Plastical

For the first week of the #7daysofaction campaign, in April this year, I wrote a series of short blogposts going through some of the statistics about people with learning disabilities in inpatient services in England. For this week’s #7daysofaction you’ll be relieved to know that I’m not going to churn out as many posts (the national position hasn’t changed hugely since April). Instead I want to take a bit of a longer view about where we are – in this post compared to just before the Winterbourne View Panorama programme, and then in other posts looking back 40 years or even longer.

Image from Michael Bernard Loggins (2007). Imagionality: Michael’s lovable fun of dictionaries. Manic D Press: San Francisco.

In this post I’m trying to get a handle on how specialist inpatient services for people with learning disabilities have changed (or not) in the time since the Panorama programme on Winterbourne View went out. Obviously since then there has been a major government and NHS England focus on reducing the number of people in inpatient services. Disappointment has also been expressed about the rate of progress, and more recently worries about the possible re-badging of inpatient services as something else and new services being set up that look a lot like inpatient services.

The Care Quality Commission (CQC) regularly updates a complete directory of the care services it has registered, which is available online. With the help of the CQC, I found their care directory updated on the 9^th May 2011, just before the Winterbourne View programme went out. I also looked at a recently updated care directory for 1 August 2016, to see what had happened over the time period of the Transforming Care programme.

The CQC care directory allows you to apply filters to find the particular kinds of services you’re interested in. I applied the following filters to find services registered as specialist hospital inpatient services for people with learning disabilities:

• Service user band: Learning disabilities or autistic spectrum disorder
• Service type: Hospital services for people with mental health needs, learning disabilities and problems with substance abuse
• Organisation type: Independent health organisation OR NHS health organisation

On 9 May 2011, I found 91 different independent healthcare services fitting these filters, at 83 different postcodes (some organisations had more than one service registered at the same geographical location). These services were being run by 32 different independent healthcare organisations. On the same date, there were 195 NHS healthcare services fitting these filters, at 187 different postcodes, being run by 69 different NHS Trusts. Overall there were inpatient services at 270 different postcodes.

By 1 August 2016, after almost 5 years of the Transforming Care programme, what services fitted the same set of filters? The number of independent sector inpatient services had slightly increased to 97 services at 95 different postcodes, run by an almost unchanged number (31) of independent healthcare organisations. The number of NHS inpatient services had decreased to 176 different services at 174 postcodes, being run by a smaller number (55) of NHS Trusts. