce the chances of long-standing constipation, such as engaging in physical activity and eating healthier diets.</p><p>8) In 2019, <a href="https://www.england.nhs.uk/publication/leder-action-from-learning/">NHS England identified constipation</a> as a priority for action for people with learning disabilities following a LeDeR report identifying 12 people with learning disabilities dying as a result of constipation. <a href="https://www.england.nhs.uk/publication/constipation-learning-disability-resources/">Constipation leaflets were published in 2019</a>, but have not been updated since.</p><p>9) In 2016, the <a href="https://www.gov.uk/government/publications/constipation-and-people-with-learning-disabilities">Public Health England Learning Disabilities Observatory produced reasonable adjustments guidance (including an easy-read introduction) concerning constipation and people with learning disabilities</a>. Funding for this Observatory stopped in 2019 and this guidance has not been updated since.</p><p>10) There are no NICE clinical guidelines relating to constipation and people with learning disabilities.</p><p><br /></p><p>It's clear there's no reason for services not to know that constipation can be a serious problem for a lot of people with learning disabilities, and that the consequences of long-standing constipation can be fatal. It's also highly revealing that there's very little evidence about helping people live their lives in ways that would make constipation less likely, rather than prescribing laxatives. And it says something quite fundamental that nothing designed to seriously and practically address constipation amongst people with learning disabilities has been sustained. As a very wise colleague and friend said to me recently, how can you make people give a shit?</p>Chris Hattonhttp://www.blogger.com/profile/05299821560069281510noreply@blogger.com0tag:blogger.com,1999:blog-1016904785776950121.post-67354044848742610452023-05-07T16:06:00.001+01:002023-05-07T16:06:40.797+01:00How many people with learning disabilities are prescribed mental health medications? Numbers from the 'Health and Care of People with Learning Disabilities' dataset<p>For over 30 years, it's been clear that huge numbers of people with learning disabilities in England (and in other places too) are prescribed (told by their doctor to take) what are sometimes called 'psychotropic' drugs - drugs that are prescribed to change something about a person's mental state. Typically, these are drugs prescribed for reasons of 'mental health', although they might also be prescribed to change a person's behaviour.</p><p>In England, NHS England and other organisations have been running the <a href="https://www.england.nhs.uk/learning-disabilities/improving-health/stomp/" target="_blank">STOMP programme</a> since 2016. STOMP stands for 'Stopping over medication of people with a learning disability, autism or both'. More recently STAMP ('Supporting Treatment and Appropriate Medication in Paediatrics) has been added by NHS England. Part of the aim of both these programmes is to reduce the number of people with learning disabilities and autistic people who are prescribed these drugs.</p><p>This blogpost will simply summarise some recent information about the percentages of people with learning disabilities being prescribed a range of mental health drugs. It mainly uses information from the <a href="https://digital.nhs.uk/data-and-information/publications/statistical/health-and-care-of-people-with-learning-disabilities/experimental-statistics-2021-to-2022" target="_blank">'Health and Care of People with Learning Disabilities' </a>dataset, compiled by NHS Digital (now merged into a mega NHS England). Every year (going April to March), this takes information from GP information systems in England to produce statistics about the health and health treatment of people registered with a GP as a person with learning disabilities, often comparing them to the health and healthcare of people without learning disabilities. It's a brilliant source of information that isn't used as much as it should be. The interactive information tool is quite hard to get your head around but it does make it quite flexible - for many things you can look at how things are by age, sex, region and even more locally than that (to Sub Integrated Care Board level, it that floats your boat), and for most things you can look back over the last five years or so. The most recent information available covers April 2021 to March 2022, with updates usually released every year in December.</p><p>There are a few cautions to bear in mind though. The biggest one is that the information only covers about 6 in 10 people registered with a GP (59.2%). This is because the information is collected from the electronic information systems that GPs use, and one of the companies that own the electronic information system used by a lot of GPs wanted to charge too much money for it to be used. So coverage across different parts of the country is really patchy. The second caution is that there are likely to be many people with learning disabilities who are not registered as such with their GP - this is even more so for autistic people with registration with their GP as an autistic person (recognising that some people don't want to be registered with their GP in these ways). A third caution is that the extent to which this dataset includes people with learning disabilities in inpatient units really isn't clear. Finally, it's really important to remember that all this information is based on what health systems and GPs record, which is likely to have its own biases, particularly when it comes to people with learning disabilities.</p><p><br /></p><p><b>'Severe mental illness' and antipsychotics</b></p><p>Antipsychotics are a set of drugs that are supposed to be prescribed for people with mental health issues with labels such as psychosis, which in GP-record world (along with some other mental health issues) are classed as 'severe mental illness'.</p><p>In 2021/22, 7.5% of people with learning disabilities were diagnosed with a 'severe mental illness', compared to 0.9% of people without learning disabilities. A clutch of research projects have shown that mental health issues such as psychosis might be more common amongst people with learning disabilities, but nowhere near to the extent that GPs are diagnosing severe mental illness, with the suspicion that some people with learning disabilities are getting this label to justify them being prescribed antipsychotic drugs for reasons essentially of attempted behavioural control. These percentages haven't changed much from 2017/18 (7.6% of people with learning disabilities; 0.9% of people without learning disabilities.</p><p>In terms of sex (the term used in the dataset), more girls/women (8.0% in 2021/22; up from 7.8% in 2017/18) than boys/men (7.2% in 2021/22, down from 7.4% in 2017/18) with learning disabilities had a severe mental illness diagnosis, while there was no difference amongst people without learning disabilities. In terms of age bands, from the age of 35-44 years onwards, more than 10% of people with learning disabilities had a diagnosis of severe mental illness, peaking at 15.8% of people aged 65-74.</p><p><b><i>Antipsychotics.</i></b> Overall, in 2021/22 14.5% of people with learning disabilities were being prescribed antipsychotics, compared to 0.9% of people without learning disabilities. For people with learning disabilities, this was a reduction from 15.8% of people being prescribed antipsychotics in 2017/18 (there was no change over time for people without learning disabilities). </p><p>Fewer girls/women with learning disabilities were being prescribed antipsychotics (13.9% in 2021/22, down from 14.4% in 2017/18) than boys/men with learning disabilities (15.0% in 2021/22, down from 16.2% in 2017/18). In terms of age bands, from the ages of 18-24 years onwards, more than 10% of people with learning disabilities in 2021/22 were being prescribed antipsychotics, peaking at 25.3% of people aged 65-74.</p><p>More recently, the Health and Care dataset has added information on people being prescribed antipsychotics when they don't have a diagnosis of severe mental illness or palliative care needs. In 2021/22, 9.1% of people with learning disabilities (7.8% of girls/women; 9.9% of boys/men) without a severe mental illness diagnosis were still getting prescribed antipsychotics, compared to 0.5% of people without learning disabilities or a severe mental illness diagnosis. </p><p>Taking into account differences in the populations of people with and without learning disabilities in things like age and sex, in 2021/22 being prescribed antipsychotics was 15 times more common among people with learning disabilities than you would expect from general population prescribing rates; for those without a diagnosis of severe mental illness this rose to being 18 times more common.</p><p><br /></p><p><b>Depression and anti-depressants</b></p><p>The Health and Care dataset has very similar information about GP diagnosis of depression and the prescribing of anti-depressants.</p><p>Overall, the percentage of people with and without learning disabilities diagnosed with depression has increased over time, at a slightly higher rate for people with learning disabilities (14.5% in 2021/22, up from 13.2% in 2017/18) than people without learning disabilities (13.7% in 2021/22, up from 12.5% in 2017/18).</p><p>Amongst people with learning disabilities, girls/women were more likely to be diagnosed with depression (18.4% in 2021/22, up from 16.8% in 2017/18) than boys/men (12.1% in 2021/22, up from 10.7% in 2017/18). In terms of age bands, from the ages of 25-34 years onwards, more than 10% of people with learning disabilities had a diagnosis of depression, peaking at 22.9% of people aged 55-64.</p><p><b><i>Anti-depressants</i></b>. Overall, in 2021/22, 21.2% of people with learning disabilities were being prescribed anti-depressants, compared to 10.7% of people without learning disabilities. Girls/women with learning disabilities were more likely to be prescribed anti-depressants (26.0% in 2021/22, compared to 14.2% of girls/women without learning disabilities) than boys/men with learning disabilities (18.1% in 2021/22, compared to 7.2% of boys/men without learning disabilities). In terms of age bands, from the ages of 18-24 years onwards, more than 10% of people with learning disabilities were being prescribed anti-depressants, peaking at 31.8% of people aged 55-64.</p><p>For a longer period of time, the Health and Care dataset has also been reporting on people being prescribed anti-depressants when they don't have a diagnosis of depression. In 2021/22, 12.0% of people with learning disabilities without a diagnosis of depression were being prescribed anti-depressants, compared to 4.5% of people without learning disabilities or a diagnosis of depression. For both groups, this had increased since 2017/18 (11.0% of people with learning disabilities without a diagnosis of depression; 4.3% of people without learning disabilities or a diagnosis of depression). Again, this was more common for women with learning disabilities without a diagnosis of depression (13.6% in 2021/22) than men (10.9%). In terms of age bands, from the ages of 18-24 years onwards, more than 10% of people with learning disabilities but with no diagnosis of depression were being prescribed anti-depressants, peaking at 16.7% of people aged 55-64.</p><p>Taking into account differences in the populations of people with and without learning disabilities in things like age and sex, in 2021/22 being prescribed antidepressants was twice as common among people with learning disabilities than you would expect from general population prescribing rates; for those without a diagnosis of depression this rose to being 3 times more common.</p><p><br /></p><p><b>Other mental health drugs</b></p><p>The Health and Care dataset also reports on other types of drugs used to affect people's mental health or behaviour.</p><p><b><i>Benzodiazepenes</i></b> are a type of 'sedative' - they slow down the body and mind and are prescribed for anxiety or sleep problems . In 2021/22, 7.1% of people with learning disabilities were being prescribed benzodiazepenes (down from 7.6% in 2017/18) compared to 1.8% of people without learning disabilities (down from 2.4% in 2017/18). </p><p>Amongst people with learning disabilities, in 2021/22 more women with learning disabilities (7.6%, down from 8.1% in 2017/18) than men (6.8%, down from 7.2% in 2017/18) were being prescribed benzodiazepenes. In terms of age bands, more than 10% of people with learning disabilities between the ages of 45 and 74 were being prescribed benzodiazepenes.</p><p><b><i>Epilepsy drug</i></b>s are used to help control seizures, but can also be prescribed to affect someone's behaviour. In 2021/22, 4.9% of people with learning disabilities without an active epilepsy diagnosis were being prescribed epilepsy drugs (down from 5.5% in 2017/18) compared to 2.4% of people without learning disabilities or an active epilepsy diagnosis (stable over time from 2017/18). Amongst people with learning disabilities without an active epilepsy diagnosis, in 2012/22 more women (5.6%) than men (4.4%) were being prescribed epilepsy drugs. </p><p>Taking into account differences in the populations of people with and without learning disabilities in things like age and sex, in 2021/22 being prescribed benzodiazepenes was 5 times as common among people with learning disabilities than you would expect from general population prescribing rates. In 2021/22, being prescribed with epilepsy drugs without an active epilepsy diagnosis was twice as common for people with learning disabilities than you would expect.</p><p><br /></p><p><b>Conclusions</b></p><p>These statistics drawn from over half of all people registered with a GP in England, with all their caveats, clearly show that people with learning disabilities continue to be disproportionately prescribed mental health medications, often in the absence of a potentially relevant mental health or other diagnosis. While it might be argued that the STOMP and STAMP initiatives are having some impact on reducing the number of people being prescribed antipsychotics, benzodiazepenes and epilepsy drugs, the increasing numbers of people being prescribed antidepressants is threatening to cancel out any of these gains.</p><p>There are also some big gender differences amongst people with learning disabilities, with little sign of these gaps closing over time. And worryingly, given what we know about the side effects of many of these drugs over time, their addictive properties, and their potential impact on how they make people feel, significant numbers of people with learning disabilities are being prescribed these drugs at much earlier ages than people without learning disabilities for potentially longer periods of time.</p><p>From the Health and Care dataset. we don't know how many people with learning disabilities are being prescribed more than one mental health drug, although <a href="https://onlinelibrary.wiley.com/doi/10.1111/jir.12775" target="_blank">a research project in Jersey</a> suggested that almost a quarter (23%) of people with learning disabilities were being prescribed two or more mental health drugs. We also don't know how many people with learning disabilities in inpatient units are being prescribed these types of medications. Finally we don't know much about what people with learning disabilities and those close to them think about these medications and what impact they have on people's lives - <a href="https://medmentalhealth.wixsite.com/medmentalhealth" target="_blank">a new research project</a> with co-researchers with learning disabilities is going to ask exactly these questions.</p>Chris Hattonhttp://www.blogger.com/profile/05299821560069281510noreply@blogger.com0tag:blogger.com,1999:blog-1016904785776950121.post-66242227419240898402022-10-23T20:31:00.007+01:002022-10-28T10:57:45.284+01:00I am a 9.5 in 10 (with apologies to UB40): social care employment statistics and people with learning disabilities<p><span style="font-family: trebuchet, serif;">This blogpost is the third in a set looking at various aspects of the </span>social care statistics recently published by NHS Digital for 2021/22<span style="font-family: trebuchet, serif;">, focusing on adults with learning disabilities in England. The first two blogposts gave </span>an overview of trends in <a href="https://chrishatton.blogspot.com/2022/10/doing-less-with-less-social-care.html" target="_blank">social care support</a> and <a href="https://chrishatton.blogspot.com/2022/10/spending-more-and-doing-less-social.html" target="_blank">social care spending</a> for adults with learning disabilities<span style="font-family: trebuchet, serif;">.</span></p><p class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="color: black; font-family: "trebuchet",serif; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">This blogpost updates <a href="https://chrishatton.blogspot.com/2021/11/people-with-learning-disabilities-in.html" target="_blank">previous posts</a> on what the statistics say about the self/paid employment of working age (aged 18-64 years old) adults with learning disabilities in England. These figures are provided by local authorities every year, and since 2014/15 have only been provided for people getting long-term social care (before 2014/15 it was the larger group of people known to local authorities as a person with learning disabilities, even if they weren't getting long-term social care support). This means that these figures don't include the much, much larger group of adults with learning disabilities who aren't known to local authorities or GPs and who don't get any kind of support related to their learning disability.</span><span style="color: black; font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><o:p></o:p></span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span style="color: black; font-family: "trebuchet",serif; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">It is important to note that these statistics are collected for financial years (April to March), so they will represent what was happening for adults with learning disabilities up to March 2022, through the continuing COVID-19 pandemic in England. It is also really important to say that the quality of this information has been questioned at the best of times – there are massive caveats about the extent to which local authorities would be able to collect this kind of information accurately throughout a pandemic.</span><span style="color: black; font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><o:p></o:p></span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span style="color: black; font-family: "trebuchet",serif; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Some of the numbers reported here are included in the Adult Social Care Outcomes Framework </span><span style="color: black; font-family: "trebuchet",serif; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">(indicator 1E, if you're interested), although some of the numbers are more buried in publicly available but less accessible CSV datafiles. </span><span style="color: black; font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><o:p></o:p></span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span style="color: black; font-family: "trebuchet",serif; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">What do the numbers tell us?</span><span style="color: black; font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><o:p></o:p></span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span style="color: black; font-family: "trebuchet",serif; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">The first graph below shows the number of working age adults with learning disabilities that councils say are in any self/paid employment, broken down by whether people are in employment for 16+ hours per week or less than 16 hours per week (and 1 hour a week can count in these statistics). The gap between 2013/14 and 2014/15 is because of the change in data collection I mentioned earlier, so numbers before and after then can't be compared, and 2008/2009 was the first year that information was collected so it's rather dodgy for that year.</span><span style="color: black; font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><o:p></o:p></span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span style="color: black; font-family: "trebuchet",serif; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"> </span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: black; font-family: "trebuchet",serif; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRDKAzGbO2qVQ8bwXq30jVV4mw3qzPnr5_9muDpXbrZZKctOKHbcD1HJT6LqpiYY4_8iyK3mJ-NCLbNtnINLt1oACVSFxJZeZ9rsVSAy6fO_NOK-9FU2ft0XCYYkds1HkcYWdqNgvlSmOgH2Vq3Ciqa71yr5u3TnIO0gCChXeVxV_SVyzpWNE3xOYT5A/s2193/Picture17.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1314" data-original-width="2193" height="384" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRDKAzGbO2qVQ8bwXq30jVV4mw3qzPnr5_9muDpXbrZZKctOKHbcD1HJT6LqpiYY4_8iyK3mJ-NCLbNtnINLt1oACVSFxJZeZ9rsVSAy6fO_NOK-9FU2ft0XCYYkds1HkcYWdqNgvlSmOgH2Vq3Ciqa71yr5u3TnIO0gCChXeVxV_SVyzpWNE3xOYT5A/w640-h384/Picture17.png" width="640" /></a></span></div><p></p><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><br /></div></div><span style="color: black; font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><o:p></o:p></span><p></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; text-align: justify;"><span style="font-family: trebuchet, serif; text-align: left;">According to these figures, in 2021/22 there were 6,380 working age adults with learning disabilities getting long-term social care in any form of self/paid employment. After a couple of years of the number of people in paid/self employment edging towards 8,000, this is now the lowest number of people in paid employment since the first dodgy year of data collection in 2008/09. Consistent across the years is that most of the people in employment (71% of people in 2021/22) are working for less than 16 hours per week.</span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span style="color: black; font-family: "trebuchet",serif; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">What do these numbers mean in terms of employment rates? The graph below shows the employment rates for working age adults with learning disabilities over the same time period. The columns show the overall employment rate - in 2021/22 this was 4.8%, compared to </span><span style="color: black; font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><span style="font-family: "trebuchet",serif;"><a href="https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/employmentandemployeetypes/bulletins/uklabourmarket/march2022" target="_blank">76% for adults generally</a></span></span><span style="color: black; font-family: "trebuchet",serif; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><a href="https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/employmentandemployeetypes/bulletins/uklabourmarket/march2022" target="_blank"> </a>in March 2022. This is the lowest employment rate for adults with learning disabilities recorded since the statistics were changed in 2014/15.</span><span style="color: black; font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><o:p></o:p></span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span style="color: black; font-family: "trebuchet",serif; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">The lines on the graph show employment rates for men and women with learning disabilities separately. Employment rates for men (the purple line) are consistently higher (5.3% in 2021/22) than employment rates for women (the blue line) (4.1% in 2021/22 with this gender employment gap staying fairly stable over time.</span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span style="color: black; font-family: "trebuchet",serif; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><br /></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-mRjOfwo3Zkj_byQfQkeNaOhutxuOTb67vDCAewVsdDwJF7hiQsukLE8Zo6CMwAb_zxVFtWJPZDdW3iIJE1dieledHigx6sqVJrlriN6E7iEJYZsYoOox2-hSICv6yAlCPHZ8XymynC4gAvULp4BieEoxvdViBoJn7ETg6i8tzss98DdOiNh_17J22Q/s2189/Picture18.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1196" data-original-width="2189" height="350" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-mRjOfwo3Zkj_byQfQkeNaOhutxuOTb67vDCAewVsdDwJF7hiQsukLE8Zo6CMwAb_zxVFtWJPZDdW3iIJE1dieledHigx6sqVJrlriN6E7iEJYZsYoOox2-hSICv6yAlCPHZ8XymynC4gAvULp4BieEoxvdViBoJn7ETg6i8tzss98DdOiNh_17J22Q/w640-h350/Picture18.png" width="640" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><p></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><span style="font-family: trebuchet, serif;">The last graph below sounds an appropriate note of caution about the reliability of information on self/paid employment provided by councils. This shows, for all working age adults with learning disabilities getting long-term social care, whether councils say they are: 1) in self-paid employment; 2) not in employment but actively seeking work (and presumably therefore liable to potential benefit sanctions); 3) not in employment but not actively seeking work. There is also a fourth category, where councils say they don't know the employment status of the person.</span><span style="font-family: trebuchet, serif;"> </span></p><p align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; text-align: center;"><span style="color: black; font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><o:p></o:p></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgi_DRgnBoTsb7cuGWcXIxGisDs8GLKkToyvOgY9mMN-aFOWKict-ndlzLHN5IpxnCU0PRYDN0Kyv8QxOO0QqNgYLuheTx--0lx0V3fWFrY27HK5kC8RXx93VT_W9i55dAUAiDBHq_FJsa8IwKgUGSGVQcwHU-jfy0KY4O3XRBasqqZbxMVnl6E1AOiiQ/s1653/Picture19.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="972" data-original-width="1653" height="376" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgi_DRgnBoTsb7cuGWcXIxGisDs8GLKkToyvOgY9mMN-aFOWKict-ndlzLHN5IpxnCU0PRYDN0Kyv8QxOO0QqNgYLuheTx--0lx0V3fWFrY27HK5kC8RXx93VT_W9i55dAUAiDBHq_FJsa8IwKgUGSGVQcwHU-jfy0KY4O3XRBasqqZbxMVnl6E1AOiiQ/w640-h376/Picture19.png" width="640" /></a></div><div class="separator" style="clear: both; text-align: center;"><span style="text-align: left;"> </span></div><p></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><span style="font-family: trebuchet, serif;">Over time, the number of people whose employment status is unknown has decreased rapidly, from 44% of working age adults with learning disabilities in 2014/15 to 21% of people in 2021/22 (21% is still a big chunk, however). It is unclear how councils are making decisions about whether to record someone as actively seeking work or not.</span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span style="color: black; font-family: "trebuchet",serif; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Overall, this update shows, bearing in mind understandable caveats about the quality of the information that could be collected during the continuing COVID-19 pandemic, further reductions in employment rates (from a ridiculously low base) for working age adults with learning disabilities getting long-term social care, with most work being extremely part-time, and a gender employment gap. </span><span style="color: black; font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><o:p></o:p></span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span style="color: black; font-family: "trebuchet",serif; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">As far as we know, many more than 5.1% of working age adults with learning disabilities want to work. We know that </span><span style="color: black; font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><a href="https://www.blogger.com/blog/post/edit/1016904785776950121/1313705137535327965"><span style="font-family: "trebuchet",serif;">secure, stable paid employment for people with learning disabilities is associated with better physical and mental health</span></a></span><span style="color: black; font-family: "trebuchet",serif; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">, and we know that </span><span style="color: black; font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><a href="https://www.blogger.com/blog/post/edit/1016904785776950121/1313705137535327965"><span style="font-family: "trebuchet",serif;">supported employment is highly cost-effective</span></a></span><span style="color: black; font-family: "trebuchet",serif; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">. Building sustainable, fulfilling paid employment for people with learning disabilities, in our current circumstances of wide-ranging labour shortages, surely has to be an urgent ‘building back better’ priority? Perhaps the ambitions of the May 2022 <a href="https://www.gov.uk/government/publications/people-at-the-heart-of-care-adult-social-care-reform-white-paper" target="_blank">Government adult social care reform white paper </a>will be reflected in improved figures next year...