Winterbourne View 15 Years On - 2026: Update on Report card 4: Leaving inpatient units

This blogpost is the final one of four looking at whatever remains of 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 2023.

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, with less focus on preventing people going into inpatient services in the first place (as we've seen, admissions are rising) or what happens to people while they're in inpatient units.

Again, 15 years on from Winterbourne View 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 2026 (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 year on year to March 2026, where the figures look worse than in March 2015. In March 2026 there was no planned transfer date for the vast majority of people in inpatient units (81%), compared to 43% of people in March 2019 and 50% of people in March 2015. In March 2026, only 6% had a planned transfer date within 6 months, compared to 23% of people in March 2019 and 18% of people in March 2015.

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, improved again up to March 2023, and has been drifting downwards ever since. By March 2026 the proportion of planned transfers where the council was aware (57%) was still lower than it was in March 2015 (69%). Of concern is that in March 2026 for 27% of people with a planned transfer it wasn’t known whether the council was aware of the plan or not, again worse than in March 2015 (7%). 

As we've seen from other blogposts in this series, more people with learning disabilities and autistic people are being admitted to inpatient, with some possibly staying for shorter periods in general security wards, while others seem to be in higher security wards for very long periods of time. For both of these groups, is planning carefully for a person leaving to have a fulfilling life beyond the inpatient ward no longer seen as possible or relevant?

  

There are other signs too of an absence 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 2026. Over time, the proportion of plans agreed by anyone and everyone potentially involved has plummeted. Only 16% of plans had been agreed by the person themselves in March 2026, compared to over two thirds of people (69%) in March 2016. Similar drops are reported for the proportion of family/carers (from 60% to 13%) and advocates (from 64% to 15%) agreeing the plans.

The figures for professional groups agreeing transfer/discharge plans are similar. By March 2026, 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 17% in March 2026), a minority of local community support teams in the area the person was supposed to be moving to (from 69% to 16%) and a minority of those commissioners who are reporting the information the graph is based on! (from 83% to 17%). 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 ten yearly blocks, from October 2015 through to September 2026. Some of the details of where people have been 'discharged' to have changed in the AT dataset recently, but it can still consistently be summarised in the broad categories of 'Another hospital' (the red columns), 'Community' (the blue columns) and 'Other' (the purple columns.

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), decreased to 1,875 people in 2021/22 (the COVID-19 pandemic undoubtedly had an impact on the number of people leaving inpatient units), increased slowly to 1,995 people in 2023/24, and jumped to 2,475 people in 2024/25. This increase roughly matches the increased number of admissions we've seen in a previous blogpost.

Of the people who have been 'discharged', 18% (435 people) in 2024/25 were actually transferred straight to another hospital, the biggest percentage of transfers direct to other hospitals since 20% of people in 2018/19. The most common type of place to be discharged to was 'Community' (79% of people in 2024/25; 1,950 people), which in 2024/25 was mainly a person's family home - both in numbers and percentages this has rapidly increased in recent years. Is this a positive trend, or a sign of crisis-driven revolving door admissions and discharges with little planning or support?

Where did everyone else go? In 2024/25, there were also another 90 people (4%) who moved to an ‘other’ location - these numbers and percentages have been steadily reducing over time.

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). Years of failing to get to grips with the fundamental problems has seemingly led to policymakers more or less giving up on their early ambitions after Winterbourne View. Over time there is more churn of people with learning disabilities and autistic people into, out of, and around within the hospital system, within a context of poorer support for people in distress outside hospitals. Is this success?

Winterbourne View 15 Years On - 2026: Update on 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 2023 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. Care planning within inpatient units and various types of review have been a regular policy lever that NHS England have tried to pull, although rigorous evidence for their success or otherwise has not yet been completed.

Care plans

In 2022, the information collected about care plans for people in inpatient units changed. Information about care plans from March 2015 to March 2021 is in the graph below. By March 2021, just over a quarter of people (26%) were recorded as not needing inpatient services, with almost all of these recorded as working towards discharge. More people (40%) were recorded as needing inpatient services and having an active treatment plan, and a third of people (33%) recorded as needing inpatient services and not dischargeable. Over time, there had been drifts downward in people recorded as being dischargeable and drifts upwards in people recorded as not dischargeable.

From March 2022 onwards, the recorded categories have changed, but the trends over time seen up to 2021 have speeded up. By March 2026, over two thirds of people (68%) were recorded as having an active treatment plan but without a discharge plan in place. Only 9% of people in March 2026 were recorded as clinically ready for discharge (this category seemed to replace the delayed transfer of care category in 2025, which dropped from 11% to 0% in a year) - are there now no more delayed transfers of care out of inpatient units?

Reviews

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 2026. The graph generally shows that things seem to improve at times when there was more government/NHS England attention or pressure, but without that pressure reviews begin to drift again. We seem to be in a phase where more reviews are happening more quickly for some people, while other people are waiting longer for reviews or reviews are not even scheduled.

For example, in March 2026 almost a quarter of people (23%) had had a review in the last 4 weeks, and a further 20% of people had had a review in the last 4-8 weeks, a big improvement from what seems like a bit of a low point in March 2022. It was also the case that in March 2026 14% of people had last had a review 26-52 weeks ago, a further 14% of people had last had a review over a year ago, and for 10% of people there was no review date scheduled, All these figures have worsened over the last few years.

This might reflect the pattern we've seen in the first two blogposts, where more people with learning disabilities and autistic people are being admitted to inpatient units. with many people potentially in inpatient units for shorter periods of time (with the potential for a revolving door). At the same time, there seems to be a group of people with learning disabilities and autistic people who have been in inpatient units for very long periods of time, and for whom reviews might be happening less frequently or not at all. 

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 2026. 

While the majority of people have had a C(E)TR at some point (83%), there seems to be a consistent draft away from people in inpatient units having regular C(E)TRs in the last five years, including people not having had a C(E)TR at all, from 5% of people in March 2021 to 17% of people in March 2026.

The graph below shows when people are next scheduled to have a C(E)TR. There is a similar worsening picture over the last years, with the percentage of people with no scheduled C(E)TR increasing from 4% of people in March 2021 to 29% of people in March 2026 and the times of scheduled C(E)TRs drifting longer in all categories.

Extra information relatively recently added to the Assuring Transformation dataset shows that in March 2026 there were 230 admissions to inpatient units of people with learning disabilities and autistic people, 170 new admissions and 60 transfers from another hospital. Of these, a C(E)TR or a Local Area Emergency Protocol (LAEP) was completed for only 40 (17%) of these admissions.

Commissioners of these services are also supposed to be doing regular 'oversight visits'. For children (aged under 18) who had been in an inpatient unit for at least six weeks, in March 2026 more than half of them (56%) had had an oversight visit in the last six weeks and a further 37% of children had had an oversight visit more than six weeks ago, leaving 22% of children without an oversight visit so far.

Similar figures are available for adults in inpatient units. For adults who had been in an inpatient unit for at least eight weeks (I don't know why an extra two weeks is added for adults compared to children), over a third (37%) had had an oversight visit in the last eight weeks and a further 53% had had an oversight visit more than eight weeks ago, leaving 9% of adults without an oversight visit so far.

In terms of scrutiny and support, in March 2026 30% of people with learning disabilities and autistic people in inpatient units did not have either an Independent Mental Health Advocate (IMHA) or an Independent Mental Capacity Advocate (IMCA). The percentage of people without an IMHA or an IMCA had increased from 20% in March 2022.

Overall there are signs that people with learning disabilities and autistic people are less likely to be having regular reviews or to have an independent advocate, while their care plans are indicating people aren't getting out any time soon. 

Winterbourne View 15 Years On - 2026: Update on 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 2023. 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 England/DHSC.

How far are people from home?

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 2026 (no data were published for May 2021). 

The graph firstly shows that for substantial numbers of people (17% of people in May 2026), their distance from home is still recorded as 'unknown'. Over time, the number of 'unknowns' has got worse then slightly better, although the percentage of 'unknowns' was higher in 2026 than it was in 2017. This makes interpreting other apparent changes over time difficult, as we don't know how far these extra 'unknown' people are from home. 

It's probably fair to say that the percentage of people in inpatient units less than 10km from home has increased over time, from 16% of people in May 2017 to 27% of people in May 2026. However, even by May 2026, a quarter (24%) of people were reported to be in inpatient units more than 50km from their home, a figure that has stayed fairly static from May 2022. 

Just looking at information for March 2026, people in inpatient units further from home were more likely to have been in those inpatient units for longer.

How long are people in inpatient units?

A consistent policy aim of Transforming Care/Building The Right Support has been to reduce the length of time that people spend in inpatient units. The graph below shows how long people have been with their 'current provider' according to Assuring Transformation statistics, from March 2015 through to March 2026. There has been a slight change of wording in the Assuring Transformation spreadsheet here, from 'current unit' to 'current provider' - I'm not sure if this means exactly the same thing or if a person could be moved around within the same provider and be counted here. 

There are very gradual trends towards a greater proportion of people being in their current inpatient unit for shorter lengths of time from 2015 to 2026. For example, in March 2026 22% of people had been with their current provider for 3 months or less, compared to 15% of people in March 2015. This might reflect the greater number of admissions to inpatient units we saw in the first blogpost. However, there are still substantial percentages of people who have been with their current service provider for long periods of time - in March 2026 12% of people had been with their current service provider for 5 years or longer, a percentage little changed for at least half a decade.

As we've seen in the previous post, 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 with their current provider). The graph below shows this information from March 2015 to March 2026. 

The impact of people being transferred around can be clearly seen. The percentages of people in inpatient units for shorter periods has gradually increased over time. For example, the percentage of people in inpatient units for less than 6 months increased from 14% in March 2015 to 27% in March 2026. There have also been recent improvements in the percentage of people continuously in inpatient units for very long periods of time, although in March 2026, 29% of people had still been continuously in inpatient services for 5 years or longer.

