Social care statistics and adults with learning disabilities in England - 2023/24 update

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. Data tables for 2023/2024 (a lot of this involves delving into the CSV databases rather than it being easily available) were released on 31st October. As with my blogpost on this last year, I've just gone for 8 things that jumped out at me rather than a lot of detail and graphs:

1) After several years of continuous increases in the number of adults getting long-term social care up to 2019/20, since then the number of adults with learning disabilities getting social care support has stalled, particularly among younger adults. In 2023/24, 135,205 adults with learning disabilities aged 18-64 got social care support at some point in the year, less than the 135,430 people getting social care support in 2019/20. However, the number of adults with learning disabilities aged 65+ getting social care support has continued to increase, from 17,715 people in 2019/20 to 19,125 people in 2023/24.

2) Using projections about the increasing number of adults likely to need social care support from 2014/15 to 2023/24, there are between 13,000 and 24,000 adults with learning disabilities who need social care support but are not getting it.

3) While the number of adults with learning disabilities aged 18-64 living in residential care and nursing care continues to (slowly) decrease, the number of adults with learning disabilities aged 65+ living in residential care and nursing care has been increasing from 2020/21 to 2023/24. Adults with learning disabilities aged 65+ are now 22% of all adults with learning disabilities in residential care and 47% of all adults with learning disabilities in nursing care.

4) For the first time in 2023/24, over 50,000 adults with learning disabilities aged 18-64 getting social care support were living with family (or friends) on a settled basis (50,110 people) - well over a third (37%) of all working age adults with learning disabilities getting social care support. The number of adults with learning disabilities aged 18-64 getting social care support who were recorded as staying with family/friends on a short term basis (730 people in 2023/24) is smaller but increasing. 

5) Council spending on social care for adults with learning disabilities was £8.1 billion in 2023/24, up  12.1% (not inflation adjusted) from 2022/23.

6) Council spending on social care for adults with learning disabilities is over one third (36%) of all council social care spending on adults.

7) In 2023/24, £583 million in social care spending for adults with learning disabilities was paid for by 'client contributions'. This is an increase of 13.7% from 2022/23 and constitutes 7% of all council social care spending for adults with learning disabilities.

8) Among working age adults with learning disabilities getting council social care, the rate of people in any form of paid employment dropped to 4.7% in 2023/24, a historic low, with the gender employment gap remaining (5.1% for men; 4.1% for women).

New evidence of ethnic inequalities in healthcare among people with learning disabilities - the Health and Care of People with Learning Disabilities dataset 2022/23

As the LeDeR report 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 major review commissioned by the NHS Race and Health Observatory , '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).

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. 'The Health and Care of People with Learning Disabilities' 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.

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.

Of those people where there was ethnicity information:

• 79.9% of people with learning disabilities compared to 74.8% of people without learning disabilities were from a white ethnic group
• 9.8% of people with learning disabilities compared to 13.4% of people without learning disabilities were from an Asian/Asian British ethnic group
• 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
• 2.9% of people with and without learning disabilities were from a 'mixed/multiple' ethnic group
• 1.7% of people with learning disabilities and 3.5% of people without learning disabilities were from an 'other' ethnic group

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 summary table is available in Appendix 2b of the 'We Deserve Better' report).  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.

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.

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:

• 74% of people with learning disabilities from a white ethnic group
• 68% of people with learning disabilities from a Black/African/Caribbean/Black British ethnic group
• 68% of people with learning disabilities from an Asian/Asian British ethnic group
• 64% of people with learning disabilities from a 'mixed/multiple' ethnic group
• 62% of people with learning disabilities from an 'other' ethnic group

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.

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:

• 61% of people with learning disabilities from a white ethnic group
• 46% of people with learning disabilities from an Asian/Asian British ethnic group
• 41% of people with learning disabilities from a 'mixed/multiple' ethnic group
• 38% of people with learning disabilities from an 'other' ethnic group
• 35% of people with learning disabilities from a Black/African/Caribbean/Black British ethnic group

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%).

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 (see this blogpost for details, 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.

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:

• 60% of people with learning disabilities from a 'mixed/multiple' ethnic group
• 38% of people with learning disabilities from a Black/African/Caribbean/Black British ethnic group
• 31% of people with learning disabilities from an Asian/Asian British ethnic group
• 29% of people with learning disabilities from an 'other' ethnic group
• 26% of people with learning disabilities from a white ethnic group

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.

What do the latest statistics say about social care and adults with learning disabilities? 8 key messages (and 0 graphs)

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. Data tables for 2022-2023 were released on 19th October. Rather than inflict my usual graphalanche, here are 8 things that jumped out at me:

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. 

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.

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.

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.

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.

6) Council spending on social care for adults with learning disabilities is almost one third (32%) of all council social care spending.

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.

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).

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. 

Statutory homelessness statistics and people with learning disabilities 2023 - getting even worse

This short blogpost updates a post from just over a year ago, using the latest statistics on statutory homelessness in England, 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) we know relatively little about homelessness among people with learning disabilities in the UK, although it looks like people with learning disabilities (often unrecognised) are more likely to experience homelessness.

To quote this typically lucid report from the House of Commons Library on statutory homelessness in England, "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". 

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.

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.

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. 

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.

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.

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.

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 blog describing the project, which also has links to more in-depth descriptions of the research.

Update 2: David's sent me this link to a must-read, authoritative report 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!

Winterbourne View 12 years on - 2023. Report card 4: leaving inpatient units

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.

The first blogpost looked at statistics on the number of people being admitted to inpatient services, and where they were being admitted from.

The second blogpost looked at how far people were from home and how long they were staying in inpatient services.

The third blogpost looked at planning and reviews for people within inpatient services.

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.

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.

In addition to planned transfer dates, do we know anything about the plans themselves?

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.

  

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.

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?

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.

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?).

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.

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.

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?.

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.

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.

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). Surely the government must see that, after 12 years, something radically different is required?

Winterbourne View 12 years on - 2023. Report card 3: Planning within inpatient units

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.

The first blogpost 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.

The second blogpost looked at how far people were from home and how long they were staying in inpatient services.

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).

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.

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.

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.

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?

Winterbourne View 12 years on - 2023. Report card 2: How far are people from home, for how long?

 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. The first blogpost in this updated series 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 the Assuring Transformation dataset, provided by NHS Digital/NHS England.

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. 

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.

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.

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.

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.

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.

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.