</span></p>Chris Hattonhttp://www.blogger.com/profile/05299821560069281510noreply@blogger.com0tag:blogger.com,1999:blog-1016904785776950121.post-45630226159879168882022-10-23T20:13:00.016+01:002022-10-26T16:46:40.091+01:00I got bills: Social care spending 2021/22 and people with learning disabilities<p>NHS Digital have recently released their <a href="https://digital.nhs.uk/data-and-information/publications/statistical/adult-social-care-activity-and-finance-report/2021-22" target="_blank">annual tranche of statistics concerning social care for adults in England</a>. This blogpost is the latest in <a href="https://chrishatton.blogspot.com/2021/10/building-back-better-or-new-normal.html" target="_blank">a series about social care statistics</a> concerning adults with learning disabilities in England, updating the statistics to include the latest 2021/22 figures. Because the reporting year for these statistics runs from April to March, these are the second set of annual statistics that might tell us something about the impact of the COVID-19 pandemic on social care services for adults with learning disabilities. When looking through these statistics it is important to remember the pressures local authorities have been under, which might have affected the quality of the information collected.</p><p class="MsoNormal"><o:p></o:p></p><p class="MsoNormal">Councils with social services responsibilities return information to NHS Digital every year on how many adults are using various forms of social care, and how much councils spend on social care (this doesn’t include other types of state funding relevant to social care, such as housing benefit as part of supported living support). I've tried to use some of the statistics to answer three questions about spending on social care services for adults with learning disabilities (questions relating to how many adults with learning disabilities are using social care <a href="https://chrishatton.blogspot.com/2022/10/doing-less-with-less-social-care.html" target="_blank">are in a previous blogpost</a>).</p><p><b>Question 1: How much money are councils spending on social care services for adults with learning disabilities?</b></p><p class="MsoNormal"><o:p></o:p></p><p class="MsoNormal">The graph below shows gross expenditure by local authorities on social care for adults with learning disabilities from 2014/15 to 2021/22, broken down by age band and categories of spending. It is important to remember that these figures do not include housing benefit (an essential component of supported living arrangements). These figures are also not adjusted for inflation, which as we enter a time of high inflation is going to be even more important to take into account. However, using 2014/15 as a baseline (there had already been real-terms cuts to social care budgets by this point), the graphs also includes lines of what expenditure would be if social care expenditure only increased in line with inflation, using adult social care inflation figures from the invaluable PSSRU publication <a href="https://www.pssru.ac.uk/project-pages/unit-costs/unit-costs-of-health-and-social-care-2021/" target="_blank">Unit Costs of Health and Social Care (2021 edition)</a>. </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjK--MVNCjbDuxs9qvqPp1KxZp6UMFnEgfECvV4oHTkFht7ukE1M6QmenujG8mn4oZ2hMDGaVxJfpMTQiavpM7t7pYATbZucSLNhyB8XSqxyejUH47QY2YiYaf9PwK7DyRFTi4nKeqH9mwR4nAQd2_5xrMC53lqJkx4zFUcBZQJsjBHYN_jzs3mYtjy_w/s3010/Picture6.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1922" data-original-width="3010" height="408" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjK--MVNCjbDuxs9qvqPp1KxZp6UMFnEgfECvV4oHTkFht7ukE1M6QmenujG8mn4oZ2hMDGaVxJfpMTQiavpM7t7pYATbZucSLNhyB8XSqxyejUH47QY2YiYaf9PwK7DyRFTi4nKeqH9mwR4nAQd2_5xrMC53lqJkx4zFUcBZQJsjBHYN_jzs3mYtjy_w/w640-h408/Picture6.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><p></p><p class="MsoNormal">A couple of observations. Overall, despite the number of adults getting social care decreasing during 2021/22, social services expenditure continued its steady upwards trajectory in absolute terms in 2021/22 at an annual growth rate of 4% from 2014/15. Local authority gross expenditure on social care for adults with learning disabilities totalled £6.5 billion in 2021/22, 30% of all local authority expenditure on adult social care. For both adults with learning disabilities aged 18-64 and adults with learning disabilities aged 65+, increases in expenditure ran slightly ahead of inflation. This indicates local authorities trying to protect these budgets, while at the same time falling short of what would be needed given projected increases in the population of adults with learning disabilities needing social care support.</p><p class="MsoNormal">The two line graphs below show trends in expenditure on specific types of social care service for adults with learning disabilities aged 18-64 and 65+ (with different scales for the two age groups). Spending on supported living continues to increase and has now overtaken spending on residential care - these two are by far the largest components of social care expenditure to support adults with learning disabilities.</p><p class="MsoNormal"><o:p></o:p></p><p class="MsoNormal"><o:p> </o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0VyEuOctv76D-fGMNOg-9-pPMcfND7gut3JxkYXhXyZ2uGW3IylsSY09O39ZxBDf1l_b8yHkTZvGazmhdWU0JuEcioRf4diWOFNFeG0tl8_KBrnihYeF6Q8FoSZj9mrfi_cKu39Khp7dbsb53HDC7HHOsqHT5x7gip-CI8JZs5wbamkMEKPIL1G1Ehw/s2556/Picture7.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1920" data-original-width="2556" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0VyEuOctv76D-fGMNOg-9-pPMcfND7gut3JxkYXhXyZ2uGW3IylsSY09O39ZxBDf1l_b8yHkTZvGazmhdWU0JuEcioRf4diWOFNFeG0tl8_KBrnihYeF6Q8FoSZj9mrfi_cKu39Khp7dbsb53HDC7HHOsqHT5x7gip-CI8JZs5wbamkMEKPIL1G1Ehw/w640-h480/Picture7.png" width="640" /></a></div><br /><p></p><div class="separator" style="clear: both; text-align: center;"><br /></div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhoKS0Mg6zvf6MNkCWMUhVkCy7c_611hivR48JZBnUIRbggBLYMM7jKYN1A4KqJW6k7DV1a2jJN-pTyPF7tZviOQ1QdXnCdRmrPYBmvb3dpAYo3B3vukLa4QIGSgSuXeW1lqpSrWf7XjlQ4NCfGlN_jIMwJjVMFBrlSrQceBsjEgbmp5OLfzUlvEwBiVw/s2546/Picture8.png" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" data-original-height="1923" data-original-width="2546" height="484" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhoKS0Mg6zvf6MNkCWMUhVkCy7c_611hivR48JZBnUIRbggBLYMM7jKYN1A4KqJW6k7DV1a2jJN-pTyPF7tZviOQ1QdXnCdRmrPYBmvb3dpAYo3B3vukLa4QIGSgSuXeW1lqpSrWf7XjlQ4NCfGlN_jIMwJjVMFBrlSrQceBsjEgbmp5OLfzUlvEwBiVw/w640-h484/Picture8.png" width="640" /></a><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div><b>Question 2: How much are people paying for social care in 'client contributions'?</b></div><div><br /></div><div>When looking at the figures above on expenditure, it is important to remember that this is gross current expenditure - it does not take account of any income that might be coming into local authorities providing social care services. One source of income is 'client contributions' - money for social care support that is paid by people drawing on social care support or those close to them.</div><div><br /></div><div>The two graphs below show the amount of income received by local authorities in client contributions for different types of social care support, for services for adults with learning disabilities aged 18-64 and for adults with learning disabilities aged 65+. As with the earlier overall expenditure graph, using 2014/15 as a baseline the graphs also includes lines of what expenditure would be if client contributions for social care only increased in line with inflation, using adult social care inflation figures from the PSSRU publication <a href="https://www.pssru.ac.uk/project-pages/unit-costs/unit-costs-of-health-and-social-care-2021/" target="_blank">Unit Costs of Health and Social Care (2021 edition)</a>. </div><div><br /></div><div>For both adults aged 18-64 and adults aged 65+, the biggest types of client contributions were for residential care and contributions under <a href="https://www.disabilityrightsuk.org/charging-community-care" target="_blank">the 'fairer charging' regimen and its successors</a>. Also for both age groups, client contributions over time have increased faster than inflation, and in total added up to £472.7 million in 2021/22, representing 7% of total gross social care spending.</div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiafhze7Va92BmmIFwRFoPtxVp2vCl-WM8UbCgD88uesxDW4pCM9emRoorD5EZjIPBC5edIh-yrlf5dJrJmwsAYGpZVcAtp8WU_Tv5nZdCJcxyhry_Yp3lEZWKen8zyTsyXxJ4slcr0qC7zlw8EMrcRtBkz2vCgNp2bmi0_zdBQ50xK5tZRsOCrD9rlmw/s2423/Picture11.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1609" data-original-width="2423" height="424" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiafhze7Va92BmmIFwRFoPtxVp2vCl-WM8UbCgD88uesxDW4pCM9emRoorD5EZjIPBC5edIh-yrlf5dJrJmwsAYGpZVcAtp8WU_Tv5nZdCJcxyhry_Yp3lEZWKen8zyTsyXxJ4slcr0qC7zlw8EMrcRtBkz2vCgNp2bmi0_zdBQ50xK5tZRsOCrD9rlmw/w640-h424/Picture11.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMLwP3cHect361m59jLPOsWRUURDmCkK_kGvfzZJ_EBHcnUyGr-qhGGn4fRXc5-OJ6DuLy2oQzG-4TeuCKOY4m7HRu54YKJiTjCJSz7CG6ukpl8qSKFgUKC5aA9XnWT3n5M-dykFkRl6PkbKEW3J0Y65eKWKYzVxr4jRfzgowIqU7tZg0SeMKF-Dbefw/s2423/Picture12.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1609" data-original-width="2423" height="424" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMLwP3cHect361m59jLPOsWRUURDmCkK_kGvfzZJ_EBHcnUyGr-qhGGn4fRXc5-OJ6DuLy2oQzG-4TeuCKOY4m7HRu54YKJiTjCJSz7CG6ukpl8qSKFgUKC5aA9XnWT3n5M-dykFkRl6PkbKEW3J0Y65eKWKYzVxr4jRfzgowIqU7tZg0SeMKF-Dbefw/w640-h424/Picture12.png" width="640" /></a></div><br /><div><br /></div><div><b>Question 3: Are unit costs changing over time?</b></div><div><br /></div><o:p>U</o:p>nit costs for residential care and nursing care for adults with learning disabilities continued their upward trend in 2021/22 for adults aged 18-64. For adults aged 18-64, the average cost to local authorities of residential care was £1,726 per person per week and nursing care £1,568 per person per week. Unit costs were cheaper in 2021/22 for adults aged 65+ compared to adults aged 18-64 (£1,155 per person per week in residential care; £792 per person per week in nursing care), with unit costs decreasing for adults aged 65+ from 2020/21 to 2021/22. It is worth noting that unit costs are higher for these services for adults with learning disabilities aged 18-64 than for any other group of people getting social care.<p></p><p class="MsoNormal"><o:p></o:p></p><p class="MsoNormal"><o:p> </o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibLI6B1qw40b4rsMJ5G9QPwm-yjWG1SE2rGMclDkOGJco6vSLHRdrJEFcc3qneV45uTdv5ZB6-FfYJiSyUQOOrd7tOXuSqfKktvqTGHKDMSx62uiBVCYVon7HdCsCWImqIA9RrVXoLKjVRogf-rY0E5MjZ1PVMrpP9WJ-mdFqM8_UWobA8jzix7gglrQ/s2657/Picture9.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1298" data-original-width="2657" height="312" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibLI6B1qw40b4rsMJ5G9QPwm-yjWG1SE2rGMclDkOGJco6vSLHRdrJEFcc3qneV45uTdv5ZB6-FfYJiSyUQOOrd7tOXuSqfKktvqTGHKDMSx62uiBVCYVon7HdCsCWImqIA9RrVXoLKjVRogf-rY0E5MjZ1PVMrpP9WJ-mdFqM8_UWobA8jzix7gglrQ/w640-h312/Picture9.png" width="640" /></a></div><div><br /></div><div><br /></div><div><br /></div><div><b>Summing up</b></div><div><br /></div><div>Social care spending for adults with learning disabilities reported in 2021/22 seems to continue longer-term trends, with increases just above inflation, continued increases in spending on supported living, and both supported living and residential care being the biggest types of social care spending. Client contributions also continue to rise faster than inflation year-on-year. There is a more mixed picture when it comes to the unit costs of residential and nursing care.</div><div><br /></div><div>Given that there were 2,275 fewer adults getting social care at the end of March 2022 compared to the end of March 2020, with high inflation and staff shortages a present reality, what kind of a future are councils planning for? How much are councils spending on block contracts irrespective of whether people want to live there, and on 'voids' where people aren't even living? A future combining a high eligibility barrier with expensive, restrictive service options predominating seems the very opposite of value for money.</div><div><br /></div><div><br /></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div>Chris Hattonhttp://www.blogger.com/profile/05299821560069281510noreply@blogger.com0tag:blogger.com,1999:blog-1016904785776950121.post-86696776098167195162022-10-21T18:22:00.281+01:002022-10-24T09:39:53.100+01:00The missing thousands - social care statistics 2021/22 and people with learning disabilities (1)<p>NHS Digital have recently released their <a href="https://digital.nhs.uk/data-and-information/publications/statistical/adult-social-care-activity-and-finance-report/2021-22" target="_blank">annual tranche of statistics concerning social care for adults in England</a>. This blogpost is the latest in <a href="https://chrishatton.blogspot.com/2021/10/building-back-better-or-new-normal.html" target="_blank">a series about social care statistics</a> concerning adults with learning disabilities in England, updating the statistics to include the latest 2021/22 figures. Because the reporting year for these statistics runs from April to March, these are the second set of annual statistics that might tell us something about the impact of the COVID-19 pandemic on social care services for adults with learning disabilities. When looking through these statistics it is important to remember the pressures local authorities have been under, which might have affected the quality of the information collected.</p><p class="MsoNormal"><o:p></o:p></p><p class="MsoNormal">Councils with social services responsibilities return information to NHS Digital every year on how many adults are using various forms of social care, and how much councils spend on social care (this doesn’t include other types of state funding relevant to social care, such as housing benefit as part of supported living support). I've tried to use some of the statistics to answer four questions (questions relating to social care spending and employment will be in two follow-up blogposts).<o:p></o:p></p><p class="MsoNormal"><b>Question 1: How many adults with learning disabilities were getting access to social care in 2021/22?</b></p><p class="MsoNormal"><o:p></o:p></p><p class="MsoNormal">From 2014/15 the types of long-term social care support people get have been grouped into one of six mutually exclusive categories: residential care, nursing care, direct payment only, support via a personal budget partly including a direct payment, a council-managed personal budget, and council-commissioned community support only.<span style="mso-fareast-language: EN-GB; mso-no-proof: yes;"><o:p></o:p></span></p><p class="MsoNormal">The first graph below shows the number of adults with learning disabilities aged 18-64 getting various types of personal budget or council-commissioned community support at some point during the year from 2014/15 to 2021/22), and also the number of adults aged 18-64 in residential or nursing care.</p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlTSUx0vy4DRPfbbB-8bLgqwzLlvyx7o83wHjLmMay7-YstwuUrZRVK0cdGzwaPIJyW3DvpR-C51VOhqKn4xcgP_TlTf88LNeqHY24C_kF79y8bJzMEGVEJoICxYQFkn-HyhwJeHnU-A6o6iEjXbzMMCwBZnV1cZQPkH438msXz0Ior2wPlGL-VEAyFw/s2040/Picture1.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1137" data-original-width="2040" height="356" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlTSUx0vy4DRPfbbB-8bLgqwzLlvyx7o83wHjLmMay7-YstwuUrZRVK0cdGzwaPIJyW3DvpR-C51VOhqKn4xcgP_TlTf88LNeqHY24C_kF79y8bJzMEGVEJoICxYQFkn-HyhwJeHnU-A6o6iEjXbzMMCwBZnV1cZQPkH438msXz0Ior2wPlGL-VEAyFw/w640-h356/Picture1.png" width="640" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><p></p>This graph suggests that some trends evident from 2014/15 to 2018/19 (before the COVID-19 pandemic) for adults with learning disabilities aged 18-64 have continued through to 2021/2022, while other trends have changed pace or reversed. <div><br /></div><div>Residential care has continued to reduce year-on-year from 26,975 people in 2014/15 to 21,880 people in 2012, as has nursing care (1,265 people in 2014/15 through to 1,035 people in 2021/22). The number of people getting social care in the form of direct payments increased from 2014/15 (21,580 people) to 2020/21 (28,015 people), but has levelled off in 2021/22 (27,930 people). The number of people getting social care at least partly in the form of a direct payment increased from 2014/15 (13,265 people) to 2019/20 (17,255 people), but has decreased since (16,265 people in 2021/22). The most common form of long-term social care support was the council-managed personal budget (the extent to which many of these feel any different to council-commissioned community services is debatable), which continues to increase over time (from 49,150 people in 2014/15 to 61,530 people in 2021/22). Finally, while the number of people getting council-managed community support decreased substantially from 2014/15 (12,000 people) to 2020/21 (4,900 people), this number increased sharply in 2021/22 (8.090 people).<br /><div><br /></div><div>In terms of residential and nursing care, the graph shows that although the number of adults aged 18-64 in residential care and nursing care continues to gradually decline over time, in 2020/21 they still represented 17% of all adults with learning disabilities aged 18-64 getting long-term social care.</div><div><p class="MsoNormal"><o:p></o:p></p><p class="MsoNormal">In total 132,465 adults with learning disabilities aged 18-64 were getting long-term social care at some point in 2021/22. While there had been a steady trend of increasing numbers of adults with learning disabilities getting long-term social care year on year from 2014/15 to 2019/20, from 2019/20 to 2021/22 there have been two years of decreases in these numbers - there were 2,965 fewer adults with learning disabilities aged 18-64 getting long-term social care at some point in 2021/22 than in 2019/20. <br /></p><p class="MsoNormal">The second graph below presents the same information for adults with learning disabilities aged 65+. Please note that, because the number of people with learning disabilities aged 65+ using social care is much smaller compared to people aged 18-64, I have used a different vertical scale.</p><p class="MsoNormal"></p><div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8GvIKEL_w6dloPVNOBVAGMhCRQbqiX1CO19zfmuC2KeeILKIkhlmkCo3eouo7HnzujE-vlS7mz2NXyI_TeyH8nmQ6xDB7NDOEPZm4qiwmw79Q4QGCBIAvceNh51yCPaMAYnpwHrWpiy-u1UcW4H1kV-FwSGJ2pUTaPxwa1X86gQfiz2psWqXWhJewmg/s2409/Picture2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1107" data-original-width="2409" height="294" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8GvIKEL_w6dloPVNOBVAGMhCRQbqiX1CO19zfmuC2KeeILKIkhlmkCo3eouo7HnzujE-vlS7mz2NXyI_TeyH8nmQ6xDB7NDOEPZm4qiwmw79Q4QGCBIAvceNh51yCPaMAYnpwHrWpiy-u1UcW4H1kV-FwSGJ2pUTaPxwa1X86gQfiz2psWqXWhJewmg/w640-h294/Picture2.png" width="640" /></a></div><br />Unlike the figures for adults with learning disabilities aged 18-64, there is a continuous year-on-year upward trend in the numbers of adults with learning disabilities aged 65+ getting long-term social care, from 14,570 people in 2014/15 through to 18,405 people in 2021/22. </div><div><br /></div><div>The upward trend for the number of people in residential homes and nursing homes was interrupted in 2020/21 with a slight dip, but has resumed from 2020/21 to 2021/22, when 5,830 people were in residential homes and 860 people were in nursing homes. People getting long-term social care in the forms of direct payment only (620 people in 2014/15; 1,065 people in 2021/22), part direct payment (505 people in 2014/15; 785 people in 2021/22), and council-managed personal budgets (5,920 people in 2014/15; 9,350 people in 2021/22), with occasional fluctuations, have continued to trend upwards over time. The number of people getting council-commissioned community support has continued to decrease over time (1,430 people in 2014/15; 515 people in 2021/22).</div><div><br /></div><div>For adults with learning disabilities aged 65+ getting long-term social care, 36% were getting this care in the form of residential or nursing care.</div><div><br /></div><div><p></p><p class="MsoNormal">However, the statistics I’ve presented so far are for people getting long-term social care at some point in each year. This may under-estimate the impact of COVID-19 on the number of people currently getting social care, particularly where people have died during the year. The NHS Digital statistics also have snapshot figures on the number of people with learning disabilities getting adult social care at the end of each financial year, which we can compare to the number of people getting social care at some point during the year. The graph below shows this information for adults with learning disabilities aged 18-64, from 2014/15 to 2021/22. In 2020/21 and 2021/22, there is a clear reversal in the upward trend, with both people getting long-term social care at some point in the year (132,465 people) and people getting long-term social care support at the end of the financial year (124,635 people) falling for two consecutive years.</p><p class="MsoNormal"><o:p> </o:p><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEho7Hd-lD2eHzVSw0UuO-aYyYxS3gZMgX5XfjaBuhMOAUbD13EFegIPjfYCvBLfoXdGRjPhRWDxsIjH7OfRufiaYQHYnqUfwC0g9vkkML1URXxLs-48h3_jDbtQr95tS2qW3qI5Mx4MD0zam6fYv68318LjrjbXcctfIK2FIcAug8rzkcyN18gOg7Otug/s2192/Picture3.png" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" data-original-height="1055" data-original-width="2192" height="308" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEho7Hd-lD2eHzVSw0UuO-aYyYxS3gZMgX5XfjaBuhMOAUbD13EFegIPjfYCvBLfoXdGRjPhRWDxsIjH7OfRufiaYQHYnqUfwC0g9vkkML1URXxLs-48h3_jDbtQr95tS2qW3qI5Mx4MD0zam6fYv68318LjrjbXcctfIK2FIcAug8rzkcyN18gOg7Otug/w640-h308/Picture3.png" width="640" /></a></p><div style="text-align: center;"><div class="separator" style="clear: both; text-align: center;"><br /></div></div><p></p><p class="MsoNormal">The next graph below shows the same information for people aged 65+, with a different pattern to people aged 18-64. The number of people getting long-term social care support at some point in the year continues to increase into 2021/22. The number of people getting long-term care at the end of the 2020/21 financial year dropped from 2018/19 to 2020/21, but increased again from 2020/21 to 2021/22. </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiccznfNUCEUeun2KXUXRUF-mQTFRAhqvExifMftj9LPF9tlgWizdF3m4ThiZfkeAxkxFRtP0-3j7yhU352rCPzCW38A-bR4apGx2d7QCNurco5t7imW6Ld8tOPKXTfTdD_AdZ2o9SUrMTker-psGVHgZRTAAV0QAMIEHH__KA-uatmLgQ830RUBkJxQw/s2192/Picture4.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1055" data-original-width="2192" height="308" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiccznfNUCEUeun2KXUXRUF-mQTFRAhqvExifMftj9LPF9tlgWizdF3m4ThiZfkeAxkxFRtP0-3j7yhU352rCPzCW38A-bR4apGx2d7QCNurco5t7imW6Ld8tOPKXTfTdD_AdZ2o9SUrMTker-psGVHgZRTAAV0QAMIEHH__KA-uatmLgQ830RUBkJxQw/w640-h308/Picture4.png" width="640" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><p></p><p class="MsoNormal">While these statistics are difficult to interpret, there were 2,275 fewer adults with learning disabilities of all ages getting long-term social care at the end of March 2022 compared to the same time two years before.</p><p class="MsoNormal">There is also the question of whether the number of adults with learning disabilities getting long-term social care is increasing in line with projected increases in the number of adults with learning disabilities needing social care. The graph shows the total number of adults with learning disabilities aged 18+ getting long-term social care support at any time in the year and at the end of each year, using the same overall format as the graphs above. Added to the graph are projected numbers of adults with learning disabilities requiring social care support, taken from <a href="https://eprints.lancs.ac.uk/id/eprint/129308/1/Emerson_NIHR_SSCR_Final_Report.pdf" target="_blank">population projections published in 2012</a> and baselined for 2014/15. There are two projections using dashed lines - the dark blue dashed line is the number of adults with critical or substantial needs only, and the light blue dashed line is for the number of adults with critical, substantial or moderate needs. </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWuFN1GWUvFNwg-1hH7GaLlXAV82DYPynYD2A0xCpdQtrETpmFm7vQqvS2G-aHFLmrNpQNCvzXszM6zm6Hw2FoJL78JJSOQFxQHgQwSuxwcLPPZwMqnzF7VRpQrBF-ELeMjQOnXFtV2CFZU_c4Tee0CupXlHS9u0RSVJlddpViTx_1TtMAPd9Rzivbpg/s2193/Picture10.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1307" data-original-width="2193" height="382" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWuFN1GWUvFNwg-1hH7GaLlXAV82DYPynYD2A0xCpdQtrETpmFm7vQqvS2G-aHFLmrNpQNCvzXszM6zm6Hw2FoJL78JJSOQFxQHgQwSuxwcLPPZwMqnzF7VRpQrBF-ELeMjQOnXFtV2CFZU_c4Tee0CupXlHS9u0RSVJlddpViTx_1TtMAPd9Rzivbpg/w640-h382/Picture10.png" width="640" /></a></div><br /><p class="MsoNormal">As the graph shows, up to 2018/19 the number of adults getting long-term social care was just about keeping pace with the projected numbers of adults with critical or substantial needs (which is drawing the eligibility hurdle really quite high), but by 2021/22 the gap between the number of people projected to need social care and those actually getting social care was around 10,000 people. The gap is even greater if you take the projected number of adults with learning disabilities with critical, substantial or moderate needs (a gap of around 19,000 people in 2021/22).</p><p class="MsoNormal"><o:p><br /></o:p></p><p class="MsoNormal"><o:p><b>Question 2: Where are people with learning disabilities living?</b></o:p></p><p class="MsoNormal">The headline social care statistics only report the living situations of people living in residential care and nursing homes (social care support for people in other living situations is characterised by whether they’re getting council-commissioned support or some form of personal budget). The number of adults with learning disabilities in residential and nursing care from 2014/15 to 2021/22 is in the graph below, broken down by whether people are aged 18-64 or 65+. For people aged 18-64, the trend is for a substantial decrease in the number of people living in residential care – a reduction of 19% in 7 years, with a similar percentage drop (18%) for adults aged 18-64 in nursing care. For adults with learning disabilities aged 65+, the number of people in residential care and nursing care has been gradually increasing up to 2019/20 (although with dips in 2017/18 and 2020/21). </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEilHqTyY9o5SFzcwdeL2pzDwjhF0dTF4Or7aUaCLOqInUlTn0wkZDgJfaNArdXdIHFQE5_fedI0lYbARSrfGgSzAtW6XpkoxwJjykt32_UpMlw2x0qpYVym3V6uQHEjbp9hxFhCoGaE1zCNYfZULnx-bB5PTZU1NEdb0b2UqG64fcdBDVk233GTWA1mKQ/s2045/Picture14.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1141" data-original-width="2045" height="358" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEilHqTyY9o5SFzcwdeL2pzDwjhF0dTF4Or7aUaCLOqInUlTn0wkZDgJfaNArdXdIHFQE5_fedI0lYbARSrfGgSzAtW6XpkoxwJjykt32_UpMlw2x0qpYVym3V6uQHEjbp9hxFhCoGaE1zCNYfZULnx-bB5PTZU1NEdb0b2UqG64fcdBDVk233GTWA1mKQ/w640-h358/Picture14.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><p></p><p class="MsoNormal">More hidden in the social care statistics is more detailed information on where local authorities think that adults with learning disabilities aged 18-64 who are getting long-term social care are living (a holdover indicator introduced, along with employment, with Valuing People). The monster graph below stacks up all the different types of living situation, from 2014/15 to 2021/22 (again note the ominous decreases in 2020/21 and 2021/22). </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9mq1zzQUrOmbpqvHzpg_gZAQFzwoqWVEQrfpahn82kRXokE7l-vTXy4iLM40ac8FWMp1sZZU6WVzLNfPhj0OSrC_SO0o2JZ37O4qxxpEsVlqNvopCMQUW11kMpCK3TqdTJwWjK0NjJZUyRpD8dH94MiVwqJYO-SMHGQi362h7XUd5HRRR1S7mDK_Umg/s3709/Picture15.