Looking at information just for March 2026, people were likely to have been in inpatient units for two years or more if their legal status was MHA Part III (without restrictions, and particularly with restrictions), and more likely to have been in inpatient units for two years or shorter if their legal status was Part II or 'informal'.

Similarly, in March 2026 people in low secure, medium secure or high secure inpatient units were more likely to have been in inpatient units for two years or longer, and more likely to have been in inpatient units with a general level of security for two years or shorter.

Finally, Assuring Transformation also reports the average length of time that people have been with their current provider, and continuously in inpatient services. The graph below shows that in March 2026 people had been on average with their current provider for just over 2 years, with some recent improvement from March 2023. The total length of time people have been continuously in inpatient services showed a recent reduction from March 2022 to March 2026 but still stands at an average of 4 and a half years years.

What does this mean? First, despite some signs of gradual improvements over time, 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 almost a quarter of people are more than 50km from home and this information simply not being reported for one in six people. 

The information on how long people are staying in inpatient units, while gradually improving, reflects both the continuing ‘churn’ of people between inpatient units without seeing the outside world, and the possibility of a pattern of people experiencing a revolving door between their homes and inpatient units that might be suggested by the increasing number of admissions reported in the first blogpost.

In the next blogpost in this series, I will look at what Assuring Transformation tells us about reviews and planning when people are in inpatient units.

Winterbourne View 15 Years On - 2026: Update on Report card 1: People being admitted to inpatient units, legal status and ward security

It has been three years since I last updated a series of 'report card' blogposts about what official monthly statistics published by NHS Digital/NHS England/DHSC say about autistic people and people with learning disabilities in inpatient units. The revelation of horrendous abuse at an inpatient unit, Winterbourne View, was 15 years ago now, and a lot of ink has been spilled on various policy 'initiatives' (Transforming Care, Building The Right Support and the rest) which seem to have recently fizzled out in the absence of triumphal success. The purpose of this update is 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), and if any changes have been sustained as the focus of policy attention has moved elsewhere.

These blogposts will focus on information produced publicly by NHS Digital/NHS England from the 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 2026. 

As with the previous series, these four blogposts will focus on:

• Who is going into inpatient services?
• How far are people from home, and how long are people spending in inpatient services?
• What planning and review is happening in inpatient services?
• What is happening about people leaving inpatient services, and where are they going?

Using a different dataset, there is also a recent blogpost on what the statistics say about people with learning disabilities and autistic people being subject to restraints in inpatient services.

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. 

Before I talk about what the statistics tell us about admissions, I'll give a brief sketch of what the statistics say about who is in hospital inpatient units. This is in the terms of what statistics are collected, so they give a far from complete or rounded picture of the people involved.

In terms of gender, in March 2026 30% of people with learning disabilities or autistic people in inpatient units were female (including trans women), 47% were male (including trans men) and 1% were non-binary - information on gender was not coded for 21% of people. For 3% of people (60 people), their gender identity is not the same as the gender assigned them at birth - how well trans people are being supported in inpatient units is unknown. The coding of gender in March 2016 was more restrictive, and reported that 24% of people with learning disabilities and autistic people were female and 76% were male.

In terms of age, in March 2026 10% of people with learning disabilities or autistic people in inpatient units (230 people) were children and young people under the age of 18, a percentage that has hovered around this level since 2017. Almost a quarter of people in inpatient units in March 2026 were young adults aged 18-24 (22%; 435 people), with 30% of people (665 people) aged 25-34 and 20% of people (445 people) aged 45-54. Fewer people (17% in March 2026; 385 people) were aged 45 or above, a decrease from 25% of people in March 2016.

Recorded ethnicity has been fairly consistent over time, although the ethnicity of around 10% of people is consistently recorded as not known. In March 2026 the ethnicity of 75% of people with learning disabilities and autistic people in inpatient units was recorded as 'White', 6% of people were recorded as 'Black or Black British', 4% of people were recorded as 'Asian or Asian British', 3% of people were recorded as 'Mixed', and 1% of people were recorded as 'Other ethnic group'.

Throughout the collection of this data, people in inpatient units have been categorised into three very broad groups: Learning disability (only); Autism (only); and Learning disability and autism. The percentage recorded across these categories has changed hugely in a decade. In March 2026, 26% of people were recorded in the Learning disability (only) category, down from 54% of people in March 2016. In March 2026, 58% of people were recorded in the Autism (only) category, up from 22% of people in March 2016. Finally, in March 2026 16% were recorded in the Learning disability and autism category, down from 23% of people in March 2016. It might be worth mentioning that 11% of people in inpatient units acquired a 'diagnosis' of autism AFTER they had been admitted to the inpatient unit.

Admissions

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 ten 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.

 

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. From then the number of admissions has risen every year, reaching 2,240 admissions in 2024/25, which is pretty much as high as it's ever been in this dataset. In total, there have been 19,250 admissions to these inpatient units in the last ten years - we don't know how many of these are the same people being admitted more than once or different people being admitted.

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 almost 20% of all admissions. The third thing I want to mention is that another 20% of 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 (62% in 2024/25) are people who have not been in an inpatient unit for at least a year (or maybe never).

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 nine one-year blocks (starting in October 2016, through to September 2025). In 2024/25, almost half of people (47%) were admitted from their ‘usual place of residence’ and almost all the rest (49%) were admitted from other inpatient and/or hospital services (more or less equally split between mental health/learning disability inpatient wards and general or A&E wards in general hospitals). 

It seems clear to me that policy wheezes designed to reduce the chances of people being admitted to inpatient services are not working within a general context of ongoing austerity and fragile community mental health and learning disability support, showing up in increased admissions, including admissions from general hospitals, and 20% of admissions being people who had been in a similar inpatient unit less than a year before. In March 2026, just 22% of people in inpatient units were on a 'dynamic support/risk register' designed to identify and support people at potential risk of going into an inpatient unit.

 

Legal status and ward security

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. 

The graph below shows the number of people in inpatient units at the end of March each year from 2016 to 2026, broken down by the legal status of people in inpatient units according to Assuring Transformation data.

The most common legal status for people in inpatient units is a Part II section, where the number of people dropped from March 2016 to March 2021, but has since increased again to 1,265 people in March 2026. This has almost returned to March 2016 levels, with an overall decrease of only 5% from 2016 to 2026. Overall, people on Part II sections in March 2026 now constitute well over half (57%) of people with learning disabilities and autistic people in inpatient units, compared to less than half (47%) of people just ten years earlier in 2016.

The next most common legal status is a Part III section with restrictions, where the number of people has fairly consistently dropped from March 2016 to 535 people in March 2026, a reduction of 26% over the time period. 

Less common are people with Part III sections without restrictions (which dropped by 49% from 2016 to 205 people in March 2026), people not subject to the Mental Health Act (which dropped by 38% from 2016 to 200 people in March 2026), and people in other sections (which dropped by 75% from 2016 to 10 people in March 2026). 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 2026.

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 only 3% from March 2016 to March 2026. In March 2026, over half of people with learning disabilities and autistic people in inpatient units are in units with a 'general' level of ward security (1,295 people; 58%), compared to less than half of people (47%) ten years before, in March 2026.

The next most common level of ward security is 'low secure', where the number of people dropped by 49% from 2016 to 430 people in March 2026. 

The number of people in medium secure inpatient units dropped by 36% from 2016 to 335 people in March 2026, with smaller numbers of people recorded in high secure units (75 people) and Psychiatric Intensive Care Units (95 people - an increase of 90% from 2016).

Clearly, reducing the number of people in inpatient units has not excluded people in units with higher levels of security.

Looking at these figures over a decade now, it looks like the overall slight reduction in the number of people with learning disabilities and autistic people in inpatient units stalled during the Covid-19 pandemic and has stayed pretty static ever since. Meanwhile, apart from a dip in admissions during Covid, the number of admissions to inpatient units continue to rise every year. People are being shunted around inpatient units, going through what looks like a revolving door in and out of inpatient units, and aren't getting the support they need where they live so that an inpatient unit wouldn't be seen as an option. Policy wheezes like C(E)TRs before admission and dynamic risk registers are clearly ineffectual in the face of 15 years of austerity and counting, the consequences of the Covid-19 pandemic, and a lack of attention to and investment in both social care and community mental health support that people with learning disabilities and autistic people can make use of.

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.

Restraints used on people with learning disabilities and autistic people in inpatient units - what do seven years of statistics tell us?

Before I start, a quick warning. Most of my blogposts these days run through official statistics to try and build a picture of what's happening for (to?) people with learning disabilities. Through the distancing veil of numbers and graphs, this picture is usually quite upsetting. I found putting together the graphs for this blogpost more upsetting than any I've done recently - just thought I'd let you know this in advance when you're deciding whether to read it or not.

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 since this information became publicly available around 7 years ago. I haven't looked properly at this information for the best part of five years, and the picture, in becoming more comprehensive, has become even more grim.

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. NHS England/DHSC extracts the information specifically related to people with learning disabilities and autistic people in any mental health inpatient service every month, including both the 'specialist' inpatient services that were largely the focus of Transforming Care/Building The Right Support, and general mental health inpatient services. Providing information for the MHSDS is mandatory for NHS funded service providers, including independent sector providers. The number of people with learning disabilities and autistic people in inpatient services according to the MHSDS is much higher than the number of people recorded in the Assuring Transformation dataset, which the government prefers to use when quoting how well it's doing.

There are going to be a lot of graphs. When going through them, I think there are at least three big things that have had an impact on the number of restraints reported in these mandatory statistics:

1) The Covid-19 pandemic. For reasons that will become clear later, it's hard to be completely confident in trends over time in the restraints data, but it looks like during the Covid-19 pandemic (at its peak in 2020-2021) there were fewer people being admitted to inpatient units and those people who were there were more likely to be subject to some types of restraint.