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2730" data-original-width="3709" height="472" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9mq1zzQUrOmbpqvHzpg_gZAQFzwoqWVEQrfpahn82kRXokE7l-vTXy4iLM40ac8FWMp1sZZU6WVzLNfPhj0OSrC_SO0o2JZ37O4qxxpEsVlqNvopCMQUW11kMpCK3TqdTJwWjK0NjJZUyRpD8dH94MiVwqJYO-SMHGQi362h7XUd5HRRR1S7mDK_Umg/w640-h472/Picture15.png" width="640" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><p class="MsoNormal">To hopefully make this a bit more digestible, I’ve picked out trends for the most common types of living situation in the graph below. As the graph shows, the most common (and increasing up to 2019/20) living situations for adults with learning disabilities aged 18-64 were not residential or nursing care. By far the most common living situation was people living with their families (47,835 people in 2021/22; 36% of people recorded in this database). Over 30,000 people were living in some form of supported accommodation in 2021/22 (31,960 people; 24%), over 20,000 people were tenants or owner-occupiers (20,035 people; 15%) and 3,375 people (3%) were living in a Shared Lives arrangement. Throughout the COVID-19 pandemic adults with learning disabilities in all these living situations (and that’s without thinking of the majority of adults with learning disabilities, who do not get any social care support) were not exactly at the front of the queue when it came to government guidance, support with PPE and the essentials of daily life, repurposing much-needed social care support, and support to ensure that support workers could minimise the COVID-19 risks to themselves and the people they were supporting. </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihqZgDYnfVzQY_sKK43huhah0e0zphopPEKZJF6Mno2l5Qu_9NzEb_kh49cvqKEhF2iqZ1H68OB5-VJ4FUtCoZjCELjBERl0PVJQSUqmDoclvSvJpKeXW27YloZhv7ye3sb7uGPbab8CwK-bNnd3gc1pBXb4-JKJnYktloQ97eKDreqU4rOLQMHq1WNA/s3706/Picture16.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2619" data-original-width="3706" height="452" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihqZgDYnfVzQY_sKK43huhah0e0zphopPEKZJF6Mno2l5Qu_9NzEb_kh49cvqKEhF2iqZ1H68OB5-VJ4FUtCoZjCELjBERl0PVJQSUqmDoclvSvJpKeXW27YloZhv7ye3sb7uGPbab8CwK-bNnd3gc1pBXb4-JKJnYktloQ97eKDreqU4rOLQMHq1WNA/w640-h452/Picture16.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><div><b>Question 3: What happened to people trying to get a social care service?</b></div><p class="MsoNormal"><o:p></o:p></p><p class="MsoNormal">Although it is limited, adult social care statistics also include information on new people coming to the attention of social care services, and what happens to them after a ‘completed episode of short-term care to maximise independence’ (which to my untutored eye looks functionally equivalent to assessment). The graph below shows this information for all adults with learning disabilities aged 18+, from 2014/15 to 2021/22. Looking at the graph, 2018/19 looks like a bit of an anomaly, largely due to much higher numbers of people being signposted to universal services or other forms of non-social care support than in any other year. There seems to be an upward trend in the number of adults with learning disabilities coming to the attention of social services from 2014/15 to 2018/19, followed by a decrease from 2018/19 through to 2020/21, and a recent increase from 2020/21 to 2021/22 (although not to the levels of 2019/20).<o:p></o:p></p><p class="MsoNormal">In terms of what was happening in 2021/22, 1.030 adults with learning disabilities (almost all of whom were aged 18-64) came to social services as new clients.</p><p class="MsoNormal">Of these, 40% (415 people) were identified as having no needs and therefore requiring no services. For 14% (140 people) the response from social services was to signpost people to universal services or other forms of non-social care support. Almost one sixth of people (180 people; 17%) went on to get some form of low level or short-term support from social care, with a similar number (175 people; 17%) going on to get some form of long-term social care support. Very few (40 people; 4%) declined a service that was offered. </p><p class="MsoNormal"><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhad-IevvG6NdrnlxvN9F98o-WLjLeXHqaMUOXXETjXTiHwfveNSdK54FSijz5d_NhXGuZJGR0FqcCP7edtZCb5EgzFM5xxoOM0NwEsi_hhwO3uVC8Ig2uOxX0fHSeqeANfxNdxoKxsFXGZ2DUSOOj0eXTbukQZ97-sNvWem2QrWdiuXBdDy4vn1l3Ghw/s2416/Picture5.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1899" data-original-width="2416" height="504" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhad-IevvG6NdrnlxvN9F98o-WLjLeXHqaMUOXXETjXTiHwfveNSdK54FSijz5d_NhXGuZJGR0FqcCP7edtZCb5EgzFM5xxoOM0NwEsi_hhwO3uVC8Ig2uOxX0fHSeqeANfxNdxoKxsFXGZ2DUSOOj0eXTbukQZ97-sNvWem2QrWdiuXBdDy4vn1l3Ghw/w640-h504/Picture5.png" width="640" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><p></p><p class="MsoNormal">Throughout the two years of the pandemic, the number of adults with learning disabilities coming to the attention of social care has been lower than in any of the previous three years, with a minority of this group getting any form of social care support during the COVID-19 pandemic beyond signposting elsewhere. </p><p class="MsoNormal"><o:p><b>Question 4: What do adults with learning disabilities think about the social care services they're getting?</b></o:p></p><p class="MsoNormal"><o:p>At the same time as the publication of the 2021/22 social care statistics, <a href="https://digital.nhs.uk/data-and-information/publications/statistical/personal-social-services-adult-social-care-survey/england-2021-22" target="_blank">information from the latest Personal Social Services Adult Social Care Survey for 2021/22</a> was also released by NHS Digital. This is administered by councils to thousands of adults making use of social care services every year, and asks (in carefully developed and tested standard and easy read formats) a range of questions about people's experiences of social care services and about people's wellbeing and health.</o:p></p><p class="MsoNormal"><o:p>The graph below presents information from this survey from 2014/15 to 2021/22 for three groups of adults getting social care services; people with a primary care need of learning disabilities, people with a primary care need of physical support, and people with a primary mental health care need. The responses to four questions are summarised in the graph. For most groups, in response to the four questions at almost all time points there is little change over time (the exception being the percentage of people with learning disabilities saying they were not depressed or anxious, which increased by 16% in 2018/19 and has stayed at this higher level since), and overall people with learning disabilities report a consistently much more positive experience than the other two groups of people.</o:p></p><p class="MsoNormal">The general lack of change over this time period, when things have got harder for a lot of people getting social care and including the COVID-19 pandemic (although many groups were marginally more positive in 2020/21, at the height of lockdowns, than before or since), reinforces other research suggesting that these kinds of questions can be relatively insensitive to changes in people's circumstances.</p><p class="MsoNormal">The higher positivity of people with learning disabilities may be a genuine difference - it may also partly be a function of different question formats (people with learning disabilities are more likely to answer easy read format questions than other groups), and partly because people with learning disabilities were more likely to get help to answer questions, particularly from care workers, than the other two groups.</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvMuyaUYwcMjTeOK9rutEqrG-FKKQlmaN6mwL7SbgrUYzrraN2DZgQ0RngV8Hf72IA_kRzsF1929GJH5Tx-MZwSXVzBVm8A352cnHXsecfBwvx7_rDfJK9tpXk4yG_f9ZHXTdPuaVVTt3lMgc0QZ7-aoZdFHwQPc2QfF8RXz7fqqCAVS8RrfwYJ-2Z3w/s2609/Picture13.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1387" data-original-width="2609" height="340" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvMuyaUYwcMjTeOK9rutEqrG-FKKQlmaN6mwL7SbgrUYzrraN2DZgQ0RngV8Hf72IA_kRzsF1929GJH5Tx-MZwSXVzBVm8A352cnHXsecfBwvx7_rDfJK9tpXk4yG_f9ZHXTdPuaVVTt3lMgc0QZ7-aoZdFHwQPc2QfF8RXz7fqqCAVS8RrfwYJ-2Z3w/w640-h340/Picture13.png" width="640" /></a></div><br /><p class="MsoNormal"><b>Summing up</b></p><p></p><p class="MsoNormal">To sum up, it seems like the continuing impact of the COVID-19 pandemic and the response of social care services to the pandemic has magnified some longer term trends in social care services, while putting other trends into reverse. The big, and grim, difference is that 2,275 fewer adults were getting long-term social care at the end of March 2022 compared to the end of March 2020, reversing a long-term trend of year-on-year increases. The gap between the number of adults with learning disabilities likely to need social care support and those getting social care support is now into the tens of thousands. This is particularly acute amongst adults aged 18-64 rather than adults aged 65+. Fewer requests for social care support are coming through to local authorities, and only a minority of these requests result in social care support.</p><p class="MsoNormal">There is also a question about how sensitive these statistics are to the seismic changes to people’s social care support that people with learning disabilities have been reporting throughout the COVID-19 pandemic. For example, in the <a href="https://warwick.ac.uk/fac/soc/cedar/covid19-learningdisability/results/" target="_blank">Coronavirus and people with learning disabilities project</a> many people reported paying for social care services they weren’t currently getting, getting less of a service than they used to, or some services which involved going out being replaced by online services, none of which would be picked up by these statistics. This research project also reports changes to people's health and wellbeing over time that are not being picked up by the Adult Social Care Survey.</p><p class="MsoNormal"><br /></p><p class="MsoNormal"><br /></p><p class="MsoNormal"><br /></p><p class="MsoNormal"><br /></p><div class="separator" style="clear: both; text-align: center;"><br /></div></div><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><br /></div>Chris Hattonhttp://www.blogger.com/profile/05299821560069281510noreply@blogger.com0tag:blogger.com,1999:blog-1016904785776950121.post-44407419419333593372022-08-23T18:36:00.011+01:002022-08-30T08:47:35.096+01:00Why don't NHS England want to know about over 1,000 people in inpatient services?NHS England are doing another consultation of changes they are making to the information they collect in the Assuring Transformation dataset about the number of people with learning disabilities and autistic people in inpatient services. It's for data gatherers and is not accessible https://nhs-digital.citizenspace.com/standards-assurance/assuring-transformation-data-collection-v4/ <div><br /></div><div>This consultation describes the Assuring Transformation (AT) dataset as the 'definitive source of information on inpatient numbers and activity'. This short blogpost is me, once again, with a reminder that this is not the case. There is another dataset routinely collected by mental health service providers, called the Mental Health Services Dataset (MHSDS), that is much more comprehensive in its coverage. I'll try and show why this matters by just looking at <a href="https://digital.nhs.uk/data-and-information/publications/statistical/learning-disability-services-statistics/at-july-2022-mhsds-may-2022-final" target="_blank">figures at the end of May 2022</a> (the most recent information we have).</div><div><br /></div><div>At the end of May 2022, AT reported that there were 2,075 autistic people and people with learning disabilities in inpatient services. MHSDS reported there were 3,205 people, over 50% and 1,000 people more than the AT dataset. If you're redesigning a national plan, would you not be interested in these extra 1,000 people? </div><div><br /></div><div>If you look at the figures for specific provider organisations, the biggest discrepancies in reporting are in the organisations with the most people with learning disabilities and autistic people in their inpatient services. So, here's a list of the organisations where there's a discrepancy of 50 or more people between the AT and MHSDS datasets - many of these will be names you recognise:</div><div><br /></div><div>Cygnet Healthcare Ltd.<span> <span> </span> AT - 195 people <span> MHSDS - 360 people </span></span></div><div><span><span>(so 165 autistic people and people with learning disabilities in their inpatient services are not visible in the AT dataset, and presumably invisible to the commissioners that provide the data for AT)</span></span></div><div><span><span><br /></span></span></div><div><span><span>Elysium Healthcare.<span> </span><span> <span> </span>AT - 160 people<span> MHSDS - 235 people (75 people invisible to AT)</span></span></span></span></div><div><span><span><span><span><br /></span></span></span></span></div><div><span><span><span><span>Partnerships in Care Ltd.<span> AT - 95 people<span> </span><span> MHSDS - 170 people (75 people invisible to AT)</span></span></span></span></span></span></div><div><span><span><span><span><br /></span></span></span></span></div><div><span><span><span><span>Priory Group Ltd.<span> </span><span> </span><span> <span> AT - 130 people<span> MHSDS - 65 people</span></span></span></span></span></span></span></div><div><span><span><span><span><span><span><span>(this is one of a small number of organisations where there are more people recorded in the AT dataset than in the MHSDS, so presumably there are people in inpatient services according to AT that don't count as mental health services according to the MHSDS???)</span></span></span></span></span></span></span></div><div><span><span><span><span><span><span><span><br /></span></span></span></span></span></span></span></div><div><span><span><span><span><span><span><span>St Andrews Healthcare.<span> <span> </span>AT - 110 people<span> MHSDS - 170 people (60 people invisible to AT)</span></span></span></span></span></span></span></span></span></div><div><span><span><br /></span></span></div><div><span><span>The Huntercombe Group.<span><span> AT - 90 people<span> MHSDS - no people (again, seems very odd)</span></span></span></span></span></div><div><span><span><span><span><span><br /></span></span></span></span></span></div><div><span><span><span><span><span><br /></span></span></span></span></span></div><div><span><span><span><span><span><br /></span></span></span></span></span></div><div><span><span><span><span><span>Birmingham and Solihull Mental Health NHS Foundation Trust.</span></span></span></span></span></div><div><span><span><span><span><span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> AT - 15 people<span> </span><span> MHSDS - 75 people (60 people invisible to AT)</span></span><br /></span></span></span></span></span></div><div><span><span><span><span><span><span><span><br /></span></span></span></span></span></span></span></div><div><span><span><span><span><span><span><span>Bradford District Care NHS Foundation Trust.</span></span></span></span></span></span></span></div><div><span><span><span><span><span><span><span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> AT - no people<span> </span><span> MHSDS - 80 people (80 people invisible to AT)</span></span><br /></span></span></span></span></span></span></span></div><div><span><span><span><span><span><span><span><span><span><br /></span></span></span></span></span></span></span></span></span></div><div><span><span><span><span><span><span><span><span><span>Cumbria, Northumberland, Tyne and Wear Foundation NHS Trust.</span></span></span></span></span></span></span></span></span></div><div><span><span><span><span><span><span><span><span><span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> AT - 75 people<span> </span><span> MHSDS - 145 people (70 people invisible to AT)</span></span><br /></span></span></span></span></span></span></span></span></span></div><div><br /></div><div>Greater Manchester Mental Health NHS Foundation Trust.</div><div><span><span><span><span><span><span><span><span><span><span><span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> AT - 20 people<span> </span><span> MHSDS - 80 people (60 people invisible to AT)</span></span><br /></span></span></span></span></span></span></span></span></span></span></span></div><div><span><span><span><span><span><span><span><span><span><span><span><span><span><br /></span></span></span></span></span></span></span></span></span></span></span></span></span></div><div><span><span><span><span><span><span><span><span><span><span><span><span><span>Mersey Care NHS Foundation Trust.</span></span></span></span></span></span></span></span></span></span></span></span></span></div><div><span><span><span><span><span><span><span><span><span><span><span><span><span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> AT - 95 people<span> MHSDS - 145 people (50 people invisible to AT)</span></span><br /></span></span></span></span></span></span></span></span></span></span></span></span></span></div><div><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><br /></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></div><div><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span>Nottinghamshire Healthcare NHS Foundation Trust.</span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></div><div><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> AT - 80 people<span> MHSDS - 155 people (80 people invisible to AT)</span></span><br /></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></div><div><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><br /></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></div><div><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><br /></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></div><div><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span>For some of the NHS Trusts in particular, some of this discrepancy is likely to be because they run generic mental health inpatient services, where people are usually inpatients for relatively short periods of time, and who the MHSDS dataset is much better at picking up than the AT dataset. And for areas looking to reduce reliance on long-stay 'specialist' inpatient services, this might be a deliberate and potentially defensible strategy. But this is highly unlikely to be the case for the private sector organisations on this list. What is going on there, and when the discrepancies between the two datasets have been known for years (and complained about repeatedly by the National Audit Office), why hasn't NHS England got this sorted out?</span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></div><div><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><br /></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></div><div><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span><span>And meanwhile, over 1,000 people with learning disabilities and autistic people in inpatient services, at a stroke of a computer key, are rendered invisible.</span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></div>Chris Hattonhttp://www.blogger.com/profile/05299821560069281510noreply@blogger.com0tag:blogger.com,1999:blog-1016904785776950121.post-73738277006810915042022-08-22T18:39:00.038+01:002022-08-23T08:32:44.031+01:00Pushing the rock back up the hill - the autumn COVID booster vaccine and people with learning disabilities<p>For a long time now, there has been <a href="https://www.bbc.co.uk/news/uk-england-shropshire-62495021" target="_blank">disquiet rising to desperatio</a>n among people with learning disabilities and those close to people who have been trying to organise a fourth autumn COVID vaccine. Even among people with learning disabilities who have received three doses of the COVID vaccine so far, many people are reporting a real resistance among GPs and other health professionals to provide a fourth dose as part of the autumn COVID booster programme. As far as I know (and I've been a bit out of the loop for a while), I haven't seen any announcement by the JCVI (the Joint Committee on Vaccination and Immunisation) or the Department of Health <span>and Social Care</span> that all people with learning disabilities identified as such on GP registers will be prioritised for the autumn booster programme.</p><p>This really matters, particularly as waves of new COVID variants continue to hit and health services continue to crumble in the face of sustained impossibilities. While the vastly increased risk of death from COVID-19 amongst people with learning disabilities (particularly, but not exclusively, among people with Down syndrome) has been much reduced by COVID vaccines, people with learning disabilities are continuing to die from COVID-19. The graph below shows <a href="https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-deaths/" target="_blank">the weekly figures from NHS England</a> for people flagged in health services in England as a person with learning disabilities or an autistic person dying in hospital from a confirmed COVID-19 diagnosis. This will substantially underestimate the number of people who have died from COVID-19, but with <a href="https://www.england.nhs.uk/publication/covid-19-deaths-of-patients-with-a-learning-disability-notified-to-leder/" target="_blank">NHS England stopping monthly reports of deaths from the LeDeR programme</a> it is now all we have. Even this underestimate reports that 186 people with learning disabilities and autistic people have died from COVID-19 in 2022 - that's more than 5 people every week. As people get older, and develop more or worsening health conditions (particularly given the current state of health services and the cumulative consequences of the withdrawal of health and social care support for many through the pandemic), waning vaccine effectiveness over time and new COVID variants could be an increasingly dangerous combination.</p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhgdKVCD-rvQ24NN8G_iQbHjAMDfzLpStE-R_yrShLIerITd6owU0VBYzv4tuafSvxOrkXln6qG5ryV-bBYjCd95nytIzhxvMQGoaMje9W7F_uw_1_pRQRGLTDiwvdZeNZL8nbZHSPTpzGRR6Esk9OA96T6ZQPcu4NO9ICNX6_W19XQiEEMB7RNGaauxA" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="947" data-original-width="1417" height="428" src="https://blogger.googleusercontent.com/img/a/AVvXsEhgdKVCD-rvQ24NN8G_iQbHjAMDfzLpStE-R_yrShLIerITd6owU0VBYzv4tuafSvxOrkXln6qG5ryV-bBYjCd95nytIzhxvMQGoaMje9W7F_uw_1_pRQRGLTDiwvdZeNZL8nbZHSPTpzGRR6Esk9OA96T6ZQPcu4NO9ICNX6_W19XQiEEMB7RNGaauxA=w640-h428" width="640" /></a></div><br /><br /><p></p><p>Before looking at what we know about COVID-19 vaccine coverage amongst adults with learning disabilities (I haven't found any reliable statistics relating to children with learning disabilities) it is crucial to say that, for various reasons, there are some people with learning disabilities for whom vaccination is not an option. This is likely to include many people who are at increased risk of serious and life-threatening consequences if they were to catch COVID-19, and for whom the complete withdrawal of sensible public health consequences to reduce COVID-19 case rates generally, alongside the near complete withdrawal of COVID testing and confusion over how to access anti-viral medications, has resulted in some people and those close to them <a href="https://www.theguardian.com/commentisfree/2021/jul/22/people-learning-disabilities-freedom-day-covid" target="_blank">living under conditions of virtual house arrest </a>for well into a third year.</p><p>Bearing this in mind, what do we know about how many adults with learning disabilities have had at least one dose of the COVID-19 vaccine, and how many so far have had three doses?</p><p>Up until 22nd June, <a href="https://reports.opensafely.org/reports/vaccine-coverage/" target="_blank">the OpenSafely platform</a>, based on records from around 40% of GP surgeries in England, provided regular, detailed statistics on COVID-19 vaccine coverage, including information on various groups of adults with learning disabilities identified as such on GP registers. Since June 2022 they have stopped published regular updates, so from this source June is the most recent data we have.</p><p>The graph below shows the percentage of people with and without learning disabilities in older and at risk ('shielding') categories who had received at least one COVID-19 vaccine dose by 22 June 2022. Well over 90% of people with and without learning disabilities in these groups had received at least one COVID-19 vaccine dose.</p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgQYHBlbt6mKJjvWKHgT7JyFYQcRy5UyQHww_-BsPwjNPLWO0SDTBP0nRwPLXv_B6j1iV28fd_CitL4KflV-WyweVIbQAPgY_t9S1HC9BQZte1qLNWQMtGm4yXF8YKMfsg99AL5wMQxzoHp_iS-tNmhybH4hMn4h56W__Lxm4anSuLg2klL7wRG_sH9rw" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="537" data-original-width="972" height="354" src="https://blogger.googleusercontent.com/img/a/AVvXsEgQYHBlbt6mKJjvWKHgT7JyFYQcRy5UyQHww_-BsPwjNPLWO0SDTBP0nRwPLXv_B6j1iV28fd_CitL4KflV-WyweVIbQAPgY_t9S1HC9BQZte1qLNWQMtGm4yXF8YKMfsg99AL5wMQxzoHp_iS-tNmhybH4hMn4h56W__Lxm4anSuLg2klL7wRG_sH9rw=w640-h354" width="640" /></a></div><br /><p>The following graph shows a detailed breakdown of vaccine coverage among non-shielding adults with learning disabilities aged 16-64, according to sex, age band and ethnicity. While the overall rate of people getting at least one COVID-19 vaccine dose is approaching 90%, there are huge inequalities in vaccine coverage by ethnicity and age.</p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgOecJZlFKsU1gjuUVPWPIN6Xnt7zrLwmNGYP2QaihGSkjYLPWS-BhkQP3fs-exWCKYWiEuFeAKTMgKnSfxAoxMWCwCJqqOYHT2DG_xe0PZ2VImsWBdoplg8CDK034A-u1UcwXyMYfl_q9siC9KqPrcSoUgPmAfrF7TcM-hbxXpBgVISwhU7R2dKY4Oyg" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="886" data-original-width="911" height="622" src="https://blogger.googleusercontent.com/img/a/AVvXsEgOecJZlFKsU1gjuUVPWPIN6Xnt7zrLwmNGYP2QaihGSkjYLPWS-BhkQP3fs-exWCKYWiEuFeAKTMgKnSfxAoxMWCwCJqqOYHT2DG_xe0PZ2VImsWBdoplg8CDK034A-u1UcwXyMYfl_q9siC9KqPrcSoUgPmAfrF7TcM-hbxXpBgVISwhU7R2dKY4Oyg=w640-h622" width="640" /></a></div><br /><p></p><p>What do these percentages mean in terms of the number of adults with learning disabilities in England who have (and have not) received at least one dose of the COVID-19 vaccine? The table below shows my best guess at this number, mainly scaling up from the 40% of GP registers reported by OpenSafely. Overall, this produces an estimate that over 278,000 adults with learning disabilities have had at least one COVID-19 vaccine dose, and over 30,000 adults have not been vaccinated at all. </p><p class="MsoNormal" style="background: white; line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><b><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">OpenSafely
– first dose vaccinations up to 22 June 2022 (40% of GP practices) of adults
with learning disabilities</span></b><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><o:p></o:p></span></p><table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="background: white; border-collapse: collapse; mso-padding-alt: 0cm 0cm 0cm 0cm; mso-yfti-tbllook: 1184;">
<tbody><tr>
<td style="border: 1pt solid windowtext; padding: 0cm 5.4pt; width: 61.5pt;" valign="top" width="82">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"> <o:p></o:p></span></p>
</td>
<td style="border-left: none; border: 1pt solid windowtext; mso-border-left-alt: solid windowtext 1.0pt; padding: 0cm 5.4pt; width: 63.85pt;" valign="top" width="85">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Vaccinated<o:p></o:p></span></p>
</td>
<td style="border-left: none; border: 1pt solid windowtext; mso-border-left-alt: solid windowtext 1.0pt; padding: 0cm 5.4pt; width: 63.7pt;" valign="top" width="85">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Not vaccinated<o:p></o:p></span></p>
</td>
<td style="border-left: none; border: 1pt solid windowtext; mso-border-left-alt: solid windowtext 1.0pt; padding: 0cm 5.4pt; width: 61.65pt;" valign="top" width="82">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Total eligible<o:p></o:p></span></p>
</td>
<td style="border-left: none; border: 1pt solid windowtext; mso-border-left-alt: solid windowtext 1.0pt; padding: 0cm 5.4pt; width: 64pt;" valign="top" width="85">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Percentage vaccinated (at least one
dose)<o:p></o:p></span></p>
</td>
<td style="border-left: none; border: 1pt solid windowtext; mso-border-left-alt: solid windowtext 1.0pt; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Extrapolated number vaccinated (at least
one dose)<o:p></o:p></span></p>
</td>