2) In 2022 and 2023, a reported cyber attack had an impact on the quantity and quality of data reported in the MHSDS, with some national information not reported for around a year. This means there are some gaps in what is reported, and some of the numbers might be less reliable than usual.

3) The completeness of reporting. When I first started looking at this information in 2020 and 2021, it was clear that many big inpatient service providers (including some very big independent sector inpatient providers) were routinely not reporting any restraints at all. The Mental Health Units (Use of Force) Act 2018 was passed into law in 2018 to improve this state of affairs, but statutory guidance from DHSC was not issued until December 2021. This means that, if reporting becomes more comprehensive, we should see this reflected in the restraint statistics. 

How many people with learning disabilities and autistic people are in inpatient services?

For pretty much all the graphs in this blogpost, I'll be sharing information from the MHSDS for every six months over a seven-year period, from March 2019 to March 2026. The first graph below shows information on the number of people with learning disabilities and autistic people in inpatient services at the end of the month in question, divided into people in independent sector services (the light blue line), NHS services (the dark blue line), and finally the total number of people in inpatient services (the black line).

The numbers here (typically 3,500-4,000 people) are much higher than those reported retrospectively by commissioners in the Assuring Transformation dataset (typically 2,000-2,500 people), possibly because the MHSDS is much better at identifying those flagged as a person with learning disabilities or an autistic person across the whole range of mental health inpatient services.

As I mentioned above, there seems to be a slight dip during the peak of the Covid-19 pandemic, then there is a year (where there is a gap in the black line) where the cyber attack makes the numbers a little unreliable. The introduction of the 2021 statutory guidance for the Mental Health Units (Use of Force) Act (2018) should not have an impact on the reporting of the number of people in inpatient services. However, there does seem to be a recent trend upwards in the number of people with learning disabilities and autistic people in both independent sector and NHS inpatient units, possibly partly due to the gradual demise of Transforming Care/Building The Right Support policy attention. At the end of March 2024 there were 3,540 people in inpatient units, rising to 3,930 people at the end of March 2026. This increase is in both independent sector inpatient services (from 1,070 people to 1,220 people) and in NHS inpatient services (from 2,425 people to 2,645 people).

What does the MHSDS say about restrictive interventions?

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.

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 that month, from March 2019 to March 2026. The figures for the total number of people subject to restrictive interventions (the black line) is again broken down into independent sector inpatient services (the light blue line) and NHS inpatient services (the dark blue line). 

During the Covid-19 pandemic, the number of people subject to restrictive interventions was reported by independent sector services to have dipped, while there was an increase reported in NHS inpatient services. Was this a 'real' difference, or were independent sector services less likely to be reporting restrictive interventions to the MHSDS than NHS services?

A clue to answering this question is in what happened to reported numbers of people subject to restrictive interventions in relation to the statutory guidance for the Mental Health Units (Use of Force) Act, issued in December 2021. The graph below shows that from September 2021 to September 2022 there were big increases reported by independent sector services but not by NHS services. The cyber attack in 2022-23 makes interpretation over time difficult, but there are clear upward trends over the last few years in the number of people subject to restrictive interventions in both independent sector and NHS inpatient services.

By March 2026, within that one month 855 people with learning disabilities or autistic people in inpatient services were subject to at least one restrictive intervention - 250 people in independent sector inpatient services and 580 people in NHS inpatient services.

Because the number of people reported to be 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. The graph below shows these percentages for people in independent sector services, people in NHS services, and everyone combined. Even given patchy reporting (the change in the percentage of people reported to be subject to restrictive interventions in independent sector inpatient services increased by over 500% in a year from September 2021 to September 2022, with the introduction of the statutory guidance) and patchy data due to cyber attacks, the overall trend is clearly upwards. What looked like a discrepancy between the independent sector and the NHS early on seems highly likely to be a function of incomplete reporting by independent sector providers, with recent data being similar for both sectors.

I just want to take a moment to reflect on what this graph is saying - in the month of March 2026, 21.8% (more than 1 in 5) of people with learning disabilities and autistic people in an inpatient service were subject to restraint at least once.

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 broken down by whether people are in independent sector or NHS inpatient services.

We've seen from the graphs above that the number of people in inpatient units has started to gradually increase, and the number of people reported as subject to restraints has increased over time (partly due to more comprehensive reporting), so the percentage of people in inpatient units reported as subject to restraints has also increased sharply over time, now standing at over 20% of people. 

The next graph below in some ways shows a similar picture - changes during the Covid-19 pandemic (a reported decrease in the independent sector, a reported increase in the NHS), a big increase reported in the independent sector with the introduction of the statutory guidance, and a general trend of continuing increases more recently. What is different is that despite having smaller numbers of people in their inpatient services and smaller numbers of people reported as subject to restraint, the total number of restrictive interventions reported by independent sector inpatient services is beginning to match those reported by NHS inpatient services.