<td style="border-left: none; border: 1pt solid windowtext; mso-border-left-alt: solid windowtext 1.0pt; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Extrapolated number not vaccinated<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border-top: none; border: 1pt solid windowtext; mso-border-top-alt: solid windowtext 1.0pt; padding: 0cm 5.4pt; width: 61.5pt;" valign="top" width="82">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">80+<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.85pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">518<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.7pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">21<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 61.65pt;" valign="top" width="82">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">539<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 64pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">96.1%<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">1,295<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">53<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border-top: none; border: 1pt solid windowtext; mso-border-top-alt: solid windowtext 1.0pt; padding: 0cm 5.4pt; width: 61.5pt;" valign="top" width="82">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">70-79<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.85pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">2,996<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.7pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">133<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 61.65pt;" valign="top" width="82">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">3,129<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 64pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">95.7%<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">7,490<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">333<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border-top: none; border: 1pt solid windowtext; mso-border-top-alt: solid windowtext 1.0pt; padding: 0cm 5.4pt; width: 61.5pt;" valign="top" width="82">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">65-69<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.85pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">2,485<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.7pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">175<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 61.65pt;" valign="top" width="82">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">2,660<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 64pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">93.4%<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">6,213<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">438<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border-top: none; border: 1pt solid windowtext; mso-border-top-alt: solid windowtext 1.0pt; padding: 0cm 5.4pt; width: 61.5pt;" valign="top" width="82">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">65+ in care homes<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.85pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"> <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.7pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"> <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 61.65pt;" valign="top" width="82">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"> <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 64pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">96.7% (overall)<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">6,344*<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">216<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border-top: none; border: 1pt solid windowtext; mso-border-top-alt: solid windowtext 1.0pt; padding: 0cm 5.4pt; width: 61.5pt;" valign="top" width="82">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">16 -69 shielding<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.85pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">25,319<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.7pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">1,512<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 61.65pt;" valign="top" width="82">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">26,831<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 64pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">94.4%<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">63,298<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">3,780<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border-top: none; border: 1pt solid windowtext; mso-border-top-alt: solid windowtext 1.0pt; padding: 0cm 5.4pt; width: 61.5pt;" valign="top" width="82">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">16-64 (not shielding)<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.85pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">77,427<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.7pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">10,367<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 61.65pt;" valign="top" width="82">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">87,794<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 64pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">88.2%<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">193,568 <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">25,918<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border-top: none; border: 1pt solid windowtext; mso-border-top-alt: solid windowtext 1.0pt; padding: 0cm 5.4pt; width: 61.5pt;" valign="top" width="82">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Estimated totals<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.85pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"> <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.7pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"> <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 61.65pt;" valign="top" width="82">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"> <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 64pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"> <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">278,208<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">30,738<o:p></o:p></span></p>
</td>
</tr>
</tbody></table><p class="MsoNormal" style="background: white; line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">* Total number of
older people with learning disabilities in residential care and nursing homes
in England taken from NHS Digital SALT social care statistics 2020/21 – overall
COVID-19 vaccination rate applied to these figures for extrapolated numbers of
people vaccinated and not vaccinated<o:p></o:p></span></p><p>
</p><p class="MsoNormal"><o:p> </o:p>There is also information published weekly by <a href="https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-vaccinations/">NHS England from the National Immunisation Management System</a>, based on GP register data across England. They report on the number of 'at risk' people or carers aged 16-64 identified as a person with learning disabilities on GP registers who have had COVID-19 vaccinations. Up to 31st July 2022, this dataset reports that 239,727 people (88.9%) had received at least one COVID-19 vaccine dose and 30,059 people had not had a COVID-19 vaccine - the figures don't exactly match up but they are in the same ballpark as the estimates in the table. This dataset also reports big variations in COVID vaccine coverage for 'at risk' adults with learning disabilities aged 16-64 across English regions - more people in the South West (92.2%) and the South East (91.4%) had received at least one vaccine dose compared to people in the North West (87.5%) and London (82.2%).</p><p class="MsoNormal"><br /></p><p class="MsoNormal">So, while overall the vast majority of adults with learning disabilities in England have had at least one dose of the COVID-19 vaccine, over 30,000 adults have not had a vaccine dose and there are big variations according to age, ethnicity, and where the person lives in England. One dose of the COVID-19 vaccine can be the result of a one-off effort - three doses require a functioning vaccine system on a more sustained basis. Using the same sources of data and formats as the information above for at least one dose, how many adults with learning disabilities have had three doses of the COVID-19 vaccine?</p><p class="MsoNormal">The graph below, from OpenSafely data, shows that for people aged 65+, 83% to 88% of people with learning disabilities had had three COVID-19 vaccine doses, typically 4%-5% lower than people without learning disabilities. 'Shielding' (probably equivalent to 'Clinically Extremely Vulnerable' people) people with learning disabilities aged 16-69 had been vaccinated with three doses at a higher rate than people without learning disabilities (82.8% vs 76.9%).</p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhS3UNMj2tHqP9OvIows16mvUI61MmeW_GpmWBQ62vddasE8_rrHZDUNQ0B0FUY7biRI6hBCufWnLuz55olRJUhMMbdS2pObyMwtgtIMzfTtlMMvjOn2Lbk7-pAE8nh21tXnJ0LuSgqWG7c0ep3fG6wb3hmWPA-OykmmqeWgDgg7WAL-994_0nTS1l-0A" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="644" data-original-width="1112" height="370" src="https://blogger.googleusercontent.com/img/a/AVvXsEhS3UNMj2tHqP9OvIows16mvUI61MmeW_GpmWBQ62vddasE8_rrHZDUNQ0B0FUY7biRI6hBCufWnLuz55olRJUhMMbdS2pObyMwtgtIMzfTtlMMvjOn2Lbk7-pAE8nh21tXnJ0LuSgqWG7c0ep3fG6wb3hmWPA-OykmmqeWgDgg7WAL-994_0nTS1l-0A=w640-h370" width="640" /></a></div><br /><p class="MsoNormal">Amongst non-shielding adults with learning disabilities aged 16-64 (see the graph below) the inequalities in three dose vaccine coverage by ethnicity, age and to a certain extent sex are even more stark. Only 40.1% of Black people, compared to 72.5% of White people, had received three vaccine doses. Only 29.1% of people aged 16-17 had received three vaccine doses, reflecting the cumulative consequences of earlier JCVI decisions not to vaccinate children and young people. As people move up through the age bands, the consequences of lower vaccination rates among younger people early on is resulting in the overall percentage of adults with learning disabilities getting three vaccine doses going down, if anything, rather than going up.</p><p class="MsoNormal"><br /></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEj17X_Ztov7OHQ1jbXR75IL-hpkbVa9qyD0METR7a4-WNEzPYz8JNKAR0RfTnQl609bnKtX7UiDDW4_QEHFZF3XcD3zTFp7f4BwUDL0bxmTZQR74c2q8Exf5oeCG10uhE3yybDAy7PsZXkxJspxi2p_oWm-Cxtbub1uOWjSY4PXK3-RNkJUQ94tS5dxGQ" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="886" data-original-width="911" height="622" src="https://blogger.googleusercontent.com/img/a/AVvXsEj17X_Ztov7OHQ1jbXR75IL-hpkbVa9qyD0METR7a4-WNEzPYz8JNKAR0RfTnQl609bnKtX7UiDDW4_QEHFZF3XcD3zTFp7f4BwUDL0bxmTZQR74c2q8Exf5oeCG10uhE3yybDAy7PsZXkxJspxi2p_oWm-Cxtbub1uOWjSY4PXK3-RNkJUQ94tS5dxGQ=w640-h622" width="640" /></a></div><br /><p></p><p class="MsoNormal">Using the same guessing methods as before, the table below shows that I estimate over 220,000 adults with learning disabilities in England have had three vaccine doses, and over 80,000 adults with learning disabilities have not had three COVID vaccine doses.</p><p class="MsoNormal"><b><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">OpenSafely
– third dose vaccinations up to 22 June 2022 (40% of GP practices) of adults
with learning disabilities</span></b></p><table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="background: white; border-collapse: collapse; mso-padding-alt: 0cm 0cm 0cm 0cm; mso-yfti-tbllook: 1184;">
<tbody><tr>
<td style="border: 1pt solid windowtext; padding: 0cm 5.4pt; width: 61.5pt;" valign="top" width="82">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"> <o:p></o:p></span></p>
</td>
<td style="border-left: none; border: 1pt solid windowtext; mso-border-left-alt: solid windowtext 1.0pt; padding: 0cm 5.4pt; width: 63.85pt;" valign="top" width="85">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Vaccinated (three doses)<o:p></o:p></span></p>
</td>
<td style="border-left: none; border: 1pt solid windowtext; mso-border-left-alt: solid windowtext 1.0pt; padding: 0cm 5.4pt; width: 63.7pt;" valign="top" width="85">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Not vaccinated with three doses<o:p></o:p></span></p>
</td>
<td style="border-left: none; border: 1pt solid windowtext; mso-border-left-alt: solid windowtext 1.0pt; padding: 0cm 5.4pt; width: 61.65pt;" valign="top" width="82">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Total eligible<o:p></o:p></span></p>
</td>
<td style="border-left: none; border: 1pt solid windowtext; mso-border-left-alt: solid windowtext 1.0pt; padding: 0cm 5.4pt; width: 64pt;" valign="top" width="85">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Percentage vaccinated (three doses)<o:p></o:p></span></p>
</td>
<td style="border-left: none; border: 1pt solid windowtext; mso-border-left-alt: solid windowtext 1.0pt; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Extrapolated number vaccinated (three
doses)<o:p></o:p></span></p>
</td>
<td style="border-left: none; border: 1pt solid windowtext; mso-border-left-alt: solid windowtext 1.0pt; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Extrapolated number not vaccinated
with three doses<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border-top: none; border: 1pt solid windowtext; mso-border-top-alt: solid windowtext 1.0pt; padding: 0cm 5.4pt; width: 61.5pt;" valign="top" width="82">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">80+<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.85pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">476<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.7pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">63<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 61.65pt;" valign="top" width="82">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">539<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 64pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">88.3%<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">1,190<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">158<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border-top: none; border: 1pt solid windowtext; mso-border-top-alt: solid windowtext 1.0pt; padding: 0cm 5.4pt; width: 61.5pt;" valign="top" width="82">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">70-79<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.85pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">2,716<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.7pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">413<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 61.65pt;" valign="top" width="82">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">3,129<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 64pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">86.8%<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">6,790<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">1,033<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border-top: none; border: 1pt solid windowtext; mso-border-top-alt: solid windowtext 1.0pt; padding: 0cm 5.4pt; width: 61.5pt;" valign="top" width="82">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">65-69<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.85pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">2,219<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.7pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">441<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 61.65pt;" valign="top" width="82">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">2,660<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 64pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">83.4%<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">5,548<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">1,103<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border-top: none; border: 1pt solid windowtext; mso-border-top-alt: solid windowtext 1.0pt; padding: 0cm 5.4pt; width: 61.5pt;" valign="top" width="82">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">65+ in care homes<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.85pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"> <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.7pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"> <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 61.65pt;" valign="top" width="82">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"> <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 64pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">89.3% (overall)<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">5,858*<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">702<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border-top: none; border: 1pt solid windowtext; mso-border-top-alt: solid windowtext 1.0pt; padding: 0cm 5.4pt; width: 61.5pt;" valign="top" width="82">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">16 -69 shielding<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.85pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">22,218<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.7pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">4,613<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 61.65pt;" valign="top" width="82">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">26,831<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 64pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">82.8%<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">55,545<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">11,533<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border-top: none; border: 1pt solid windowtext; mso-border-top-alt: solid windowtext 1.0pt; padding: 0cm 5.4pt; width: 61.5pt;" valign="top" width="82">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">16-64 (not shielding)<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.85pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">61,096<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.7pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">26,698<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 61.65pt;" valign="top" width="82">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">87,794<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 64pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">69.6%<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">152,740 <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">66,745<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border-top: none; border: 1pt solid windowtext; mso-border-top-alt: solid windowtext 1.0pt; padding: 0cm 5.4pt; width: 61.5pt;" valign="top" width="82">
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Estimated totals<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.85pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"> <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 63.7pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"> <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 61.65pt;" valign="top" width="82">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"> <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 64pt;" valign="top" width="85">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"> <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">227,671<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; padding: 0cm 5.4pt; width: 68.05pt;" valign="top" width="91">
<p align="right" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: right;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">81,274<o:p></o:p></span></p>
</td>
</tr>
</tbody></table><p class="MsoNormal">
</p><p class="MsoNormal" style="background: white; line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span face=""Trebuchet MS",sans-serif" style="color: #666666; font-size: 10pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">* Total number of
older people with learning disabilities in residential care and nursing homes
in England taken from NHS Digital SALT social care statistics 2020/21 – overall
COVID-19 vaccination rate applied to these figures for extrapolated numbers of
people vaccinated and not vaccinated</span><o:p></o:p></p><p class="MsoNormal"><br /></p><p class="MsoNormal">The national NHS England/NIMS data I mentioned earlier reports that 194,028 'at risk' adults with learning disabilities aged 16-64 have had three COVID vaccine doses, and 75,758 people have not had three vaccine doses. Again, there are big regional variations - the South West (79.0%) and South East (77.6%) again report much higher rates than the North West (68.7%) and London (61.5%).</p><p class="MsoNormal"><br /></p><p class="MsoNormal">So, for me at least, there is compelling case for a sustained vaccination effort for people with learning disabilities across England, both to address existing inequalities in first dose vaccine coverage and to get as many people as possible to a point where they have the maximum vaccine protection possible for them. What are the prospects of this happening? After all, there have been sustained vaccination efforts earlier in the pandemic.</p><p class="MsoNormal">The first major issue for me is that the general infrastructure for delivering COVID-19 vaccines has been largely dismantled in England. This graph below, one of many from the excellent <a href="https://coronavirus.data.gov.uk/details/vaccinations?areaType=nation&areaName=England" target="_blank">gov.uk COVID-19 vaccination website</a>, shows how many 1st, 2nd and 3rd doses have been delivered, day by day, up to 16th August 2022. The different waves of 1st, 2nd and 3rd doses delivered can be clearly seen, but from March 2022 onwards there has been relatively little COVID vaccine activity. With both community and hospital-based health services overwhelmed, waiting times growing, and COVID-19 vaccination centres dismantled, it is unclear where the capacity for another major vaccination effort will come from. This applies doubly to the learning disability health service professionals who provided specialist support for people with learning disabilities to get their COVID-19 vaccines - these relatively scarce professionals were withdrawn from ongoing and much-needed health support for people with learning disabilities whose health needs have increased in their absence. Social care support staff shortages are also going to have an impact.</p><p class="MsoNormal"><br /></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhWpJZwuVEXMd-ZjftU2sSYbRIaRclnMd3p2kNxHBamlWhUL-QLC4rrkpKXFcaXv97aEhdKQCj9slIOUHdhjauzvs6hsHadtwWbkxXmRrt7cqIfwwEMtZHI9X7dBSxntbXStWG2oCAIWflsdX74u9xVBi59bEl-sS2fUrFOaqc72C52pTfetxYP9VPZ_Q" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="481" data-original-width="1540" height="200" src="https://blogger.googleusercontent.com/img/a/AVvXsEhWpJZwuVEXMd-ZjftU2sSYbRIaRclnMd3p2kNxHBamlWhUL-QLC4rrkpKXFcaXv97aEhdKQCj9slIOUHdhjauzvs6hsHadtwWbkxXmRrt7cqIfwwEMtZHI9X7dBSxntbXStWG2oCAIWflsdX74u9xVBi59bEl-sS2fUrFOaqc72C52pTfetxYP9VPZ_Q=w640-h200" width="640" /></a></div><br /><br /><p></p><p class="MsoNormal">The second major issue for me is the attitude and stance of the JCVI itself, which throughout the COVID-19 pandemic has adopted a narrowly clinical stance and has shown a resistance to publicly change its guidance. To my mind, this has resulted in precisely the ambiguous mess that we are in now when it comes to prioritising people with learning disabilities for an autumn COVID-19 booster.</p><p class="MsoNormal">In the first fight over vaccine prioritisation in early 2021, the JCVI adopted a stance that, based on clinical evidence, only people with Down syndrome (and, at a pinch, people with severe and profound learning disabilities) should be prioritised for the COVID-19 vaccine. [There is a critique to be made of the evidence they used to drawn this conclusion, but I will spare you that now.] When it was pointed out to them that there was no practical way of reliably identifying these specific groups of people within GP registers, they came up with this formulation in their l<a href="https://www.gov.uk/government/publications/letter-from-the-health-and-social-care-secretary-on-covid-19-vaccination-in-people-with-learning-disabilities/letter-from-the-jcvi-to-the-health-and-social-care-secretary-23-february-2021" target="_blank">etter of 23rd February 2021 to the Secretary of State for Health</a> (any errors are in the original):</p><p class="MsoNormal"><br /></p><p style="-webkit-font-smoothing: antialiased; background-color: white; color: #0b0c0c; line-height: 1.31579; margin-bottom: 20px; margin-top: 20px;"><span style="font-family: arial;">"On review, <abbr style="cursor: help; text-decoration-line: none; text-decoration-style: initial;" title="Joint Committee on Vaccination and Immunisation">JCVI</abbr> agreed with its earlier conclusions from the <abbr style="cursor: help; text-decoration-line: none; text-decoration-style: initial;" title="Public Health England">PHE</abbr> and LedeR reports that mortality among individuals with learning disability most likely reflected those with more severe forms of disability, including Downs’ syndrome, those at higher risk of exposure because they were in residential or nursing care, those in older age groups, and those more likely to have other underlying health conditions which place them at higher risk from COVID-19. It is expected that individuals with more severe learning disabilities are more likely to be on the GP Learning Disability Register, as suggested in the <abbr style="cursor: help; text-decoration-line: none; text-decoration-style: initial;" title="Public Health England">PHE</abbr> report. However, because of concerns about the coding of learning disability on GP systems, particularly with regard to the coding of severity of any disability, <abbr style="cursor: help; text-decoration-line: none; text-decoration-style: initial;" title="Joint Committee on Vaccination and Immunisation">JCVI</abbr> asked the OpenSAFELY team to look at mortality and morbidity in those with various code sets for learning disabilities on GP systems and to include data from wave 2 of the pandemic. The updated analysis confirmed high mortality and morbidity in those on the GP register, even after controlling for place of residence.</span></p><p style="-webkit-font-smoothing: antialiased; background-color: white; color: #0b0c0c; line-height: 1.31579; margin-bottom: 20px; margin-top: 20px;"><span style="font-family: arial;"><abbr style="cursor: help; text-decoration-line: none; text-decoration-style: initial;" title="Joint Committee on Vaccination and Immunisation">JCVI</abbr> therefore agrees with the current operational plan to use the PRIMIS specification, which identifies all of those on the GP Learning Disability Register plus those with codes for other related conditions, including cerebral palsy, to be invited for vaccination in priority group 6 (unless already in priority group 4, such as those with Down’s syndrome). The committee also recognised that some severely affected individuals would not be coded at all on GP systems, and supported the planned approach to work with local authorities to identify those in residential and nursing care, and those who required support, for example as part of assisted living in the community, and those in shared accommodation with multiple occupancy, to ensure this population could be offered vaccination."</span></p><p class="MsoNormal"><br /></p><p class="MsoNormal">Or, as succinctly summarised <a href="https://www.gov.uk/government/publications/letter-from-the-health-and-social-care-secretary-on-covid-19-vaccination-in-people-with-learning-disabilities/letter-from-the-health-and-social-care-secretary-on-covid-19-vaccination-in-people-with-learning-disabilities-23-february-2021">in the response letter from the Minister</a>:</p><p style="-webkit-font-smoothing: antialiased; background-color: white; color: #0b0c0c; line-height: 1.31579; margin-bottom: 20px; margin-top: 20px;"><span style="font-family: arial;">"Thank you for your <a class="govuk-link" href="https://www.gov.uk/government/publications/letter-from-the-health-and-social-care-secretary-on-covid-19-vaccination-in-people-with-learning-disabilities/letter-from-the-jcvi-to-the-health-and-social-care-secretary-23-february-2021" style="-webkit-font-smoothing: antialiased; color: #1d70b8; text-decoration-thickness: max(1px, 0.0625rem); text-underline-offset: 0.1em;">letter on 23 February 2021 from the Joint Committee on Vaccination and Immunisation (<abbr style="cursor: help; text-decoration-line: none; text-decoration-style: initial;" title="Joint Committee on Vaccination and Immunisation">JCVI</abbr>) on COVID-19 vaccination in cohort 6 of people with learning disabilities</a>. I note that your clinical view remains that those at greatest risk are people with severe and profound learning disabilities. It is very helpful, however, to have your support for a practical operational approach, proposing to invite everyone on the GP Learning Disability Register.</span></p><p style="-webkit-font-smoothing: antialiased; background-color: white; color: #0b0c0c; line-height: 1.31579; margin-bottom: 20px; margin-top: 20px;"><span style="font-family: arial;">I am grateful for the further considerations of the <abbr style="cursor: help; text-decoration-line: none; text-decoration-style: initial;" title="Joint Committee on Vaccination and Immunisation">JCVI</abbr>. In line with your letter, I have asked the NHS to ensure that everyone on the Learning Disability Register is invited for vaccination as part of cohort 6."</span></p><p class="MsoNormal"><br /></p><p class="MsoNormal">A classic 'Nothing has changed!' moment. The JCVI stuck to their line that they were only recommending vaccines for people with Down syndrome and people with severe and profound learning disabilities, but with a begrudging and offhand statement that this kind of means in practice every adult with learning disabilities on the GP register.</p><p class="MsoNormal">And this face-saving fudge is having real consequences for people with learning disabilities now. The Green Book (yes, it really is called that) contains the last word, in excruciating detail, on what health services should do about about all sorts of vaccinations, including COVID-19 vaccinations (<a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1098808/Greenbook-chapter-14A-17August2022.pdf" target="_blank">Chapter 14a, as I'm sure you needed to know - you can read it online</a>). If you're a health professional who really wants to delve into the detail, this is where you look. So, who are the adults in clinical and other risk groups when it comes to COVID-19 vaccination? Table 3 defines and describes the set of risk groups, including, under the delightful title of 'Chronic neurological disease' (my emphasis in bold): </p><p class="MsoNormal"><span style="font-family: arial;">"Stroke, transient ischaemic attack (TIA). Conditions in which respiratory function
may be compromised due to neurological or neuromuscular disease (e.g. polio
syndrome sufferers). This group also includes individuals with cerebral palsy,
<b>severe or profound and multiple learning disabilities (PMLD)</b> including <b>all those
on the learning disability register</b>, <b>Down’s syndrome</b>, multiple sclerosis, epilepsy,
dementia, Parkinson’s disease, motor neurone disease and related or similar
conditions; or hereditary and degenerative disease of the nervous system or
muscles; or severe neurological disability."</span></p><p class="MsoNormal">To me, this is dangerously ambiguous wording. For health professionals not looking to include all adults with learning disabilities in an autumn booster COVID vaccination programme, this can be used as a justification. And the resistance to including all adults with learning disabilities in an autumn booster programme (with the infrastructure and means to make this a reality) is doubly depressing.Time and time again throughout the COVID-19 pandemic (and before, of course) institutional discrimination has been the default setting in health services when it comes to people with learning disabilities. Although there is always more to do, the first COVID-19 vaccine rollout showed what health services could achieve if people with learning disabilities were properly part of a major life-saving initiative. Yet this wasn't a ratchet, setting a new benchmark for how health services (even if only in terms of vaccination services) would routinely view people with learning disabilities. The rock that was pushed up the hill to prioritise people with learning disabilities in the first place has rolled right back to the bottom. We go again.</p>Chris Hattonhttp://www.blogger.com/profile/05299821560069281510noreply@blogger.com0tag:blogger.com,1999:blog-1016904785776950121.post-43900757899728339352022-07-29T19:27:00.000+01:002022-07-29T19:27:52.621+01:00Statutory homelessness statistics and people with learning disabilities<p>This short, hasty and ill-informed blogpost briefly summarises <a href="https://www.gov.uk/government/statistical-data-sets/live-tables-on-homelessness" target="_blank">the latest statistics on statutory homelessness in England</a>, as they relate to households with a person with learning disabilities living within them. [Before you ask, yes, looking through statistical releases to see if they contain anything about people with learning disabilities is a hobby of mine].</p><p>To quote this typically lucid <a href="https://researchbriefings.files.parliament.uk/documents/SN01164/SN01164.pdf" target="_blank">report from the House of Commons Library on statutory homelessness in England</a>, "Local authorities have a statutory duty to secure accommodation for unintentionally homeless households who fall into a 'priority need' category. There is no duty to secure accommodation for all homeless people". </p><p>There are a range of statistics presented in the live tables, one of which presents information on the number of households owed a homelessness duty broken down by whether anyone in the household has a list of particular support needs, which includes 'Learning disabilities'. Because of changes to the law in 2018, statistics are available for each quarter (three months) from April 2018 through to December 2021 (I haven't included more recent provisional information).</p><p>The graph below shows the number of households with a person with learning disabilities who were owed a homelessness duty in each quarter year. Apart from a dip in Quarter 2 in 2020 (when the government introduced temporary measures to alleviate homelessness in response to the COVID-19 pandemic), the number of households has rapidly increased. In Quarter 2 of 2018 (April-June) there were 2,670 households with a person with learning disabilities owed a homelessness duty - by the last quarter of 2021 (October-December) this had increased to 3,710 households, an increase of 39%.</p><p><br /></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiawlvM5ARHuABRFtr9l3WFViU7BFKytTxAYOpRJXouVfie4xp4zFqdPFBBRZlTFPp7LPkjil_PlMcZHoSaQrEZK3z5n5bN8BKH6bYJmAFml_QRXJgZghIENMLwQNe0u0eZLh_ptUnZwH_vHFNszswnbxcQQ3t5JtS5nfDCGLIuDZcOFSYqyLzo0lLQqQ" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="444" data-original-width="805" height="352" src="https://blogger.googleusercontent.com/img/a/AVvXsEiawlvM5ARHuABRFtr9l3WFViU7BFKytTxAYOpRJXouVfie4xp4zFqdPFBBRZlTFPp7LPkjil_PlMcZHoSaQrEZK3z5n5bN8BKH6bYJmAFml_QRXJgZghIENMLwQNe0u0eZLh_ptUnZwH_vHFNszswnbxcQQ3t5JtS5nfDCGLIuDZcOFSYqyLzo0lLQqQ=w640-h352" width="640" /></a></div><br /><br /><p></p><p>How big a proportion of households owed a homelessness duty are households with a person with learning disabilities? The graph below shows trends in two percentages over time. </p><p>The first (the blue line) is the percentage of all households owed a homelessness duty by a local authority that are households with a person with learning disabilities. This shows that households with a person with learning disabilities represented 4.3% of all households owed a homelessness duty in Quarter 2 of 2018, increasing to 5.6% of all households in Quarter 4 2021.</p><p>The second, orange, line is the percentage of households with an identified support need owed a homelessness duty that are households with a person with learning disabilities. [Not all households owed a homelessness duty officially have a support need]. This shows that households with a person with learning disabilities represented 9.3% of households with a person with support needs owed a homelessness duty in Quarter 2 2018, increasing to 10.5% of these households in December 2021.</p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEic2ZQduSsKTS4LvJKLeNxYM7Y-hmrP2GD0CLxcQ7X_vo-gEFcs-FIftF68Y9T4pu5yXo1jWhtSSyKy3d13YQiEjY7qgcuNjSs-VRxTWZ_-oT7rMpj9_OUw4v8SDORQpMNMkp32ieQb-yZAkL9HRLZC0HN9-59zEVhyRdupENruHAGgntE7y1uhJh34PA" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="531" data-original-width="752" height="452" src="https://blogger.googleusercontent.com/img/a/AVvXsEic2ZQduSsKTS4LvJKLeNxYM7Y-hmrP2GD0CLxcQ7X_vo-gEFcs-FIftF68Y9T4pu5yXo1jWhtSSyKy3d13YQiEjY7qgcuNjSs-VRxTWZ_-oT7rMpj9_OUw4v8SDORQpMNMkp32ieQb-yZAkL9HRLZC0HN9-59zEVhyRdupENruHAGgntE7y1uhJh34PA=w640-h452" width="640" /></a></div><br /><br /><p></p><p>This is not an area I know about at all well, so there may be horrible errors of interpretation here. And these statistics will clearly miss out a lot of people with learning disabilities who are homeless, for a variety of reasons. But to me these look like highly worrying statistics, for which there is absolutely no policy attention or action.</p><p><br /></p>Chris Hattonhttp://www.blogger.com/profile/05299821560069281510noreply@blogger.com0tag:blogger.com,1999:blog-1016904785776950121.post-72694218897444719732022-07-21T15:49:00.011+01:002022-07-21T17:12:06.113+01:00The LeDeR report for 2021 - what does it tell us?<p>This blogpost picks out some findings from the latest LeDeR report, which reviews the deaths of people with learning disabilities in England notified to the LeDeR programme. <a href="https://www.kcl.ac.uk/research/leder" target="_blank">There are multiple formats for this report, including easy read and infographics as well as the full report</a>. Reporting deaths to the LeDeR programme is national in scope but voluntary, with local reviewers often conducting reviews as part of or in addition to their jobs. The organisations managing and reporting on this programme changed in the middle of 2021, and the programme has continued through the ongoing COVID-19 pandemic, with its operation disrupted by the ongoing pressure on health services through the ongoing COVID-19 pandemic.</p><p><br /></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEh8oj6w70jcqXFF6njnwC2NoGFGDlh8mBe0qrQdL5IBtrpxcg1vdwZqT3E95ydMtPcTmd5eaUIkav6S2vJg48iTK8cr4igQS3TSv-M57bkm9obyC8c5fKGrqQEEbyCTA4PrIGm3VUAdPvqSkrs99xXXTKRIUhiEEEF0Afmqnm1v7Xhlw3y5V5nHN-u-4Q" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="564" data-original-width="800" height="283" src="https://blogger.googleusercontent.com/img/a/AVvXsEh8oj6w70jcqXFF6njnwC2NoGFGDlh8mBe0qrQdL5IBtrpxcg1vdwZqT3E95ydMtPcTmd5eaUIkav6S2vJg48iTK8cr4igQS3TSv-M57bkm9obyC8c5fKGrqQEEbyCTA4PrIGm3VUAdPvqSkrs99xXXTKRIUhiEEEF0Afmqnm1v7Xhlw3y5V5nHN-u-4Q=w400-h283" width="400" /></a></div><br />(source: Wellcome Trust)<p></p><p>The latest LeDeR report, published in July 2022, focuses on the calendar year 2021, with comparisons where possible to 2018, 2019 and 2020, and some comparisons to equivalent information about the general population. When looking at all this information, it's vital to bear in mind the big peaks of COVID-19 (so far), largely before the widespread availability of the COVID-19 vaccination, which hit in the spring of 2020 and the end of 2020/beginning of 2021 and resulted in <a href="https://chrishatton.blogspot.com/2021/07/inside-and-outside-lifting-of-covid-19.html" target="_blank">disproportionately high numbers of deaths among people with learning disabilities</a>.</p><p>There are three levels of information collected by the LeDeR programme. First, there are web-based open systems for notifying deaths of people with learning disabilities to the LeDeR programme (the new organisations taking this on have started collecting information about the deaths of autistic people as well, although findings from this won't be reported in the next annual report), with some basic information collected as part of this notification process. In 2021, 3,304 deaths of people with learning disabilities were reported to the LeDeR programme, compared to 3,652 deaths in 2020, 2,825 deaths in 2019, and 2,613 deaths in 2018. There is a clear COVID-19 effect here, and the report shows that COVID-19 has caused the death of additional people on top of people dying from other causes.</p><p>The second level of information is collected from initial reviews, collected by local reviewers. There have been some changes to the information collected in this initial review from the old to the new LeDeR regime, so some information for 2021 is unavailable or cannot really be compared to 2020. These reviews are supposed to happen for every death, and in the past there have been<a href="https://chrishatton.blogspot.com/2018/05/can-i-kick-it-down-road-yes-you-can.html" target="_blank"> serious backlogs in these reviews being done</a>. For the 3,304 people whose deaths had been notified to the LeDeR programme in 2021, 2,662 initial reviews (80.6%) had been completed by the time of writing the report in 2022.</p><p>The third level of information is collected from additional focussed reviews where there are thought to be potential concerns based on the initial review. Again, there have been some changes to how these are conducted, and for 2021 in total 139 focused reviews had been completed (5.2% of those who whom an initial review had been completed). </p><p>In addition, information collected for the LeDeR programme can be linked to information from death certificates on cause of death. Death certificates in themselves can be records of discriminatory health service practices (for example, the recording of 'learning disability' as a cause of death).</p><p>Taken together, this means that quite a lot of information can be missing for quite a lot of people, which is important to bear in mind when going through the report's findings.</p><p><br /></p><p>Overall, in 2021, the median age of death (if you order people's deaths from youngest to oldest, the median is the age at which half of people have died) was 61 for boys/men and 60 for girls/women (the LeDeR programme covers people's deaths from the ages of 4 upwards). For comparison, immediately pre-COVID-19 LeDeR reported the median ages of death for people with learning disabilities as 60 for both boys/men and girls/women. <a href="https://chrishatton.blogspot.com/2018/05/the-leder-report-what-does-it-say.html" target="_blank">These are similar ages of death for people with learning disabilities to those reported using a range of methods for a decade</a>, showing no clear trend of absolute improvements in life expectancy for people with learning disabilities over this timescale. There is also no sign of the gap in life expectancy between people with learning disabilities and other people closing, <a href="https://www.kingsfund.org.uk/publications/whats-happening-life-expectancy-england#:~:text=By%202019%2C%20life%20expectancy%20at,level%20of%20a%20decade%20ago." target="_blank">even as life expectancy for the general population in England is stalling and if anything starting to decrease</a>. According to the LeDeR programme, in 2019, 2020 and 2021 over 60% of people with learning disabilities in each year died before the age of 65. Comparative figures for the general population in 2020 (so including the COVID-19 pandemic) reported 15% of people died before the age of 65.</p><p><br /></p><p>During the COVID-19 pandemic, there has been a lot of focus on health conditions that might be considered risk factors if a person is infected with COVID-19, with the creation of the 'Clinically Vulnerable' and 'Clinically Extremely Vulnerable' categories which are used to prioritise COVID-19 vaccinations but now confer no additional support or consideration from education, health or social care services. There were real struggles to prioritise all people with learning disabilities (or at least those registered as such with their GP) for the COVID-19 vaccination, as many people with learning disabilities had potentially risky health conditions not recognised in the list of conditions drawn up algorithmically for the general population. The lack of clarity of<a href="https://www.gov.uk/government/news/health-and-social-care-secretary-accepts-jcvi-advice-on-autumn-booster-programme" target="_blank"> guidance for (fourth) booster COVID-19 vaccines</a> continues this injustice. </p><p>Findings from the LeDeR programme reinforce how risk algorithms drawn up on the general population miss out health conditions and issues that are common for people with learning disabilities. Amongst people with learning disabilities who had died from any cause, the most common long-term health conditions were: epilepsy (33% of people who had died); cardio-vascular (heart) diseases (32%); mental health problems (32%); sensory impairments (25%); and dysphagia (23%). Many of these health conditions (particularly issues like dysphagia) are unlikely to be on the radar of general health services, especially as they often go unrecognised even in people with learning disabilities. For example, <a href="https://digital.nhs.uk/data-and-information/publications/statistical/health-and-care-of-people-with-learning-disabilities/experimental-statistics-2020-to-2021" target="_blank">GPs recorded dysphagia</a> amongst 4.3% of people with learning disabilities in 2016/17, rising to 7.8% of people in 2020/21, reflecting (welcome) increasing recognition, but from a very low base.</p><p><br /></p><p>The LeDeR report continues to report entrenched discrimination in the way that health services manage the deaths of people with learning disabilities. Some of these practices have got even worse during the COVID-19 pandemic, but they also pre-date the pandemic, so cannot be brushed aside as the product of a health service under intense pandemic pressure. In 2021, 64% of people with learning disabilities who died had a Do Not Attempt Resuscitation (DNAR) order (for a further 12% of people it was not recorded whether a person had a DNAR or not). This is very similar to percentages recorded in 2018 (63%), 2019 (63%) and 2020 (64%). A DNAR may be entirely appropriate for a person, depending on whether due legal process has been gone through. LeDeR reviewers in 2021 (who, as we shall see, are generally quite optimistic in their evaluation of the care people had experienced) reported that 40% of the DNAR documentation and processes they reviewed were not appropriate.</p><p>What has definitely got worse is the percentage of people's deaths that have been reported to a coroner. For children with learning disabilities aged 4-17, the LeDeR programme reports that the percentage of children's deaths reported to the coroner has plummeted over time, from 42.5% in 2018, through 50.9% in 2019 and 38.0% in 2020, to 14.7% in 2021. For adults with learning disabilities the percentage of people's deaths reported to the coroner started low and continues to fall: from 24.9% in 2018, through 18.6% in 2019 and 15.3% in 2020, to just 8.7% in 2021. For comparison, in 2020 34% of all registered deaths in the UK were reported to a coroner. Despite the severe limitations of inquests when trying to gain truth and accountability for people with learning disabilities who have died (see the excellent work of <a href="https://www.inquest.org.uk/" target="_blank">Inquest</a>, <a href="https://www.georgejulian.co.uk/inquests/" target="_blank">George Julian</a>, and the <a href="https://inclusionnorth.org/our_work/stop-people-dying-too-young-the-leder-programme/" target="_blank">Stop People Dying Too Young</a> group), not even getting as far a coroner is an obvious brick wall to accountability before the process even starts.</p><p><br /></p><p>In 2021, what did people with learning disabilities die of, according to death certificates? The five most common causes of death (using quite broad standard categories, so apologies for some of the offensive jargon here) reported by the LeDeR programme were: </p><p>1) COVID-19 (532 people were reported to have died of COVID-19, or 21.3% of all deaths in 2021)</p><p>2) Diseases of the circulatory system (356 people; 14.3%)</p><p>3) Diseases of the respiratory system (300 people; 12.0%)</p><p>4) Cancers (286 people; 11.4%)</p><p>5) Diseases of the nervous system (276 people; 11.0%)</p><p>With the exception of COVID-19 in 2020 and 2021, these are fairly similar to the causes of death reported in previous LeDeR reports for 2018, 2019 and 2020.</p><p>More detailed analyses of specific causes of death in the LeDeR report further show the ways in which standard health programmes stack the deck against people with learning disabilities. One example is bowel cancer, which from 2018 to 2021 represented between 10.9% and 14.7% of all cancer deaths of people with learning disabilities, with people with learning disabilities dying from bowel cancer at an average age of 61.7 years. Yet bowel cancer screening only starts at the age of 60 (up to 74), so it is guaranteed to not pick up early signs of bowel cancer amongst many people with learning disabilities. The promising news is that the bowel cancer screening programme over the next five years is dropping its minimum age to 50 from 60, which will include many more people with learning disabilities. The bad news is that <a href="https://digital.nhs.uk/data-and-information/publications/statistical/health-and-care-of-people-with-learning-disabilities/experimental-statistics-2020-to-2021" target="_blank">other data from GPs</a> shows that only 43.3% of people with learning disabilities eligible for a bowel cancer screening test actually had one in 2020/21, compared to 62.7% of people without learning disabilities, so extending theoretical eligibility will have limited impact in the absence of practical, proactive measures to increase screening coverage.</p><p>Overall, it's not surprising (although I hope it is still shocking) that LeDeR reports 49% of people with learning disabilities died an avoidable death (based on a standard list of causes of death that have been judged to be preventable and treatable) in 2021. This compares to 22% of the general population dying an avoidable death, using the same definition, in 2020. This yawning chasm has been apparent through all the LeDeR reports and in those preceding them. </p><p><br /></p><p>In this LeDeR report (as in previous ones) I've found it very hard to reconcile the scale of grimness in the findings I've reported above with the more rosy take of LeDeR reviewers, who are asked to rate various aspects of the person's healthcare and support. As mentioned there have been some changes in how this information is collected from reviewers, so it's hard to present a consistent picture over this transition year. The information is also only shown in the report as graphs, so any percentages reported are my guesses based on squinting at the columns.Only looking at reviewer ratings based on the initial Bristol method (these are collected in initial reviews, and have much higher numbers of reviews than those using the new method), in both 2020 and 2021, care falling short of expected good practice (ratings 1 to 3) was reported in less than 20% of reviews, 'satisfactory care' (rating 4) was reported in around 25% of reviews, and 'good' or 'excellent' care was reported in almost 60% of reviews. Even for people whose death was avoidable according to the definition above, for 47% of people reviewers rated their care as good or excellent. In both 2020 and 2021 reviewers rated over 90% of people's care packages as meeting the person's needs. Reviewers also expressed concerns about people's deaths relatively rarely; 9.9% of people's deaths in 2020 and 7.3% of people's deaths in 2021.</p><p> </p><p>As in previous years, this LeDeR report makes for very grim reading. Discrimination in health service provision was patently obvious to those who cared to look even before the COVID-19 pandemic, and from this and other sources of information it's clear that the way that people with learning disabilities have been un/mis/treated through the pandemic has only exacerbated this discrimination. <a href="https://leder.nhs.uk/resources/action-from-learning-reports" target="_blank">The multiple initiatives</a> (including the LeDeR programme itself, which has a substantial local service improvement dimension) happening in various pockets of health services is clearly not moving the dial for the population of people with learning disabilities in a way that is noticeable at a national scale. </p><p>But then through a lens of socio-economic inequality (with a side order of disablist discrimination) this is hardly surprising. The LeDeR report largely doesn't (and possibly can't) address this in any detail, although there are hints that people with learning disabilities from minoritised ethnic communities are more likely to die, and die younger, compared to other people with learning disabilities. People with learning disabilities who lived in more deprived areas are also much more likely to die than people with learning disabilities who lived in wealthier areas, although we don't know this information about where people with learning disabilities are generally living. Where are the concerted initiatives that, over time, would make a massive difference to the population health of people with learning disabilities, starting from birth - stopping poverty, better education, decent quality housing throughout people's lives (with or without support from staff), employment for those who want it, support for families so that everyone can live their best life, being able to go out without fear of abuse or crime, and things set up so that people can imagine their future and go and live it? In a total vacuum of national policy or attention across government, health services have tried to fill the void, but when you've only got a health service hammer everything looks like a nail (and don't give me the ICS spiel - everything I've heard looks like they're replicating the cultures and practices of any number of acronymic health planning quangoids that came before them).</p><p>Bleak times.</p><p><br /></p>Chris Hattonhttp://www.blogger.com/profile/05299821560069281510noreply@blogger.com0tag:blogger.com,1999:blog-1016904785776950121.post-39289411780947910292022-06-23T16:23:00.003+01:002022-06-23T16:23:37.529+01:00Children with learning disabilities in schools in England: an update<p><b> </b></p><h2 style="background-color: white; color: #666666; margin: 0px; position: relative;"><span style="font-weight: normal;"><span style="font-family: helvetica; font-size: small;">Last week, <a href="https://www.gov.uk/government/statistics/special-educational-needs-in-england-january-2022" target="_blank">the Department for Education released its latest annual statistics</a> concerning children and young people identified within the English education system as children/young people with learning disabilities, recorded in an annual census of schools that takes place in January each year.</span></span></h2><h2 style="background-color: white; color: #666666; font-size: 22px; margin: 0px; position: relative;"><span style="font-family: helvetica; font-size: 13.2px;"><br /></span></h2><h2 style="background-color: white; color: #666666; font-size: 22px; margin: 0px; position: relative;"><span style="font-family: helvetica; font-size: 13.2px;"> </span></h2><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;"> </span><span style="font-family: helvetica;">In the Special Educational Needs (SEN) statistics there are a number of mutually exclusive categories of SEN, three of which concern children with learning disabilities – Moderate Learning Difficulties (MLD), Severe Learning Difficulties (SLD) and Profound & Multiple Learning Difficulties (PMLD). There are a number of other SEN categories recorded within these statistics (Specific Learning Difficulties; Speech, language and communication needs; Social, emotional and mental health; Autistic spectrum disorder; Visual impairment; Hearing impairment; Multisensory impairment; Physical disability).</span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;"><o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;">Within the annual census, a child can be classified as having a ‘primary need’ in one of these categories, and optionally classified as having an additional, ‘secondary need’ in another category. Most importantly in terms of how children are supported, children may have a special educational need that has been judged to require specific support in the form of an SEN statement (historically) or now (magically) an Education, Health and Care (EHC) plan. Beyond that, DfE statistics now only report an additional much larger number of children at a level of ‘SEN support’, which has no requirements to specifically support a child.<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;">This blogpost simply updates <a href="https://chrishatton.blogspot.com/2020/07/children-with-learning-disabilities-in.html" target="_blank">a blog I did a couple of years ago</a> on Department for Education (DfE) statistics, and goes through what some of these statistics say about the education of children and young people with learning disabilities, as identified within the education system. For a brilliant analysis of what these statistics say and what they mean for children with SEND generally, I highly recommend <a href="https://www.specialneedsjungle.com/send-stats-2022-how-pandemic-affected-numbers-pupils/" target="_blank">Matt Keer's analysis for Special Needs Jungle</a>, and I would urge you to read it.<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><o:p><span style="font-family: helvetica;"><br /></span></o:p></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;">The first question is simply – how many children and young people with learning disabilities are recorded in DfE statistics?<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;">The first graph below shows the number of children with a statement/EHC plan with a ‘primary SEN need’ of MLD, SLD and PMLD, from 2010 to 2022 (apologies for the acronyms – if using these is a deal breaker in terms of offensiveness do tell me and I won’t use them in future blogposts).<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;">The graph shows that in 2022, over 73,000 children in England had a statement/EHC plan and were identified as children with learning disabilities. For children with MLD this was 32,057 children in 2022, with a large decrease of 31% from 2010 to 2018 but an increase of 13% from 2018 to 2022.