What does this mean for a person being subject to restraint? The graph shows the average number of restrictive interventions in that month for every person that was subject to at least one. There are different trends over time for people in NHS services compared to people in independent sector services. 

In NHS inpatient services, there was a peak in the Covid-19 pandemic where people who were subject to at least one restraint were restrained on average nearly 13 times in the month - approaching once every 2 days. From this point, the average number of restraints per person for people in NHS inpatient services has reduced to between 7 and 8 times per month (still around once every 4 days).

The trend in independent sector inpatient services is the opposite. There was also an increase during the Covid-19 pandemic, but the average number of restrictive interventions per person subject to at least one has continued to increase ever since. In March 2026, a person subject to at least one restrictive intervention was on average restrained 14.2 times in that month - approaching once every 2 days.

What restrictive interventions are people subject to?

What do the statistics tell us about which types of restraint people with learning disabilities and autistic people in inpatient units have been subject to over the past seven years? The MHSDS records a lot of different types of restraint - for this blogpost I've grouped them into three sets of graphs:

1) Three forms of restraint which have been the subject of specific policy and legal attention: prone physical restraint, seclusion and segregation.

2) Various types of chemical restraint, and also mechanical restraint.

3) Various types of physical restraint (to help interpretation, I've included prone restraint in this as well as in the first set of graphs).

For each of these groups of restraints, there are two graphs; one about the number of people being subject to these types of restraint, and one about the number of instances of these types of restraint being used. With all of these graphs, the comprehensiveness of reporting really matters, so it is difficult to know the extent to which any increases over time are about more people in inpatient services, better reporting, or more people being subject to more restraints.

Prone physical restraint, seclusion and segregation

Prone physical restraint has been the subject of much policy and practice attention, with the intention of prone restraint no longer being used in inpatient services. The graphs below show that, with some fluctuations, the trend is very gradually downwards (the purple lines), although in March 2026, 65 people were still subject to 150 instances of prone physical restraint.

Seclusion and segregation have both been described as forms of solitary confinement, again with policy aims of reducing these to as near to zero as possible. If anything, the graphs report increases over time in both seclusion and segregation. Although interpreting changes over time is difficult, we can say that the current picture is grim. In March 2026, 170 people were subject to 340 instances of seclusion (the grey lines); and 65 people were subject to 95 instances of segregation (the red lines). The huge increases in the number of people reported to be subject to segregation with the introduction of the statutory guidance in 2022-23 shows just how many people were being hidden from official statistics.

Chemical restraints and mechanical restraint

The two graphs below use the same format for specific types of chemical restraint and for mechanical restraint. 

Restraint using rapid tranquiliser injections (the orange lines) are the most commonly used form of chemical restraint. Apart from a sharp jump during the Covid-19 pandemic and an apparent dip in 2022/23, the number of people subject to rapid tranquiliser injections is reported to have increased over time, reaching 120 people experiencing 410 rapid tranquiliser injections in March 2026.

Oral chemical restraint (the yellow lines) is also common. Again, there was a sharp jump in the reported use of oral chemical restraint during the Covid-19 pandemic, and fluctuating levels of oral chemical restraint reported ever since. In March 2026, 75 people were reported to have been subject to 180 instances of oral chemical restraint.

The number of people reported to have been subject to mechanical restraint (the light blue lines) seems to have gradually reduced over time (to 10 people in March 2026), with the number of instances of mechanical restraint generally fluctuating between 50 and 80 instances per month, but dropping to 20 in the month of March 2026.

Physical restraint

The graphs below report the same type of information for various types of physical restraint (including prone restraint). It's worth noticing here that vertical scales on these graphs are different to the previous two sets of graphs, as so many people are subject to so many instances of particular types of physical restraint. With the exception of prone restraint, pretty much all types of physical restraint are reported to have increased in the last seven years.

By March 2026, by far the most common form of physical restraint is standing restraint (the orange lines), exercised on 495 people a reported 2,315 times. Seated physical restraint (the purple lines) was experienced 1,860 times by 260 people in the month of March 2026. Also common are supine physical restraint (the lilac lines), experienced by 205 people on 825 occasions in March 2026, and restrictive escort (the yellow lines), experienced by 155 people on 465 occasions in March 2026. Despite apparent improvements in reporting over time, in March 2026 there were still 175 people experiencing 875 instances of 'other' physical restraint (the grey lines).