<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;">In 2022, there were 31,504 children with a statement/EHC plan and identified with a primary need of SLD, an increase in numbers of 25% from 2010 to 2022. Finally, in 2022 there were 10,108 children with a statement/EHC plan and identified with a primary need of PMLD, an increase of 16% from 2010 to 2018 but with fluctuating numbers since.<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><o:p><span style="font-family: helvetica;"> </span></o:p></div><div class="separator" style="background-color: white; clear: both; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px; text-align: center;"></div><br style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;" /><div class="separator" style="background-color: white; clear: both; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgemj3BipeO6uB70LTFCcWfc_U1cYwlY6Mr7yOwFA2pB1k0AI68MqF0VRxaXE1BZF125pJRqa2QtKS9C3sl7cSfVp8DJXKPV4zY3xVWCvzFr1HOtr0S7gWB33w0tb5UVMQ7Sxl-SzOB6bvtqqo8MK1NfhzeuB9TpMu_P5muc2IdM9yIjeyPJoRhYck2QQ" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="710" data-original-width="1066" height="426" src="https://blogger.googleusercontent.com/img/a/AVvXsEgemj3BipeO6uB70LTFCcWfc_U1cYwlY6Mr7yOwFA2pB1k0AI68MqF0VRxaXE1BZF125pJRqa2QtKS9C3sl7cSfVp8DJXKPV4zY3xVWCvzFr1HOtr0S7gWB33w0tb5UVMQ7Sxl-SzOB6bvtqqo8MK1NfhzeuB9TpMu_P5muc2IdM9yIjeyPJoRhYck2QQ=w640-h426" width="640" /></a></div><br /><br /></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><br /></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;">The second graph below shows the number of children with a ‘primary SEN need’ of MLD, SLD and PMLD at the level of SEN Support, from 2015 to 2022 (the reporting of statistics changed in 2015).<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;">The graph shows that in 2022, over 200,000 children in England were identified as children with learning disabilities at the level of SEN Support. For children with MLD this was 197,409 children in 2022, with a large increase from 2015 to 2016 and a decrease from 2016 onwards.<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;">In 2022, there were 2,434 children with a primary need of SLD at the level of SEN Support, with numbers fairly steady until 2020 but decreasing after then. Finally, in 2022 there were 769 children at the level of SEN Support with a primary need of PMLD, again with a recent decrease.<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><br /></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><br /></div><div class="separator" style="background-color: white; clear: both; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiMH7Cm82Uw7idQxTnNjC24-cPJy6Oq9g0M2pCTrBSy7y8HZ7USk63aTeGxoHqhB8xDumqRlEMMm5bDVgoEf0P5ORGvwl3YskmEq5V7yBC1n6zb6VLk6riUeLzv-DW7SncMcdirZpab_3P1jKJLAfVGtpoJut0JBQjKR9NLyqfIdNrQF_gEgDn5tdwGLA" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="617" data-original-width="1067" height="370" src="https://blogger.googleusercontent.com/img/a/AVvXsEiMH7Cm82Uw7idQxTnNjC24-cPJy6Oq9g0M2pCTrBSy7y8HZ7USk63aTeGxoHqhB8xDumqRlEMMm5bDVgoEf0P5ORGvwl3YskmEq5V7yBC1n6zb6VLk6riUeLzv-DW7SncMcdirZpab_3P1jKJLAfVGtpoJut0JBQjKR9NLyqfIdNrQF_gEgDn5tdwGLA=w640-h370" width="640" /></a></div><br /><br /></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;">How many children with learning disabilities are being educated in mainstream schools or special schools? The graph below shows the number of children with a statement/EHC plan and primary needs of MLD, SLD and PMLD being educated in mainstream schools and special schools in England, from 2010 through to 2022. These figures don’t include potentially substantial but often not really known numbers of children not in school at all (including those being educated at home), or in places like residential special schools or specialist inpatient units.</span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;">The graph has quite a lot of stuff in it, so let’s take it bit by bit. The lilac lines are for children with MLD in mainstream schools (diamonds) and special schools (circles). As we know from earlier on the number of children with statements/EHC plans associated with MLD decreased from 2010 to 2018 but increased from 2018 to 2022. This graph shows that the number of children with a statement/EHC plan and a primary of need of MLD in special schools declined gradually from 2010 to 2022; the number of children in mainstream schools declined rapidly from 2010 to 2017 but has been rapidly increasing after then.<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;">For children with statements/EHC plans associated with SLD (the blue lines), the number of children with SLD in mainstream schools slightly decreased, with fluctuations, from 2010 to 2022, while the number of children with SLD in special schools has rapidly increased.<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;">For children with a statement/EHC plan associated with PMLD (the purple lines), the numbers of children with PMLD in both mainstream and special schools has very gradually increased, with some fluctuations, from 2010 to 2022.<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><br /></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><br /></div><div class="separator" style="background-color: white; clear: both; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgGFNKF3SjClalrHbfs7TAujoG4wpvfwmb-QUL5md51-ORgfXFzJLwLmeHTReEHRQX8Y4hIYiY4-PetgeM3wvNAlINrQNQ_K85A2UE0ic56DIvXsXIWvoUoX6DBK3gOC-hvFyU3gsGUE6HtEvvrcizAb9WHy42V7iwuFHImv1ZXOKwSxNT3RzxXWedcOw" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="991" data-original-width="1502" height="422" src="https://blogger.googleusercontent.com/img/a/AVvXsEgGFNKF3SjClalrHbfs7TAujoG4wpvfwmb-QUL5md51-ORgfXFzJLwLmeHTReEHRQX8Y4hIYiY4-PetgeM3wvNAlINrQNQ_K85A2UE0ic56DIvXsXIWvoUoX6DBK3gOC-hvFyU3gsGUE6HtEvvrcizAb9WHy42V7iwuFHImv1ZXOKwSxNT3RzxXWedcOw=w640-h422" width="640" /></a></div><br /><br /></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;">Another way of looking at this is to look at the percentage of children in mainstream vs special schools. The graph below shows this from 2010 to 2022 for children with a statement/EHC plan. As the graph shows, the percentage of children with a primary need of MLD and a statement/EHC plan in mainstream school dipped from just over 50% in 2010 to 43% in 2017, with the percentage returning to above 50% in 2022. For children with a statement/EHC plan and a primary need of SLD, the percentage of children in mainstream schools decreased from 17% in 2010 to 12% in 2022. For children with a statement/EHC plan and a primary need of PMLD, the percentage of children in mainstream school remained fairly consistent around 14%-16%.</span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;"></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><span style="font-family: helvetica;"><o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgkeRy9ZLeCMQX6VN37BJdxxtVH917cTWB_wtbd4c-r9I6wH06iSit8dZcGKVfH0g8SycG-ouuXuZdugO_sz8tg266TmNgffKg7j0ZK9baychWpEQ1FylA42-5QUzntm_qQcp8WaE66JsYx1j4bslgoME8bwko819VVPRij5ky6tBwDI9jwcAL-Txpxww" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="621" data-original-width="1062" height="374" src="https://blogger.googleusercontent.com/img/a/AVvXsEgkeRy9ZLeCMQX6VN37BJdxxtVH917cTWB_wtbd4c-r9I6wH06iSit8dZcGKVfH0g8SycG-ouuXuZdugO_sz8tg266TmNgffKg7j0ZK9baychWpEQ1FylA42-5QUzntm_qQcp8WaE66JsYx1j4bslgoME8bwko819VVPRij5ky6tBwDI9jwcAL-Txpxww=w640-h374" width="640" /></a></div><br /></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><br /></div><div class="separator" style="background-color: white; clear: both; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px; text-align: center;"><br /></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;">For children identified at the level of SEN Support (I haven’t included a graph on this), in 2022 almost all the children with a primary need of MLD (99.96%) and the vast majority of children with a primary need of SLD (90.4%) or PMLD (80.3%) were in mainstream schools.<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;"><br /></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;">Although it’s not an ideal marker of the financial circumstances of families, eligibility for free school meals is collected within DfE statistics. The graph below shows the proportion of children with statements/EHCPs associated with MLD, SLD and PMLD eligible for free school meals compared to the proportion of all children eligible for free school meals. For all children on the school roll, 22.5% of children in 2022 were eligible for free school meals. For children with a PMLD label the proportion of children eligible for free school meals is higher (34.4% for children with a statement/EHC plan), then higher again for children with an SLD label (42.3% for children with a statement/EHC plan), and highest for children with an MLD label (44.8% for children with a statement/EHC plan). It is worth mentioning that the proportion of children in all groups eligible for free school meals has increased in recent years.<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><br /></div><div class="MsoNormal" style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;"><br /></div><div class="separator" style="background-color: white; clear: both; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEi72faOdbwww8OSUI0wU4Ks_ATpCudoa3293VpQb3DiD_7Yoi_bZfiLPDX0wyIzWdF-wgm-mL7e01TXpkA0ek9UJ7G6pNX3bUmqHCxcU7D-Io07zgKJKNGj-mLeJetj8uo2zPEJRy_AcbHnhHgkqzxNO2DsO_01RjrJjPuh9I3CQUgyt0uQGTf4MAPlWQ" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="591" data-original-width="986" height="384" src="https://blogger.googleusercontent.com/img/a/AVvXsEi72faOdbwww8OSUI0wU4Ks_ATpCudoa3293VpQb3DiD_7Yoi_bZfiLPDX0wyIzWdF-wgm-mL7e01TXpkA0ek9UJ7G6pNX3bUmqHCxcU7D-Io07zgKJKNGj-mLeJetj8uo2zPEJRy_AcbHnhHgkqzxNO2DsO_01RjrJjPuh9I3CQUgyt0uQGTf4MAPlWQ=w640-h384" width="640" /></a></div><br /><br /></div><div class="MsoNormal" style="background-color: white; color: #666666; font-size: 13.2px;"><span style="font-family: helvetica;">I don’t really want to put a heavily opinionated commentary on this blogpost, so here’s a summary instead.<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="background-color: white; color: #666666; font-size: 13.2px; margin-left: 18pt; text-indent: -18pt;"><ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;"><li style="margin: 0px 0px 0.25em; padding: 0px; text-indent: 0px;"><span style="font-family: helvetica;"><span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span><span style="text-indent: -18pt;">While the number of children identified as having special educational needs associated with severe learning difficulties or profound and multiple learning difficulties and needing statements or EHC plans are gradually increasing, the number of children identified as having a special educational need associated with moderate learning difficulties has been plummeting but for the last four years has started to increase again.</span></span></li><li style="margin: 0px 0px 0.25em; padding: 0px; text-indent: 0px;"><span style="text-indent: -18pt;"><span style="font-family: helvetica;">There are slightly different trends for different groups of children with learning disabilities in terms of the proportion of children in mainstream vs special schools, but some earlier trends towards special education seem to be starting to reverse for children with MLD in the last few years. Less than 20% of children with an EHCP/statement and a label of SLD or PMLD are being educated in mainstream schools.</span></span></li><li style="margin: 0px 0px 0.25em; padding: 0px; text-indent: 0px;"><span style="text-indent: -18pt;"><span style="font-family: helvetica;">Children with learning disabilities are much more likely to be eligible for free school meals than children generally.</span></span></li><li style="margin: 0px 0px 0.25em; padding: 0px; text-indent: 0px;"><span style="text-indent: -18pt;"><span style="font-family: helvetica;">It's unclear to trace much of an impact of the COVID-19 pandemic in these statistics, although other educational statistics are much more likely to pick these up.</span></span></li></ul></div>Chris Hattonhttp://www.blogger.com/profile/05299821560069281510noreply@blogger.com0tag:blogger.com,1999:blog-1016904785776950121.post-28483694074403773962022-06-02T21:51:00.194+01:002022-06-09T07:09:36.544+01:00Winterbourne View 11 Years On. Report card 4: Leaving inpatient units<p><span style="font-family: times; font-size: medium;">This blogpost is the final one of four looking at the Transforming Care programme through the prism of the national statistics regularly produced by NHS Digital, updating a series of blogposts I last updated in 2019..</span></p><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><a href="https://chrishatton.blogspot.com/2022/06/winterbourne-view-11-years-on-report.html" target="_blank">The first blogpost</a> looked at statistics on the number of people being admitted to inpatient services, and where they were being admitted from.</span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><a href="https://chrishatton.blogspot.com/2022/06/winterbourne-view-11-year-on-report.html" target="_blank">The second blogpost</a> looked at how far people were from home and how long they were staying in inpatient services.<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><a href="https://chrishatton.blogspot.com/2022/06/winterbourne-view-11-years-on-report_2.html" target="_blank">The third blogpost</a> looked at planning and reviews for people within inpatient services.<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">This final blogpost will focus on the number of people leaving inpatient services (charmingly called ‘discharge’) and what is happening leading up to people leaving. Getting people out of inpatient units has arguably been the major focus of activities under the Transforming Care/Building The Right Support banner. Again, at this point the impact of these programmes should be visible in the number of people getting ready to leave, how well people’s plans to do so are developing, and how many people are actually leaving to places outside inpatient services.</span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">The first and most obvious question is whether people in inpatient services have a planned date to leave (I will pick up on the complications of what ‘leaving’ actually means later in this post). The graph below shows the proportion of people in inpatient services with a planned date for transfer, from March 2015 to March 2022 (according to Assuring Transformation data). There have been some fluctuations over time but there is little sense of sustained improvement. In March 2022 there was no planned transfer date for 55% of people in inpatient units, compared to 50% of people in March 2015. In March 2022, 18% had a planned transfer date within 6 months, although for 9% of people their planned transfer was overdue.</span><o:p></o:p></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXS_6uaFuKA3n2qZeDCYPbC_1az5eDdnZQ5cRLTpzqpp5UwytKe_nczgszOUaQzKE-UGR0OpyIul2TsWZDNANPwM6UahqAypAVm4k3_l8Uz4_jVR4DRF3Ci5_FqmQJ05AUP1UfDs-am8rPirD4mb12sIicYi2bGYzkmMyn0kzRvGaHc9kPX145fpyR5w/s2354/AT%20data%20June%202022%20graph%204.1.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1336" data-original-width="2354" height="364" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXS_6uaFuKA3n2qZeDCYPbC_1az5eDdnZQ5cRLTpzqpp5UwytKe_nczgszOUaQzKE-UGR0OpyIul2TsWZDNANPwM6UahqAypAVm4k3_l8Uz4_jVR4DRF3Ci5_FqmQJ05AUP1UfDs-am8rPirD4mb12sIicYi2bGYzkmMyn0kzRvGaHc9kPX145fpyR5w/w640-h364/AT%20data%20June%202022%20graph%204.1.png" width="640" /></a></div><div class="MsoNormal"><br /></div><span style="font-family: times; font-size: medium;">In addition to planned transfer dates, do we know anything about the plans themselves?<o:p></o:p><br /><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">Well, if people are leaving the inpatient unit to go home in some sense then my expectation would be that the person’s local council should be aware of the plan to leave. The graph below shows information from Assuring Transformation based just on those people with a plan to leave – for this group of people, are councils aware of the plan? Over time, the proportion of people with a plan that their council is aware of dropped substantially from 2015 to 2019, although this has improved again up to March 2022. Despite this recent improvement, by March 2022 the proportion of planned transfers where the council was aware (64%) was still lower than it was in March 2015 (69%). Of concern is that in March 2022 for 21% of people with a planned transfer it wasn’t known whether the council was aware of the plan or not, an improvement from 2019 but still worse than in March 2015 (7%). At the very least this suggests that the close working between health and social care envisaged as central to Transforming Care/Building The Right Support is less than universal.</span></div><div class="MsoNormal"><o:p></o:p></div><div class="MsoNormal"><o:p> </o:p> </div><div class="MsoNormal"><o:p></o:p></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeRycqvwMSARhJlLdjoSpi-847uu6r5WBVQAylaXf7Wl8TxOjt7PLQV1PfHTUrm44ehEfcEn8vUAKqMCmoeruHZ9y8ROkKEHzFfwxNQGowT5b7mCx1sQ9BVI4a2VjKGNfqXQvBvnpyUnncPVSoxFphg33bgnfJrf5Sm5QTXF3pM5_oNTU011_rq0nm7g/s2367/AT%20data%20June%202022%20graph%204.2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1217" data-original-width="2367" height="330" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeRycqvwMSARhJlLdjoSpi-847uu6r5WBVQAylaXf7Wl8TxOjt7PLQV1PfHTUrm44ehEfcEn8vUAKqMCmoeruHZ9y8ROkKEHzFfwxNQGowT5b7mCx1sQ9BVI4a2VjKGNfqXQvBvnpyUnncPVSoxFphg33bgnfJrf5Sm5QTXF3pM5_oNTU011_rq0nm7g/w640-h330/AT%20data%20June%202022%20graph%204.2.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">There are other signs too of haste in planning for people to leave. The Assuring Transformation statistics report whether a range of people (the person themselves, a family member/carer, an advocate, the provider clinical team, the local community support team, and the commissioners) have agreed the plan to leave. For those people with a plan to leave, the graph below reports the proportion of their plans that have been agreed by different people, from March 2016 to March 2022. Over time, the proportion of plans agreed by anyone and everyone potentially involved has plummeted. Only 29% of plans had been agreed by the person themselves in March 2022, compared to over two thirds of people (69%) in March 2016. Similar drops are reported for the proportion of family/carers (from 60% to 25%) and advocates (from 64% to 28%) agreeing the plans.</span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">By March 2022, transfer plans had been agreed by a minority of provider clinical teams where the person was supposed to be moving to (from 83% in March 2016 to 33% in March 2022), a minority of local community support teams in the area the person was supposed to be moving to (from 69% to 30%) and a minority of those commissioners who are reporting the information the graph is based on! (from 83% to 33%). To what extent are these actually feasible and sustainable plans that will result in a better life at home for people in inpatient services, and what are their chances of breaking down?</span><o:p></o:p></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="mso-fareast-language: EN-GB; mso-no-proof: yes;"><!--[if gte vml 1]><v:shape
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</v:shape><![endif]--><!--[if !vml]--><!--[endif]--></span><o:p></o:p></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh916pSYVyYStSY1L28cZZSKmH0oUOtUBe9VkTxcGD-nocd1tzb1ZsFMy2N2HGCOPets3vpkEySDol0Xq26x3ffGE_Gr8G4yFzzJ6NFVb41wUM4HrjvUSTSzelnoSKvslmes6Y66lOa9CdHzHNvYvBIIoSyWVej_eVDhxC785Id5V9ZLZH4j-bRtJQI-Q/s2397/AT%20data%20June%202022%20graph%204.3.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1449" data-original-width="2397" height="386" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh916pSYVyYStSY1L28cZZSKmH0oUOtUBe9VkTxcGD-nocd1tzb1ZsFMy2N2HGCOPets3vpkEySDol0Xq26x3ffGE_Gr8G4yFzzJ6NFVb41wUM4HrjvUSTSzelnoSKvslmes6Y66lOa9CdHzHNvYvBIIoSyWVej_eVDhxC785Id5V9ZLZH4j-bRtJQI-Q/w640-h386/AT%20data%20June%202022%20graph%204.3.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">The final graph in this blogpost series is one of the most important – how many people have actually been transferred from inpatient services, and where have they gone? The graph below adds up monthly ‘discharges’ from inpatient services in the Assuring Transformation dataset in six yearly blocks, from October 2015 through to September 2021. It’s also one of the most complicated graphs in this series, so I’ll go through it in a bit of detail.</span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">The first thing to say is that overall the number of people ‘discharged’ from inpatient services increased from 2015/16 (2045 people) to 2017/18 (2,265 people), but has since decreased to 1,930 people in 2020/21 (potentially partly due to the impact of the COVID-19 pandemic).<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">Of the people who have been ‘discharged’, in 2020/21 over a quarter of people (550 people; 28%) moved to independent living or supported housing. Another over a quarter of people (545 people; 28%) moved to their family home with support, making well over half of everyone ‘discharged’ from inpatient services (56%). This is a big increase from the 41% of people 'discharged' to these living circumstances in 2015/16.<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">Where did everyone else go? For almost two fifths of people in 2020/21 (360 people; 19%) their ‘discharge’ was actually a transfer to another inpatient unit, confirming the picture of ‘churn’ of people passed around inpatient services found elsewhere in this series. More than one in ten people (235 people; 12%) moved into residential care. Given that some inpatient services have re-registered themselves as residential care homes with the CQC and a panoply of 'step-down' and other services are registered as care homes, it is unclear to what extent people are leaving an inpatient service to move somewhere more local and homely, moving somewhere very similar to where they were, or not actually moving at all.<br /><o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">In 20/21, there were also another 220 people (11%) who moved to an ‘other’ location – again it is unclear what these ‘other’ places are, but are they wildly different from where people were moving from?.<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">There are also signs of some changes over time in where people are being ‘discharged’ to. Fewer 'discharges' are to other hospital inpatient units and residential care, and more 'discharges' are to people's families with support.</span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="mso-fareast-language: EN-GB; mso-no-proof: yes;"><!--[if gte vml 1]><v:shape
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</v:shape><![endif]--><!--[if !vml]--><!--[endif]--></span><o:p></o:p></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="MsoNormal"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgukQXce7HKOYdKT9yR3MlvxW7PTGwy5n4Fmx53sXxDc4k4mYU3U74fyzcnOxq5dEkA3jetzUsQjWBrM5FQH4BmZp6GdxKvMGAc91kCihtRCt-SaxMBd6nnbsdsPjjRJD461tC63Cd0N6LrdZrwzJiQBQEo4dS29drvME9giDrXx3jOk6PsnMT4aur3Bw/s3350/AT%20data%20June%202022%20graph%204.4.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2012" data-original-width="3350" height="384" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgukQXce7HKOYdKT9yR3MlvxW7PTGwy5n4Fmx53sXxDc4k4mYU3U74fyzcnOxq5dEkA3jetzUsQjWBrM5FQH4BmZp6GdxKvMGAc91kCihtRCt-SaxMBd6nnbsdsPjjRJD461tC63Cd0N6LrdZrwzJiQBQEo4dS29drvME9giDrXx3jOk6PsnMT4aur3Bw/w640-h384/AT%20data%20June%202022%20graph%204.4.png" width="640" /></a></div><br /><o:p><br /></o:p></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: times;"><span style="font-size: medium;">So in this final post in the series, there are definite signs that Transforming Care/Building The Right Support has not continued to support the 'discharge' of more people out of inpatient services, although over half of those people who are leaving are now moving to independent or supported living or back to the family home. There are real worries about the feasibility and sustainability of some of these plans, and the extent to which many people ‘leaving’ inpatient services are actually leaving for something radically different or being churned around a system that doesn’t call itself an inpatient service system but looks mighty similar to the people living within it. The fact that for almost two fifths of people being 'discharged', they are actually being moved to another inpatient unit, is to my mind something of an indictment of the inpatient service 'system' and Transforming Care's lack of fundamental impact upon it.</span><o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: times;"><br /></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimd2ryPnx50015-Ov2IaAxbZs0dODmiKHWeQI27fVnitYnrXNWnXpi7aREg_E6eW7FM-AXR_5Xc_JRkv68HAVuKJerjXTy5o5URWTwnfYaPB2TOL90YM6UaQU19-IYIDvYGeQ3rFcNuPBqZR_FnHW9PeaPJCLgt-JCEF9kbOJtOZiU-hrCy3pGywn1Yg/s529/Rightful%20Lives%2011%20years%20on%20tweet%202.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="375" data-original-width="529" height="284" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimd2ryPnx50015-Ov2IaAxbZs0dODmiKHWeQI27fVnitYnrXNWnXpi7aREg_E6eW7FM-AXR_5Xc_JRkv68HAVuKJerjXTy5o5URWTwnfYaPB2TOL90YM6UaQU19-IYIDvYGeQ3rFcNuPBqZR_FnHW9PeaPJCLgt-JCEF9kbOJtOZiU-hrCy3pGywn1Yg/w400-h284/Rightful%20Lives%2011%20years%20on%20tweet%202.png" width="400" /></a></div><br /><span style="font-family: times;"><br /></span></div><div class="MsoNormal"><span style="font-family: times;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">I started the first of the blogposts in this series with a tweet from Rightful Lives, and I want to close on one, which takes us back to what the government promised a decade ago in response to the BBC Winterbourne View programme. The kind of statistics I've gone through here are only a very small part of the picture, but they collectively show how far we are from the promises that were made.<a href="https://www.cqc.org.uk/sites/default/files/20211021_stateofcare2021_print.pdf" target="_blank"> In its most recent State of Care report</a>, the Care Quality Commission reported that over a quarter (28%) of inpatient services for people with learning disabilities or autistic people were rated inadequate or requires improvement, and as far as I can tell this percentage is increasing over time. And this at an average charge of £283,739 per place according to <a href="https://twitter.com/NHSBenchmarking/status/1501883806604840968?s=20&t=O6D1_6TYG6rho4ihAlRM6g" target="_blank">NHS Benchmarking this year</a> - well over half a billion pounds a year of public money, presumably in excess of six billion pounds since the BBC Winterbourne View programme.</span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">And none of these past four blogposts gets to the heart of what this failure has done to countless people and those close to them since the BBC Winterbourne View programme was aired (and in the years and decades before then). The continuing litany of neglect and abuse continues unabated - people like <a href="http://sabasalman.com/#journalism" target="_blank">Saba Salman</a>, <a href="http://www.ianbirrell.com/category/disability/" target="_blank">Ian Birrell</a>, <a href="https://katharinequarmby.com/" target="_blank">Katharine Quarmby</a>, <a href="https://www.bbc.co.uk/news/uk-59388886" target="_blank">Jayne McCubbin and Ruth Clegg</a>, <a href="https://news.sky.com/story/seventy-five-people-have-died-in-autism-and-learning-disability-units-in-england-since-2015-sky-news-reveals-12491903#:~:text=News%20%7C%20Sky%20News-,Seventy%2Dfive%20people%20have%20died%20in%20autism%20and%20learning%20disability,unit%20between%202015%20and%202018." target="_blank">Rachel Lucas</a>, <a href="https://www.bbc.co.uk/news/uk-scotland-45666103" target="_blank">Lucy Adams</a> and <a href="https://www.georgejulian.co.uk/" target="_blank">George Julian</a> continue to bring the brutal reality to the attention of the public, to the general indifference of those in a position to do something about it.</span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">For all the tinkering with the machinery that has happened in the last 11 years, it's campaigning organisations like <a href="https://rightfullives.net/" target="_blank">Rightful Lives</a>, the <a href="https://skillsforpeople.org.uk/groups-courses/speaking-up-groups/waht/" target="_blank">We Are Human Too</a> campaign led by people with learning disabilities in North East England, and the self-advocacy organisation <a href="https://www.mylifemychoice.org.uk/articles/we-are-withdrawing-from-care-treatment-reviews-ctrs" target="_blank">My Life My Choice</a> who recently withdrew from conducting Care and Treatment Reviews, who are leading the way in moral clarity and integrity. </span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">Surely the government must see that, after 11 years, something radically different is required?</span></div><div class="MsoNormal"><span style="font-family: times;"><br /></span></div><div class="MsoNormal"><span style="font-family: times;"><br /></span></div><div class="MsoNormal"><span style="font-family: times;"><br /></span></div><div class="MsoNormal"><span style="font-family: times;"><br /></span></div><div><br /></div>Chris Hattonhttp://www.blogger.com/profile/05299821560069281510noreply@blogger.com0tag:blogger.com,1999:blog-1016904785776950121.post-11533678836354837782022-06-02T21:34:00.035+01:002022-06-08T07:20:32.427+01:00Winterbourne View 11 Years On. Report card 3: Planning within inpatient units<p><span style="font-family: times; font-size: medium;">This blogpost is the third of four looking at the Transforming Care/Building The Right Support programme through the prism of the national statistics regularly produced by NHS Digital, and updating a series of blogposts I last updated in Spring 2019 on the same issues.</span></p><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><a href="https://chrishatton.blogspot.com/2022/06/winterbourne-view-11-years-on-report.html" target="_blank">The first blogpost</a> looked at statistics on the number of people being admitted to inpatient services, where they were being admitted from, and the legal status and ward security of people in inpatient units.</span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><a href="https://chrishatton.blogspot.com/2022/06/winterbourne-view-11-year-on-report.html" target="_blank">The second blogpost </a>looked at how far people were from home and how long they were staying in inpatient services.</span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">This blogpost will focus on what the statistics are telling us about planning within inpatient services, using statistics from Assuring Transformation. If Transforming Care/Building The Right Support has made progress, its effects should be felt through the inpatient care plans people have, whether people’s needs are being regularly reviewed, and whether people are having regular, effective Care and Treatment Reviews (CTRs).</span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">The first graph below shows the details of care plans for people according to inpatient services, from March 2015 through to September 2021. Information in this form is not now being published.</span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">By September 2021, 15% of people were labelled ‘not dischargeable', down from 21% in March 2015. The proportion of people with an active treatment plan but no plan to leave has increased over time (from 39% of people in March 2015 to 45% of people in September 2021). The proportion of people actively working towards a plan to leave with a plan in place has dropped slightly over time, from over a third (35%) in March 2015 to 32% in September 2021. Delayed transfers of care have gradually crept up over time, and are now standing at 7% of people in September 2021. From these figures, it is impossible to tell whether these changes are due to changes in what inpatient services are doing, or changes in who is in inpatient services. For example, if Transforming Care is being effective in supporting ‘dischargeable’ people to leave inpatient services, then the proportion of ‘undischargeable’ people left in inpatient services will go up.<br /><br />But it does mean that, after 10 years of concerted government policy, there are 560 people (almost 40% of people) in September 2021 in inpatient services when, according to their care plans, they don’t need to be there.</span></div><div class="separator" style="clear: both; text-align: center;"></div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhni5n-DTbHY8JqHZL7ox8K41hyAEjCUarPeFobgQW4iTFC7TPR7qMKgearlwTcot_X5n6BAcMg-JlR2us2drh0rVLXxXr6GG4yu477i8Gxy27NwpGZq2HDMOHp9F8QauyVdFJe00bGzbcKe9OnPztMw7UOJBHXMgYm4h5BNBCVzlYP-7W7OWU7A_x5eQ/s2193/AT%20data%20June%202022%20graph%203.1.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1410" data-original-width="2193" height="412" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhni5n-DTbHY8JqHZL7ox8K41hyAEjCUarPeFobgQW4iTFC7TPR7qMKgearlwTcot_X5n6BAcMg-JlR2us2drh0rVLXxXr6GG4yu477i8Gxy27NwpGZq2HDMOHp9F8QauyVdFJe00bGzbcKe9OnPztMw7UOJBHXMgYm4h5BNBCVzlYP-7W7OWU7A_x5eQ/w640-h412/AT%20data%20June%202022%20graph%203.1.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /><br /></div><span style="font-family: times;"><span style="font-size: medium;">For everyone in inpatient services, reviews should happen regularly. The graph below shows how long ago people in inpatient services had had their last review, from March 2015 to March 2022. The graph generally shows that things seem to improve at times when there is more government/NHS England attention or pressure, but without that pressure reviews begin to drift again. By March 2022, a third of people (33%) had had a review in the past 12 weeks, and almost a quarter (23%) between 12 weeks and 6 months ago. However, a further quarter (25%) last had a review between 6 months and a year ago, and another 18% had last had a review over a year ago.</span><br /></span><div class="MsoNormal"><span style="font-family: times;"><o:p></o:p></span></div><div class="MsoNormal"><o:p><br /></o:p></div><div class="MsoNormal"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4HmpPSY23cTUzfoFryn6_krx5Dje6rEJFW-QsPkW4X8NnH-PXmofewiUYgkWDAySDgY3saSQUyEO5Cf1XgZfOBGubd_u7A1fmQSdyce44_73wtHxYanifc-ktcvXP9SmyabPhTaay_MrLhPBb77w2JwptAwzFhVY6E99Ck63oNSbodsQ-KEWoqficAQ/s2264/AT%20data%20June%202022%20graph%203.2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1330" data-original-width="2264" height="376" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4HmpPSY23cTUzfoFryn6_krx5Dje6rEJFW-QsPkW4X8NnH-PXmofewiUYgkWDAySDgY3saSQUyEO5Cf1XgZfOBGubd_u7A1fmQSdyce44_73wtHxYanifc-ktcvXP9SmyabPhTaay_MrLhPBb77w2JwptAwzFhVY6E99Ck63oNSbodsQ-KEWoqficAQ/w640-h376/AT%20data%20June%202022%20graph%203.2.png" width="640" /></a></div></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">A particular form of review introduced by Transforming Care as a way to bring in independent voices to challenge inpatient services is the Care and Treatment Review (CTR). The graph below reports the last time people in inpatient services had had a CTR, from October 2016 to March 2022. The graph shows that the vast majority of people in inpatient services have had a CTR at some point (92% of people in March 2022), and that this coverage has increased from 70% of people in October 2016. Perhaps one concern is that 11% of people last had a CTR more than a year ago, a proportion that has stayed fairly consistent over the last three years.</span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><o:p></o:p></div><div class="MsoNormal"><span style="mso-fareast-language: EN-GB; mso-no-proof: yes;"><!--[if gte vml 1]><v:shape
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</v:shape><![endif]--><!--[if !vml]--><!--[endif]--></span><o:p></o:p></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjzAH5nL5AKzbWjDLpo877obqY6rYVTOLovEu6g0Z7rpXr5k26q8D-SK2lF-oqu7H8_y6PxIrYbviCFdf3XuQ9aRJ2rcE7LaZFLJ5U91rqPY7jZ_mtvpwh3LqY8VejHecEXJRTxP2Jao6tuWKbyVfgUokBGnUvA02ikEyxAUBOvyhSjFoNcantfr-OwUw/s1949/AT%20data%20June%202022%20graph%203.3.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1011" data-original-width="1949" height="332" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjzAH5nL5AKzbWjDLpo877obqY6rYVTOLovEu6g0Z7rpXr5k26q8D-SK2lF-oqu7H8_y6PxIrYbviCFdf3XuQ9aRJ2rcE7LaZFLJ5U91rqPY7jZ_mtvpwh3LqY8VejHecEXJRTxP2Jao6tuWKbyVfgUokBGnUvA02ikEyxAUBOvyhSjFoNcantfr-OwUw/w640-h332/AT%20data%20June%202022%20graph%203.3.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">The graph below shows when people are next scheduled to have a CTR. Again, there are improvements from October 2016 to March 2022, where the proportion of people with no scheduled future CTR dropped from over half (55%) to only 6% of people. For a further 9% of people in March 2022 the date for their scheduled CTR had passed without a CTR happening.<o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="mso-fareast-language: EN-GB; mso-no-proof: yes;"><!--[if gte vml 1]><v:shape
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</v:shape><![endif]--><!--[if !vml]--><!--[endif]--></span><o:p></o:p></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxDNK43Rmk3L-Nob2aCReeZgvNItYDfStjppDIQBJWcxg26qpiKMIL1LxzRkq4xy9JgSBoJFSQrPBpS3EU1luyBnZi6UOSBe-2FJRFgPmegnVlpGFaUlUWEBhB4ntTHPEQFtggX7QbxdOa3rhMWDy915g87Pll2HOpmePFOAGm0jHvsqCK3HwUjWat2A/s1972/AT%20data%20June%202022%20graph%203.4.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1048" data-original-width="1972" height="340" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxDNK43Rmk3L-Nob2aCReeZgvNItYDfStjppDIQBJWcxg26qpiKMIL1LxzRkq4xy9JgSBoJFSQrPBpS3EU1luyBnZi6UOSBe-2FJRFgPmegnVlpGFaUlUWEBhB4ntTHPEQFtggX7QbxdOa3rhMWDy915g87Pll2HOpmePFOAGm0jHvsqCK3HwUjWat2A/w640-h340/AT%20data%20June%202022%20graph%203.4.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">Overall there are signs that more people in inpatient services are having both regular reviews and Care and Treatment Reviews, although reviews often drift back to lower levels outside times of particular pressure being applied. There are still large numbers of people in inpatient services who have not had any sort of review for a long time, however, and there are still almost 40% of people in inpatient units whose care plan says they don’t need to be there. Care and Treatment Reviews are being done, but what difference are they making?<o:p></o:p></span></div><div><br /></div>Chris Hattonhttp://www.blogger.com/profile/05299821560069281510noreply@blogger.com0tag:blogger.com,1999:blog-1016904785776950121.post-87528969941075413612022-06-02T21:11:00.043+01:002022-06-07T07:00:10.995+01:00Winterbourne View 11 Years On. Report card 2: How far are people from home, for how long?<p><span style="font-family: times; font-size: medium;">This blogpost is the second of four, updating a series of blogposts on various aspects of Transforming Care/Building The Right Support I last updated in 2019. <a href="https://chrishatton.blogspot.com/2022/06/winterbourne-view-11-years-on-report.html" target="_blank">The first blogpost in this updated series</a> looked at who was being admitted to inpatient units, where they were being admitted from, and the legal status and ward security of people in inpatient services. This second blogpost will focus on two aspects of what happens to people in inpatient services, how far people are from home and how long they are in inpatient services. They use information from <a href="https://digital.nhs.uk/data-and-information/publications/statistical/learning-disability-services-statistics" target="_blank">the Assuring Transformation dataset</a>, provided by NHS Digital.</span></p><div><div class="MsoNormal"><div class="MsoNormal"><span style="font-family: times; font-size: medium;">One of the main policies consistently trumpeted is having crisis and inpatient services close to home. The graph below reports information on the ‘distance from home’ of people in inpatient units, as reported in the Assuring Transformation dataset. The graph firstly shows that the biggest change in how far people are from home, from November 2016 to April 2022, is the huge increase in the proportion of people whose distance from home is recorded as 'unknown' (from 16% of people in Nov 2016 to 31% of people in Nov 2021). This makes interpreting other apparent changes over time difficult, as we don't know how far these extra 'unknown' people are from home (the gaps in the graph are because data on distance from home weren't always published every month). By April 2022, a quarter (26%) of people were reported to be in inpatient units more than 50km from their home. </span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">How, six years on from the introduction of this dataset, information is not provided for almost a third of people on a supposed 'flagship' indicator, is beyond me.</span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijB_DRjTdSj0xItbCdfXOtc2jxEAD2PTBLS_cWyx3dDKZTzynwCUVu0TN556Ebqq1XYP7J6eD_Da5KodQCgKbfmYHtnOJKQQcN_yAvE4Op7-Zx7TWowu5aDmk7Ft-AP7jOrOL66lHq3FKQktTsjCkZq__qr0_uKscDfTwejxiFtHR7tedzf4A9UotY-Q/s2044/AT%20data%20June%202022%20graph%202.1.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1291" data-original-width="2044" height="404" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijB_DRjTdSj0xItbCdfXOtc2jxEAD2PTBLS_cWyx3dDKZTzynwCUVu0TN556Ebqq1XYP7J6eD_Da5KodQCgKbfmYHtnOJKQQcN_yAvE4Op7-Zx7TWowu5aDmk7Ft-AP7jOrOL66lHq3FKQktTsjCkZq__qr0_uKscDfTwejxiFtHR7tedzf4A9UotY-Q/w640-h404/AT%20data%20June%202022%20graph%202.1.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">Another important policy aim of Transforming Care/Building The Right Support is to reduce the length of time that people spend in inpatient units. The graph below shows how long people have been in their current inpatient unit according to Assuring Transformation statistics, from March 2015 through to March 2022. There are very gradual and fluctuating trends over time towards a greater proportion of people being in their current inpatient unit for shorter lengths of time, although in March 2022 13% of people had been in their current inpatient unit for 5 years or longer.</span></div><div class="MsoNormal"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjzubjt9qU-qTy8AndiP9JRLkWQkD0AB57VYM8jHJ4IzTPl7Cj8etWLSjI_VCizU2XH27RNtjvUqkLyPbUaebgTlpmRaH8EUh2rCbI9x9vBzSGDrf20Nvm8KkIptjNZ3exPd3OUq7yocX2K_CbBJEwQdPLnDhK-utl1IgahBeoU7d8RF4CbDYUdpcLyg/s2388/AT%20data%20June%202022%20graph%202.2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1212" data-original-width="2388" height="324" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjzubjt9qU-qTy8AndiP9JRLkWQkD0AB57VYM8jHJ4IzTPl7Cj8etWLSjI_VCizU2XH27RNtjvUqkLyPbUaebgTlpmRaH8EUh2rCbI9x9vBzSGDrf20Nvm8KkIptjNZ3exPd3OUq7yocX2K_CbBJEwQdPLnDhK-utl1IgahBeoU7d8RF4CbDYUdpcLyg/w640-h324/AT%20data%20June%202022%20graph%202.2.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">As I mentioned in the previous post, these is a lot of evidence that substantial numbers of people are moved around different inpatient services without ever leaving the inpatient service system. Assuring Transformation also reports information on how long people have been continuously within inpatient services (not just how long they have been in their current unit). The graph below shows this information from March 2015 to March 2022. The extent of people being transferred around can be clearly seen; in March 2022 over a third of people (35%) had been continuously in inpatient services for 5 years or longer, a proportion that has hardly changed from March 2015.</span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><o:p></o:p></div><div class="MsoNormal"><span style="mso-fareast-language: EN-GB; mso-no-proof: yes;"><!--[if gte vml 1]><v:shape
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</v:shape><![endif]--><!--[if !vml]--><!--[endif]--></span><o:p></o:p></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRbmwKaCOp2Og3eATbEh83wGOd7fMj97-TLSbiu1b9S9pnBZ1zqJw9wtuTzMoi0JDjxKo_pwBFzOU6Zd2ypV7DQAVGXtk1gmiotVYeZ-rGHdJAQgPq5oY1JBComEq2GAdJR3-oVhj3fobWraR0aONJsIJ8X7hsZOOzEU_LUnV1PF4p_-gmMxf47KxPuA/s2306/AT%20data%20June%202022%20graph%202.3.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1233" data-original-width="2306" height="342" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRbmwKaCOp2Og3eATbEh83wGOd7fMj97-TLSbiu1b9S9pnBZ1zqJw9wtuTzMoi0JDjxKo_pwBFzOU6Zd2ypV7DQAVGXtk1gmiotVYeZ-rGHdJAQgPq5oY1JBComEq2GAdJR3-oVhj3fobWraR0aONJsIJ8X7hsZOOzEU_LUnV1PF4p_-gmMxf47KxPuA/w640-h342/AT%20data%20June%202022%20graph%202.3.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">Finally, Assuring Transformation also reports the average length of time that people have been in their current inpatient unit, and continuously in inpatient services. The graph below shows that people were on average in their current inpatient unit for just under 3 years, with this length of stay gradually falling from March 2015 to September 2019 but increasing from then onwards. The total length of time people have been continuously in inpatient services has increased slightly from 2015 and is now standing at an average of more than 5 years 6 months.</span><o:p></o:p></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="mso-fareast-language: EN-GB; mso-no-proof: yes;"><!--[if gte vml 1]><v:shape
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</v:shape><![endif]--><!--[if !vml]--><!--[endif]--></span><o:p></o:p></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhWWZ0vfViQme19I5tEwSB_IGFAbql_Kug4D3k7BKY9eoEF0h4uJbWjejMtGEHR7-zOH3smS9T-wrp154idxvApNUT2LNQd9i-4F74cMmEOcsinolKMz7SF3k8M9ejK1-7b584ige4OSjyEcrgx_tFSBD0UaWT9qoZm3MLR6KGHgqtFWvFal_erhKNPQ/s2295/AT%20data%20June%202022%20graph%202.4.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1144" data-original-width="2295" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhWWZ0vfViQme19I5tEwSB_IGFAbql_Kug4D3k7BKY9eoEF0h4uJbWjejMtGEHR7-zOH3smS9T-wrp154idxvApNUT2LNQd9i-4F74cMmEOcsinolKMz7SF3k8M9ejK1-7b584ige4OSjyEcrgx_tFSBD0UaWT9qoZm3MLR6KGHgqtFWvFal_erhKNPQ/w640-h320/AT%20data%20June%202022%20graph%202.4.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">What does this mean? First, it’s obvious that inpatient services have not become radically more local as Transforming Care/Building The Right Support has ‘progressed’, with Assuring Transformation reporting that a quarter of people are more than 50km from home and this information simply not being reported for almost a third of people. The information on how long people are staying in inpatient units reflects the continuing ‘churn’ of people between inpatient units without seeing the outside world, with people still on average spending 5 and a half years continuously in some form of inpatient unit.</span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;"><br /></span></div><div class="MsoNormal"><span style="font-family: times; font-size: medium;">Reducing distance from home and length of stay were both supposed to be central to Transforming Care/Building The Right Support – as far as I can tell, these have not improved in the last six or seven years and in some respects may have got worse.</span></div></div>Chris Hattonhttp://www.blogger.com/profile/05299821560069281510noreply@blogger.com0tag:blogger.com,1999:blog-1016904785776950121.post-43498684290859085542022-06-02T20:33:00.130+01:002022-06-06T07:54:27.222+01:00Winterbourne View 11 Years On. Report card 1: People being admitted to inpatient units, legal status and ward security<p><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;"><span style="color: #444444;">It was a little-heralded
anniversary last week. Eleven years since the BBC aired its programme about the
horrendous abuse meted out to people with learning disabilities and autistic
people at Winterbourne View, a ‘specialist’ inpatient unit (NOT a residential
care home – the persistent confusion about this in much of the media coverage speaks
volumes). Rightful Lives marked the anniversary like this on twitter.</span></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><span style="color: black; font-family: "Times New Roman",serif; font-size: 13.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><o:p> </o:p></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi1kxg8UXUN2MguMXSNgViJ-v3UzCWIT8MqmD2VKfBJcmyab_tC-GtWyhFpOaE9LbeDAPXsiCHTotrVJhx75fzl9efqv2AMc7es2mV0SXfHZe4QMXIp8FJGWK5wmpLxiifUq38t8ncBK36B3gD3CfloKncOE1D7p9chNHS5Zxa-bTK7Ghd9hGD812bhtQ/s606/Rightful%20Lives%2011%20years%20on.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="606" data-original-width="538" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi1kxg8UXUN2MguMXSNgViJ-v3UzCWIT8MqmD2VKfBJcmyab_tC-GtWyhFpOaE9LbeDAPXsiCHTotrVJhx75fzl9efqv2AMc7es2mV0SXfHZe4QMXIp8FJGWK5wmpLxiifUq38t8ncBK36B3gD3CfloKncOE1D7p9chNHS5Zxa-bTK7Ghd9hGD812bhtQ/w355-h400/Rightful%20Lives%2011%20years%20on.png" width="355" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><p></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;"><span style="color: #444444;">Has nothing really
changed at all in the intervening 11 years, with the panoply of policies,
progress reports, rebranded initiatives when previous ones have not met their targets,
meetings, deep dives, reviews, flow charts, workshops, more reviews, and days,
weeks and years of people’s lives living in spaces beyond human rights and dignity (not to mention the amount of public money that must have been spent on officials
to get a ‘grip’)?<o:p></o:p></span></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><span style="color: #444444;"><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;">There are many ways
to try and answer this question. One thing I’ve been doing sporadically is to
look at the official monthly statistics published by NHS Digital about autistic
people and people with learning disabilities in inpatient units, to see if
they reveal any tangible evidence of change over time (or at least since 2015, when
some of this information began to become available). The last time I went
through a comprehensive ‘report card’ on inpatient units was in Spring 2019, in
a series of four blogposts (the link to the first one of these </span><a href="https://chrishatton.blogspot.com/2019/03/transforming-care-report-card-1-people.html" style="font-family: "Times New Roman", serif; font-size: 13.5pt;">is
here</a><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;">). I’m going to update this information in a short series of blogposts
this week</span></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><span style="color: #444444;"><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;">I will not cover in detail the
issue of the overall number of people in these inpatient units (I went through this
record of failure against the succession of targets the government set for itself
</span><a href="https://chrishatton.blogspot.com/2021/05/autistic-people-and-people-with.html" style="font-family: "Times New Roman", serif; font-size: 13.5pt;">here
about a year ago</a><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;">, and </span><a href="https://chrishatton.blogspot.com/2021/11/the-number-of-people-with-learning.html" style="font-family: "Times New Roman", serif; font-size: 13.5pt;">little
has changed since</a><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;">). I want to look again at some of the other statistics
that give us some clues about what has been happening with Transforming Care
and its successors eleven years on from Winterbourne View. </span></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><span style="color: #444444;"><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;">These blogposts will
focus on <a href="https://digital.nhs.uk/data-and-information/publications/statistical/learning-disability-services-statistics">information
produced publicly by NHS Digital</a> from one of two datasets. It uses data from the</span><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;"> Assuring Transformation
dataset – for this dataset, health service
commissioners provide information (sometimes retrospectively) on the number of
people with learning disabilities and autistic people in specialist inpatient
services and on various aspects of what is happening with or to people. I’ve
collected some of the information into six-month or yearly blocks, and some of
the information I report for every six months rather than every month
(both you and I would not survive that amount of information…). This means that
most of the information goes up to March 2022. In this post I have not used information from the Mental Health
Services Dataset (MHSDS), which reports information collected by mental health
service providers concerning people identified by them as a person with
learning disabilities or an autistic person – this has been published monthly
starting more recently than the Assuring Transformation dataset and is less
detailed about processes. In different ways both datasets are partial –
Assuring Transformation does not include a lot of people in mainstream mental
health inpatient units, and some big independent sector inpatient service
organisations are not yet reporting aspects of their activity to the MHSDS.</span></span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><span style="color: #444444;"><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;">The differences between these datasets matter, and it is no surprise that government only reports data from Assuring Transformation (which reports 2,100 people in inpatient services at the end of February 2022) rather than the MHSDS (which reports 3,505 in inpatient services at the end of February 2022).</span></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;"><span style="color: #444444;">As with the previous
series, these four blogposts will focus on:</span></span></p>
<ul type="disc">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman",serif; font-size: 13.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><span style="color: #444444;">Who is going into inpatient
services?<o:p></o:p></span></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman",serif; font-size: 13.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><span style="color: #444444;">How far are people from home, and how long are people spending
in inpatient services?<o:p></o:p></span></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman",serif; font-size: 13.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><span style="color: #444444;">What planning and review is
happening in inpatient services?<o:p></o:p></span></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman",serif; font-size: 13.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><span style="color: #444444;">What is happening about
people leaving inpatient services, and where are they going?<o:p></o:p></span></span></li>
</ul>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;"><span style="color: #444444;">So – much of the
focus of the various iterations of the Transforming Care programme and its rebranded successors has been on getting people out of
inpatient units, but the slower than planned reduction in the overall number of
people in these units suggests that there are still substantial numbers of
people coming into these units. What do the statistics tell us about this?<o:p></o:p></span></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><span style="color: #444444;"><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;"><o:p> </o:p></span><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;">Every month, the
Assuring Transformation statistics report how many people have come into an
inpatient unit (called ‘admissions’) according to commissioners. The graph
below adds these together across six different years (each one October to September), so we can see the number of people coming into these
units and whether they have changed over time.</span></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;"><o:p><span style="color: #444444;"> </span></o:p></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjS5HXZgrWx5JKonHU1QcNsK3Af7FwjSWH4iuF3AqMg4Mapuhm3weFuOeF3JsiKSYbUbLvmWoVeHiw_ikvaw3y6mL6JWX75d3qiewYBAl-cR3A9z7yOu8movyIq1hs-b75mOQgXQIjk7pwDazVvou7elCVXs24jN1df5IFLp7XofwYwVG_Zgz3RNeoYXg/s2296/AT%20data%20June%202022%20graph%201.1.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1300" data-original-width="2296" height="362" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjS5HXZgrWx5JKonHU1QcNsK3Af7FwjSWH4iuF3AqMg4Mapuhm3weFuOeF3JsiKSYbUbLvmWoVeHiw_ikvaw3y6mL6JWX75d3qiewYBAl-cR3A9z7yOu8movyIq1hs-b75mOQgXQIjk7pwDazVvou7elCVXs24jN1df5IFLp7XofwYwVG_Zgz3RNeoYXg/w640-h362/AT%20data%20June%202022%20graph%201.1.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><p></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;"><span style="color: #444444;">The first thing the graph shows us is, pre-COVID, the overall number of admissions to inpatient services was increasing,
from 1,810 admissions in 2015/16 to 2,250 admissions in 2018/19. The total number of admissions dropped to 1,745 admissions in Oct 2019 - Sept 2020, when COVID-19 hit, but even through 2020/21 increased again to 1,830 admissions. In total, there have been 11,570 admissions to these inpatient units in the last six years - we don't know how many of these are the same people being admitted more than once or different people being admitted.</span></span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;"><span style="color: #444444;">The second
thing to notice is that a large proportion of admissions (the red chunk) are
actually transfers from other hospitals (mainly other inpatient services of