Summary

So, what do I think the MHSDS information tells us about restraints being used on people with learning disabilities and autistic people in inpatient services over the last seven years? A few things:

• There has to be a real lack of confidence in the comprehensiveness of the data on restraints being reported by inpatient services - this really hampers any interpretation of reported changes over time or differences between NHS and independent sector organisations. Clearly the belated implementation of the Use of Force Act (2018) has resulted in a big improvement in the comprehensiveness of the data provided, but we still have no way of knowing how complete the information is.
• Whether due to better reporting, changes over time, or a combination of both, the picture for people with learning disabilities and autistic people in inpatient services with regard to restraints is grim, and if anything getting worse rather than better.
• Overall, over 20% 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. That's over 850 people being subject to a restrictive intervention roughly once every three days.
• With more comprehensive reporting, it seems that NHS inpatient services and independent sector inpatient services are similar in the percentage of people being subject to restraint, but independent sector inpatient services on average restrain people more often (14 times in a month) than NHS inpatient services (8 times in a month).
• Standing, seated, supine, restrictive escort and 'other' physical restraints are most commonly reported (at least 150 people are subject to each of these types of physical restraint every month), and possibly increasing over time.
• Policy statements about reducing levels of prone restraint, seclusion and segregation are not working. Although the number of people reported to be subject to prone restraint has gradually reduced over time, around 65 people every month are still subject to prone restraint. The trends for seclusion (170 people) and segregation (65 people) suggest increases rather than decreases over time.
• Injected rapid tranquilisers and oral chemical restraint are the most commonly reported forms of chemical restraint, with the use of injected rapid tranquilisers (120 people in March 2026) possibly increasing over time.

This is such a grim, grim picture. What chance do people have in services with long-standing cultures of restraint, combined with support for people all over falling apart, crisis-driven and inadequately funded mental health services, and policy attention that studiously avoids focusing on what matters?

Children with learning disabilities in schools - 2026 update

This blogpost updates previous blogposts I've written about Department for Education annual statistics 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.

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). 

From 2024/25, an additional mutually exclusive category of Down syndrome has been added, related to the Down Syndrome Act (2022). I highly recommend this column by Sharon Smith in Special Needs Jungle which clearly explains the context of the Act, and the potential implications of adding this new category to the SEN statistics.

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).

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. While the categories of MLD, SLD and PMLD can be both primary and secondary needs, it appears from my reading of the statistics so far that Down syndrome has only been used as a primary need.

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 Education, Health and Care (EHC) plan (previously an SEN Statement). 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.

This blogpost simply 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. 

The first question is simply – how many children and young people with learning disabilities are recorded in DfE statistics?

The first graph below shows the number of children with a statement/EHC plan with a ‘primary SEN need’ of MLD, SLD and PMLD (and, from 2025, Down syndrome), from 2010 to 2026 (apologies for the acronyms).

The graph shows that in 2026, over 78,000 children in England had a statement/EHC plan and were identified as children with learning disabilities in one of these four categories. 

Interpreting change over time in very recent years is complicated by the addition of Down syndrome as a category of primary need in 2025, as presumably many of these children would have previously been placed in the MLD, SLD or PMLD primary need categories. It is also highly likely that this new category of primary need will take some time to bed in, so it is possible that the seeming numbers of children with Down syndrome will continue to increase quite sharply in these statistics for a while as children are recategorised.

For children with MLD there were 35,475 children in 2026, with a large decrease of 31% from 2010 to 2018 but an increase of 25% from 2018 to 2026 - the number of children in 2026 is still substantially less than the number of children in 2010. 

In 2026, there were 31,246 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 with numbers staying static from 2021 to 2026.

In 2026 there were 9,339 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 and a possible small decrease since.

It is early days for statistics concerning children with a primary need of Down syndrome, but in 2026 there there 2,242 children with a statement/EHCP and a primary need of Down syndrome.

 

The second graph below shows the number of children with a ‘primary SEN need’ of MLD, SLD and PMLD (and, from 2025, Down syndrome) at the level of SEN Support, from 2015 to 2026 (the reporting of statistics changed in 2015).

The graph shows that in 2026, 164,294 children in England were identified as children with learning disabilities at the level of SEN Support. For children with MLD this was 161,933 children in 2026, with a 16% increase from 2015 to 2016 and a 34% decrease from 2016 through to 2026.

In 2026, there were 1,592 children with a primary need of SLD at the level of SEN Support, with numbers increasing by 5% from 2015 to 2016 and decreasing by 52% from 2016 to 2026. 

In 2026 there were 503 children at the level of SEN Support with a primary need of PMLD, with an 11% increase from 2015 to 2018 and a 50% decrease from 2018 to 2026.

Finally, in 2026 there were 266 children at the level of SEN Support with a primary need of Down syndrome.

How many children with learning disabilities are being educated in mainstream schools or special schools? The graph below shows the percentage of children with statements/EHCPs in mainstream vs special schools from 2010 to 2026.

The percentage of children with a primary need of MLD and a statement/EHC plan in mainstream school dipped from 51% in 2010 to 43% in 2017, with the percentage increasing again to 63% in 2026, it's highest since statistics in this dataset began in 2010. 

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 2018, and has stayed static from 2018 to 2026. 

For children with a statement/EHC plan and a primary need of PMLD, the percentage of children in mainstream school was around 14% from 2010 to 2016, 15% from 2017 to 2020, and 16% from 2021 to 2025, reducing again to 15% in 2026.

For children with a statement/EHC plan and a primary need of Down syndrome, the percentage of children in mainstream school was 64% in 2026.

For children identified at the level of SEN Support (I haven’t included a graph on this), in 2026 almost all the children with a primary need of MLD (99.7%), the vast majority of children with a primary need of SLD (91.7%), and substantial majorities of children with a primary need of PMLD (76.5%) or Down syndrome (83.5%) were in mainstream schools.

How many children are eligible for free school meals? 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. PMLD and Down syndrome (from 2025) and the proportion of children at the level of SEN Support eligible for free school meals, from 2016 to 2026. There are a number of trends in this graph:

1) There are big increases over time in the percentage of children eligible for free schools across MLD, SLD and PMLD groups in the graph

2) A greater percentage of children with a statement/EHCP are eligible for free school meals compared to children with the same label at the level of SEN Support

3) Children with a label of MLD are most likely to be eligible for free school meals, followed by children with a label of SLD, then children with a label of PMLD, and finally children with a label of Down syndrome.

In 2026, 53% of children with a label of MLD and a statement/EHCP were eligible for free school meals (48% for children with MLD at the level of SEN Support). 49% of children with a label of SLD and a statement/EHCP were eligible for free school meals (43% for children with SLD at the level of SEN Support). 42% of children with a label of PMLD and a statement/EHCP were eligible for free school meals (33% of children with PMLD at the level of SEN Support). Finally, 29% of children with a label of Down syndrome and a statement/EHCP were eligible for free school meals (18% for children with Down syndrome at the level of SEN support.

These figures compare to 27% of all children on the school rolls being eligible for free school meals in 2026 - the graph below shows this for 2026.

At what age are children with learning disabilities identified in schools? The graph below shows how many children for every 1,000 total children in school had a statement/EHCP at each age from age 5 to age 15 in 2026. 

For children with MLD, there were big increases in the number of children with a statement/EHCP through the later ages of primary school and into the early years of secondary school, with slight decreases beyond this point.

For children with SLD, there was a steady increase in the number of children with a statement/EHCP through the school years.

For children with PMLD and children with Down syndrome, the highest numbers of children with a statement/EHCP were in the earlier years of primary school, with slight decreases beyond this point.

I'm not in a position to offer a deep interpretation of these numbers, but I hope it is useful to see them set out like this. As Sharon Smith says in her column, the implications of the introduction of a new Down syndrome category of primary need are as yet unclear, and it is unclear whether using Down syndrome as a primary care need is more meaningful than existing categories in terms of working out what education and support would be most helpful for the child and their family (there are similar questions about the usefulness of the category of Moderate Learning Difficulty).

A very rough handle on the diversity of educational and support needs children with Down syndrome can be gained by looking at children's secondary needs. I'm not totally convinced by the quality of the data when it comes to the categorisation of primary and secondary needs. For example, in 2026 there were 40 children with a primary need of MLD recorded as having a secondary need of PMLD, which in my naivety seems unlikely. But the range of secondary needs recorded for the 2,242 children with a primary need of Down syndrome in 2026 is very broad. In descending order, they were: Speech, language and communication (395 children); severe learning difficulty (142 children); moderate learning difficulty (133 children); specific learning difficulty (108 children); hearing impairment (82 children); autistic spectrum disorder (62 children); physical disability (50 children): other difficulty or disability (44 children); profound and multiple learning difficulty (28 children); vision impairment (23 children); multi-sensory impairment (12 children); and social, emotional and mental health (11 children). 

In summary, I'm not seeing a massive and sustained increase in the number of children with the labels of MLD, SLD and PMLD, certainly taking 2010 as the baseline.  If anything, recent years suggest that the number of children with these labels being supported with an EHCP is flatlining, and the number of children in these categories is relatively small compared to the most common primary needs recorded, including autistic spectrum disorder (165,399 children in 2026); speech, language and communication needs (108,936 children); and social, emotional and mental health (83,339 children).

On the long view from 2010, there may be some signs of changes in the proportion of children with these labels in mainstream schools, with the proportion of children with MLD in mainstream schools increasing and the proportion of children with SLD and PMLD in mainstream schools gradually beginning to decrease. Poverty amongst children with the labels of MLD, SLD and PMLD is continuing to increase year on year, and to much higher levels than the overall figure for all children on the school rolls.

We have had only two years of statistics using the category of Down syndrome, so it is too soon to report any trends over time for this group. Children with Down syndrome, together with children with MLD, are more likely to be in mainstream schools compared to children with SLD or PMLD. Eligibility for free school meals is at a similar level for children with Down syndrome compared to all children on the school rolls, and is lower compared to children with a primary need of MLD, SLD and PMLD. These broad-brush statistics give little indication that legislation specifically focused on people with Down syndrome is required.

What all of these statistics miss is children who are not in school, for any number of reasons. Without having some understanding of this, we only have a partial picture of children with learning disabilities in England.