various types), running consistently at well over 20% of all admissions. </span></span><span style="color: #444444; font-family: "Times New Roman", serif; font-size: 13.5pt;">The third thing I want to mention is that more than one in six
admissions (the lilac chunk) are re-admissions, where people had
previously been in an inpatient service less than a year before. Finally, the purple chunk shows that
just over half of admissions to inpatient services (60% in 2020/21) are people
who have not been in an inpatient unit for at least a year (or maybe never).</span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;"><span style="color: #444444;"><br /></span></span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;"><span style="color: #444444;">What kinds of places
are people being admitted to inpatient services coming from? The graph below
shows this information from the Assuring Transformation statistics, for five one-year blocks (starting in October 2016, through to September 2021).</span></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;"><span style="color: #444444;">In 2020/21, almost half of people (860 people; 48%) were admitted from their ‘usual place of residence’ and 43% of people (760 people) were admitted
from other inpatient and/or hospital services, particularly from ‘acute beds’
(which includes people being transferred from mainstream mental
health inpatient services). A
further 95 people (5%) in 2020/21 were admitted from ‘penal
establishments’ and 30 people (2%) were admitted from residential care services. Although there have been fluctuations over time, the picture in 2020/21 looks rather similar to the picture for 2016/17.</span></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><span style="color: black; font-family: "Times New Roman",serif; font-size: 13.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><o:p> </o:p></span></p>
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1gkVi_DR19jbUpQkwgecltwoeVJP8yw4K4elVvH5x72Xil9C_88GfGsxcBmeN2Bm6wj-WlJ47tEEm2DHIfQtZmQni2E8H4RN_RL5hOKFTUbdVlIiYKce3hn-uKLm15m2tQpRzokt5wwfExCyx37AVxi6pjYlPrKUpH8J-IOaOIrEGa0kq-x6GKJD06A/s2259/AT%20data%20June%202022%20graph%201.2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="2259" height="362" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1gkVi_DR19jbUpQkwgecltwoeVJP8yw4K4elVvH5x72Xil9C_88GfGsxcBmeN2Bm6wj-WlJ47tEEm2DHIfQtZmQni2E8H4RN_RL5hOKFTUbdVlIiYKce3hn-uKLm15m2tQpRzokt5wwfExCyx37AVxi6pjYlPrKUpH8J-IOaOIrEGa0kq-x6GKJD06A/w640-h362/AT%20data%20June%202022%20graph%201.2.png" width="640" /></a></div><br /><p align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; text-align: center;"><br /></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;"><span style="color: #444444;">Overall, despite a temporary dip in admissions almost certainly related to the COVID-19 pandemic, it seems
like the pressures are as bad in 2020/21 as they were in 2016/17 and continuing to build, for which inpatient services are
being used as a response. Building The Right Support in 2015 promised effective community support for people - so why six years on are the number of people being admitted to inpatient units from their 'usual place of residence', or the number of people re-admitted within a year of leaving an inpatient unit, virtually unchanged? If inpatient units are supposed to be better-placed to meet the needs of the people being put in them, why are so many people still being passed around different inpatient units?</span></span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;"><span style="color: #444444;">Have any changes in admissions resulted in changes to the legal status or the ward security of people with learning disabilities and autistic people in inpatient units? A persistent argument has been that people on MHA Part III sections (particularly those with legal restrictions) and people in higher security places are more likely to need to remain in inpatient services, so the number of people in these categories should not change even if the number of people in inpatient units reduces overall. </span></span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;"><span style="color: #444444;">The graph below shows the number of people in inpatient units at the end of March each year from 2016 to 2022, broken down by the legal status of people in inpatient units according to Assuring Transformation data.</span></span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;"><span style="color: #444444;">The most common legal status for people in inpatient units is a Part II section, where the number of people has dropped by 20% from 2016 to 1,040 people in March 2022. The next most common legal status is a Part III section with restrictions, where the number of people has dropped by 14% from 2016 to 535 people in March 2022. Less common are people with Part III sections without restrictions (which dropped by 39% from 2016 to 235 people in March 2022), people not subject to the Mental Health Act (which dropped by 44% from 2016 to 155 people in March 2022), and people in other sections (35 people; unchanged from 2016 to 2022). It is clear that reductions in the number of people in inpatient units have reduced for people with almost all types of legal status from 2016 to 2022.</span></span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmmHdXG5BVfRihHqVJRVlezqgf7vLUcSljkg9azOtBLkyCAKn4rSLZg30UPI5S5fn87pOGefV1DPhdvGejMOsB6_t_Ed82mdW--bC48TrACh0ysDKJ5kC9io266LpyJa5N-qVKUgvWwpttZFaPcNfimGmuru62LC4-Yq_VBlQlvsu1Hv9DryDep5EBgg/s2016/AT%20data%20June%202022%20graph%201.3.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1172" data-original-width="2016" height="372" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmmHdXG5BVfRihHqVJRVlezqgf7vLUcSljkg9azOtBLkyCAKn4rSLZg30UPI5S5fn87pOGefV1DPhdvGejMOsB6_t_Ed82mdW--bC48TrACh0ysDKJ5kC9io266LpyJa5N-qVKUgvWwpttZFaPcNfimGmuru62LC4-Yq_VBlQlvsu1Hv9DryDep5EBgg/w640-h372/AT%20data%20June%202022%20graph%201.3.png" width="640" /></a></span></div><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;"><br /><span style="color: #444444;">The picture is similar when looking at ward security, as the graph below shows. The most common level of ward security is 'general', where the number of people in 'general' ward security dropped by 22% from 2016 to 1,035 people in March 2022. The next most common level of ward security is 'low secure', where the number of people dropped by 34% from 2016 to 555 people in March 2022. Together, people in 'general' and 'low secure' places were 79% of all people with learning disabilities and autistic people in inpatient units in March 2022. </span></span><p></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;"><span style="color: #444444;">The number of people in medium secure inpatient units also dropped by 41% from 2016 to 305 people in March 2022, with smaller numbers of people recorded in high secure units (60 people) and Psychiatric Intensive Care Units (50 people)</span></span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8iR9jEfKPq-S4j9xmucpxA1Iaut2hStknfglJ4nwwFC5dm6BfF9YeQFbcfPdn0yb2U9eowt7f6FrIOtLb-i4FM38Y4Dcv9hmb-2uirY1DDjqnt5wpC-uOYP9sO4MhXaqJdbiW7Tn6_2e6vOdM1-FqhIKEmVHFx27UlbmlLi8oj9RvVpejLrlgFc1thQ/s2014/AT%20data%20June%202022%20graph%201.4.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1172" data-original-width="2014" height="372" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8iR9jEfKPq-S4j9xmucpxA1Iaut2hStknfglJ4nwwFC5dm6BfF9YeQFbcfPdn0yb2U9eowt7f6FrIOtLb-i4FM38Y4Dcv9hmb-2uirY1DDjqnt5wpC-uOYP9sO4MhXaqJdbiW7Tn6_2e6vOdM1-FqhIKEmVHFx27UlbmlLi8oj9RvVpejLrlgFc1thQ/w640-h372/AT%20data%20June%202022%20graph%201.4.png" width="640" /></a></span></div><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;"><br /><span style="color: #444444;">Clearly, reducing the number of people in inpatient units does not need to exclude people on Part III sections or people on low or medium secure wards.</span></span><p></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;"><span style="color: #444444; font-family: Times New Roman, serif;"><span style="font-size: 18px;">Overall, is this a record of sustained progress?</span></span></p>Chris Hattonhttp://www.blogger.com/profile/05299821560069281510noreply@blogger.com0tag:blogger.com,1999:blog-1016904785776950121.post-4100503456675534202021-11-30T11:52:00.004+00:002021-12-01T08:05:30.900+00:00Restraints used on people with learning disabilities and autistic people in inpatient units through the COVID-19 pandemic - what the statistics say<div style="text-align: left;">This blogpost will run through what the publicly available statistics say about what restraints (or 'restrictive interventions') autistic people and people with learning disabilities in mental health inpatient services in England have been subject to through the COVID-19 pandemic to date. My thanks to the Restraint Reduction Network for asking me to talk at their conference this year, prompting me to have a proper look at this information and marshal the many graphs into some sort of argument.</div><p><a href="https://chrishatton.blogspot.com/2021/11/the-number-of-people-with-learning.html" target="_blank">A recent blogpost gives some context </a>on the number of people with learning disabilities and autistic people who have been in inpatient services in England through the COVID-19 pandemic, using the same dataset as the one I will be using in this blogpost. It might be worth you having a quick look at that first, but a couple of headlines from that is that it looks like there were substantial dips in the number of people in inpatient services at times when the COVID-19 pandemic was peaking, with high pressure on health services and nationwide lockdowns. There have been increases in the number of people in inpatient services after these periods, but not to the levels seen before the pandemic. These dips in numbers were proportionally higher for children and young people and people not on formal sections.</p><p>The dataset I used in that blogpost and in this one is the Mental Health Services Data Set (MHSDS) - this is a large dataset collected by all NHS-commissioned mental health services in England, and includes information on people flagged in these services as an autistic person or a person with learning disabilities. <a href="https://digital.nhs.uk/data-and-information/publications/statistical/learning-disability-services-statistics " target="_blank">NHS Digital extracts the information specifically related to people with learning disabilities and autistic people </a>in any mental health inpatient service every month, including both the 'specialist' inpatient services that have largely been the focus of Transforming Care/Building The Right Support, and general mental health inpatient services. <a href="https://digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-sets/mental-health-services-data-set/about " target="_blank">Providing information for the MHSDS is mandatory</a> for NHS funded service providers, including independent sector providers.</p><p><br /></p><h3 style="text-align: left;">What does the MHSDS say about restrictive interventions?</h3><p>The MHSDS includes information on both the number of people subject to any restrictive intervention in any single month, and the number of restrictive interventions people have been subject to in any single month. It also provides information on a range of specific types of physical restraint, and on mechanical restraint, chemical restraints, seclusion and segregation.</p><p>What do the MHSDS statistics say about restrictive interventions overall? The graph below shows the number of people with learning disabilities and autistic people in inpatient units who have been subject to at least one restrictive intervention in each month, from January 2020 through to August 2021. There are particular spikes in May and July 2020, which I'll come to later, but the overall picture is of fluctuating numbers of people subject to restraints over time.</p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4nh0o9u58KcOHXDWRjvwOpH8BFwocHJeqzGKe_veV4jhk2BE0wTS6T-JPPAc4T0hyphenhyphenmDpJF0w8iFA-w0Y9okT1seA8IARaLZ3yVHqxE5Ypu7_Vw72LZca8Prom4ebkP2O7jYQhnGiABwOa/" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="643" data-original-width="1074" height="384" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4nh0o9u58KcOHXDWRjvwOpH8BFwocHJeqzGKe_veV4jhk2BE0wTS6T-JPPAc4T0hyphenhyphenmDpJF0w8iFA-w0Y9okT1seA8IARaLZ3yVHqxE5Ypu7_Vw72LZca8Prom4ebkP2O7jYQhnGiABwOa/w640-h384/image.png" width="640" /></a></div><br />Because the number of people in inpatient services also fluctuates over this time period, we can also look at what percentage of people in inpatient units in each month are subject to at least one restrictive intervention. This is what the graph below shows - again there are the spikes in May and July 2020, but overall the trend looks to be increasing over time. In January 2020, 7.5% of people were subject to at least one restrictive intervention. By August 2021 this was 9.1% of people.<p></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEaEs3LQEFidGF7JEpPKUCfqn9-9RnRra3oxo_3t82oJoHU5lOg0LZ_kNN2bnkZm4CcVqA0EGANtgjgZYMOjNSH6paXVH3JyIm9YUTq1cAMUAv70x8H4tr51qoYbG1CG4wOKIS1xVcCOVU/" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="643" data-original-width="1074" height="384" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEaEs3LQEFidGF7JEpPKUCfqn9-9RnRra3oxo_3t82oJoHU5lOg0LZ_kNN2bnkZm4CcVqA0EGANtgjgZYMOjNSH6paXVH3JyIm9YUTq1cAMUAv70x8H4tr51qoYbG1CG4wOKIS1xVcCOVU/w640-h384/image.png" width="640" /></a></div><br />As well as the number of people subject to restrictive interventions, we know that people can be subject to multiple restraints, so the graph below shows the total number of restrictive interventions that autistic people and people with learning disabilities in inpatient services were subject to each month. Again, we see substantial fluctuations month by month throughout the pandemic, with potential dips when there were fewer people in inpatient units.<p></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiX2i9U3djTk_-p4DocmnCpx50ftuPTpXWrIoNZ8Vo_-GFxEFvYBjndKyJqexI7fBNiTlESJWGRiVxOHXXy-BZXUmdkU-sxcxs7WLhS4Ulk5lQYF9lNYr3tI-eJzmjggojhuIC8CVUwz9fY/" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="643" data-original-width="1074" height="384" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiX2i9U3djTk_-p4DocmnCpx50ftuPTpXWrIoNZ8Vo_-GFxEFvYBjndKyJqexI7fBNiTlESJWGRiVxOHXXy-BZXUmdkU-sxcxs7WLhS4Ulk5lQYF9lNYr3tI-eJzmjggojhuIC8CVUwz9fY/w640-h384/image.png" width="640" /></a></div><br />To take this into account, the graph shows the average number of restrictive interventions for every person that was subject to at least one. This again shows fluctuations over time, with a potential increasing trend until the summer of 2021. On average, people were subject to around 10 restrictive interventions in every month - one every three days.<p></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4LJ2WggjWZTCO0DbEe4qC6prvgXsHXd4dIbMp5eadWYbEQINTMg-A8a8qN9EZDO3W0OXMSk8HfJYP0NDuUmGsFcMjGI69g2KhqzD6-qjaMVuH9YTtYEd2-Rw0f00TYqy_UbZZA3uV542p/" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="643" data-original-width="1074" height="384" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4LJ2WggjWZTCO0DbEe4qC6prvgXsHXd4dIbMp5eadWYbEQINTMg-A8a8qN9EZDO3W0OXMSk8HfJYP0NDuUmGsFcMjGI69g2KhqzD6-qjaMVuH9YTtYEd2-Rw0f00TYqy_UbZZA3uV542p/w640-h384/image.png" width="640" /></a></div><br />The publicly available information also allows us to look at restraints that people in different age groups have been subject to. To simplify things a bit I've looked at four age groups: children and young people aged under 18; adults aged 18-24; adults aged 25-35; and adults aged 35+. The graph below shows the percentage of people in inpatient units in each age group who have been subject to at least restrictive intervention in each month. As the graph shows, people aged 18-24 are consistently most likely to have been subject to restraint - even setting aside the May and June 2020 spikes, around 13-14% of people in this age group experience restraint in each month.<p></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjXwob5Sg0ku6WGdkmDqSPV4c3ixUMjR9CHyRlPsMa9SQSkOqIq21GKpzzIa_M1I0A-8cNWsoQx0k9CsHMajhjzAP0mpc7gtrTqbKyP2C43xF9byRD843t9eClVI9G5orSjXVlYKkamw4kz/" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="583" data-original-width="907" height="412" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjXwob5Sg0ku6WGdkmDqSPV4c3ixUMjR9CHyRlPsMa9SQSkOqIq21GKpzzIa_M1I0A-8cNWsoQx0k9CsHMajhjzAP0mpc7gtrTqbKyP2C43xF9byRD843t9eClVI9G5orSjXVlYKkamw4kz/w640-h412/image.png" width="640" /></a></div><br />Following on from this, how many restrictive interventions are people in different age groups subject to? The graph below shows that children and young people aged less than 18 are consistently most likely to experience more restrictive interventions in each month - in some months more than 20 restrictive interventions per person subject to at least one.<p></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNgyr49MgrqY2oE5AB5IMIkvbf-gpevT3iMc-1HuUzmrllhkxkTew2DZ52CWVCdnxwUKlM5uHWL90mCI-u-ZPzX35LTftNyJI_vTnY-PhZUDz2uqkCIljOzNJDRR70CwleOoJh4QLzoNkg/" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="541" data-original-width="902" height="384" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNgyr49MgrqY2oE5AB5IMIkvbf-gpevT3iMc-1HuUzmrllhkxkTew2DZ52CWVCdnxwUKlM5uHWL90mCI-u-ZPzX35LTftNyJI_vTnY-PhZUDz2uqkCIljOzNJDRR70CwleOoJh4QLzoNkg/w640-h384/image.png" width="640" /></a></div><br /><br /><p></p><h3 style="text-align: left;">What restrictive interventions are people subject to?</h3><p>What do the statistic tell us about which types of restraint people with learning disabilities and autistic people in inpatient units have been subject to throughout the COVID-19 pandemic? The graph below shows the number of people who have been subject to different types of physical restraint throughout the time of the pandemic, according to the MHSDS.</p><p>The highest numbers of people are subject to four types of physical restraint (which may be increasing over the time of the pandemic): standing restraint, supine restraint, seated restraint and 'other' physical restraint. By August 2021, at least 150 people were subject to each of these types of physical restraint (and I don't understand why 'other' restraint should be increasing over time - what types of physical restraint are being put into that mysterious box?). It is also worth noting that prone restraint is still happening and being recorded - 100 people per month experience prone restraint.</p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKJ6zOHc5RdCImsBIjDLrj-_LP3kqXNactOin3dTavYUGI1d-eoe2cs5o2RthI3yhUrrnyE8mIkE017QKYiqGIDQCef7ryiTmNnHudfLO36He-JPpMYpLDX7bk9E7cmWdFW0uelpk1FK8w/" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="658" data-original-width="1039" height="406" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKJ6zOHc5RdCImsBIjDLrj-_LP3kqXNactOin3dTavYUGI1d-eoe2cs5o2RthI3yhUrrnyE8mIkE017QKYiqGIDQCef7ryiTmNnHudfLO36He-JPpMYpLDX7bk9E7cmWdFW0uelpk1FK8w/w640-h406/image.png" width="640" /></a></div><br />How many times are people being subject to physical restraints? The graph below shows the total number of instances recorded of different types of physical restraint. The same four types of physical restraint discussed above are also the ones most commonly used: there are potential decreases over time in the number of times supine and standing restraint have been used, but a definite increase in the recording of 'other' restraint.<p></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrpZsEXLyTC_E0fxgJcHAQ8OkPPDWdZydfAM6RNEMcDHE8NeLP_dPtji5j1P4U07iauxdE3gfxo_RijaZtRGXE9mQ84KxO6Cp-HQtbwixnTauUYu7-cFroaW9mXlyDI5s62BE3JYUG-t4c/" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="658" data-original-width="1051" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrpZsEXLyTC_E0fxgJcHAQ8OkPPDWdZydfAM6RNEMcDHE8NeLP_dPtji5j1P4U07iauxdE3gfxo_RijaZtRGXE9mQ84KxO6Cp-HQtbwixnTauUYu7-cFroaW9mXlyDI5s62BE3JYUG-t4c/w640-h400/image.png" width="640" /></a></div><br />We can also look at the same type of information for other forms of restrictive intervention: chemical restraints, mechanical restraint, seclusion and segregation. The graph below shows the number of people subject to these forms of restrictive intervention. Seclusion is experienced by a large and increasing number of people across the pandemic period, up to over 160 people in the month of August 2021. Oral chemical restraint and rapid tranquilisers are each experienced by around 80 to 100 people every month, with the number of people subject to oral chemical restraint more than doubling from January 2020 to August 2021.<p></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiP7fNpeUPg_mecFIRxvPKvFkk85HznxdtjJECxLTjRbkqwWcy-fMg1UHgo_o1zK5RYGoneajpD3XvGyzPJTStCC7dP09PF8c3UWFxfDbDRc_d5XV5uVo1Ykb3Ory1RGcZHiRXQVeYY6jrr/" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="659" data-original-width="1033" height="408" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiP7fNpeUPg_mecFIRxvPKvFkk85HznxdtjJECxLTjRbkqwWcy-fMg1UHgo_o1zK5RYGoneajpD3XvGyzPJTStCC7dP09PF8c3UWFxfDbDRc_d5XV5uVo1Ykb3Ory1RGcZHiRXQVeYY6jrr/w640-h408/image.png" width="640" /></a></div><br />In terms of the number of times people have been subject to these forms of restrictive intervention, the graph below shows a similar picture, with high use of seclusion throughout and high and increasing use of oral and rapid tranquiliser chemical restraint over time.<p></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjz0fRJwPakFXcXH1puwZSjNBDSK6tcMLir6_B6ikCfYsl08e87fW5VR33R856EhnfX7zHhl0KUFk-hAhg4TJcc_HlZPNolNC8L5Tx0NiBvgAuYm1dMkP4-uvIeq4VucsGbkkTfKoTaQNNo/" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="657" data-original-width="1050" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjz0fRJwPakFXcXH1puwZSjNBDSK6tcMLir6_B6ikCfYsl08e87fW5VR33R856EhnfX7zHhl0KUFk-hAhg4TJcc_HlZPNolNC8L5Tx0NiBvgAuYm1dMkP4-uvIeq4VucsGbkkTfKoTaQNNo/w640-h400/image.png" width="640" /></a></div><br /><br /><p></p><h3 style="text-align: left;">NHS and independent sector inpatient services, and the case of the missing information</h3><p>Information from the MHSDS about restraints used on people with learning disabilities and autistic people can be broken down by whether the inpatient service is an NHS or independent sector. The two graphs below show the number of people subject to at least one restrictive intervention and the total number of restrictive interventions people are subject to, broken down by NHS vs independent sector provider.</p><p>Both graphs seem to show a similar picture. For the number of people subject to at least one restrictive intervention, in NHS inpatient services there is a dip in the first peak of the COVID-19 pandemic then a steady increase ever since. In independent sector services there is the double spike in May and July 2020 I've mentioned already, interrupting a gradual decrease and flattening out over time of the number of people subject to restrictive interventions.</p><p>The picture in terms of the total number of restrictive interventions is similar - increasing over time in NHS inpatient services, and (except for the spikes) gradually decreasing over time in independent sector inpatient services.</p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRovs3eDSB-PCrTxWOLwd87CMourYI_z66hgYKgawYB7l3OjNyvYYRPUAloEub2Es3T5q7AmkK64gL4SWQILFhVGvtD32lrxleO7f8Njg6502aChTdp6xas2h6UXGAMIcZflngSq2AHTpi/" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="644" data-original-width="1074" height="384" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRovs3eDSB-PCrTxWOLwd87CMourYI_z66hgYKgawYB7l3OjNyvYYRPUAloEub2Es3T5q7AmkK64gL4SWQILFhVGvtD32lrxleO7f8Njg6502aChTdp6xas2h6UXGAMIcZflngSq2AHTpi/w640-h384/image.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhm4oVEzJ78qC-XAwKAKtq7S3ccUSl20j-uldtT_s_4_tDWR1FC40hzLNC5N8Ipq7zM6kojgmaZiPcB9Gr2c0p4tw241D4VmdTL8gBPIRds7sYuwvgA-FzRTbWI32MvrFFZf1cKCvJtscof/" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="642" data-original-width="1074" height="382" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhm4oVEzJ78qC-XAwKAKtq7S3ccUSl20j-uldtT_s_4_tDWR1FC40hzLNC5N8Ipq7zM6kojgmaZiPcB9Gr2c0p4tw241D4VmdTL8gBPIRds7sYuwvgA-FzRTbWI32MvrFFZf1cKCvJtscof/w640-h382/image.png" width="640" /></a></div><br />Is this an accurate picture? The spikes in May and July 2020 (finally, he gets to the spikes!) give us a clue. In these two months, the Cygnet organisation (recorded in the MHSDS in May 2020 as having 360 autistic people and people with learning disabilities in inpatient units) recorded 830 and 775 restrictive interventions respectively. In June 2020, August 2020, and every month since, the number of restrictive interventions is recorded as an asterisk, meaning anything between 0 and 4 restrictive interventions in total for the month. These could mean a complete absence of reporting of restrictive interventions in inpatient services for the whole Cygnet organisation. Elysium (485 people in May 2020), Partnerships in Care (90 people) and Huntercombe (90 people) all report asterisk levels of restrictive interventions throughout the whole pandemic period - St Andrews is the only large (50+) independent sector organisation that reports data to the MHSDS every month on restrictive interventions in inpatient services.<p></p><p>So, the figures on restrictive interventions within independent sector inpatient services are likely to massively undercount the restraints that people are being subject to - even the two months of spikes will be undercounts as they are missing information from some big independent sector organisations.</p><h3 style="text-align: left;">Summary, and why data matters</h3><p>So, what do I think the MHSDS information tells us about restraints in inpatient services throughout the COVID-19 pandemic (so far)? A few things:</p><p></p><ul style="text-align: left;"><li>Overall, about 9% of people with learning disabilities and autistic people in inpatient services will be subject to an average of 10 restrictive interventions per person in any given month.</li><li>Young adults aged 18-24 are most likely to be subject to restrictive interventions.</li><li>Children and young adults up to 18 years old are moat likely to be subject to multiple restraints.</li><li>Even taking the incompleteness of reporting into account, there is a possible trend towards the increasing use of restrictive interventions over the course of the pandemic.</li><li>Standing, supine, seated and 'other' physical restraints are most commonly reported (at least 150 people are subject to each of these types of physical restraint every month).</li><li>Around 100 people every month are subject to prone restraint.</li><li>An increasing number of physical restraints are being recorded as 'other'.</li><li>Seclusion, oral chemical restraint and rapid tranquilisers are most commonly reported, and possibly increasing over the time period of the pandemic.</li></ul><p></p><p>Why does data matter?</p><p>Accountability - self-advocacy groups are getting together and wanting to use information like this to hold local inpatient services to account. <a href="https://www.mylifemychoice.org.uk/pages/20-don-t-lock-us-away" target="_blank">Please take a look at this open letter</a> from My Life My Choice, Sunderland People First, Speak Up, and Sheffield Voices - you can sign it electronically.</p><p>Visibility - although the MHSDS has been collecting restraints information for some time, it was only made routinely publicly available after <a href="https://www.bbc.co.uk/programmes/m0000mkd" target="_blank">a File on 4 programme</a> reported on restraints information gained through a bitterly contested Freedom of Information process. Without this visibility, any form of scrutiny is much more difficult.</p><p>Proactive regulation - CQC inspections of inpatient services are more frequently rating services as Inadequate, only using information on restraints that do not seem to be reported to the MHSDS (<a href="https://www.cqc.org.uk/location/1-2259383961/inspection-summary#overall" target="_blank">see this recent CQC inspection report on Cygnet Views Matlock</a>). If MHSDS data were complete and regularly reported, inspections could be more proactive rather than reactive.</p><p>The political uses of data. We need completeness of data collection for a level playing field between organisations that comprehensively report restrictive interventions vs those who don't. I really don't understand how major companies can just not report supposedly mandatory data for months and years on end, with seemingly no consequences.</p><p>Policy. It's an obvious point, but if there are national policy ambitions to reduce the use of restraints, you need to have a reasonably complete picture of what people are being subjected to.</p><p><br /></p><p>That's more than enough - words, graphs, and utter grimness of people's lives in the abstracted form of numbers.</p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p><br /></p>Chris Hattonhttp://www.blogger.com/profile/05299821560069281510noreply@blogger.com0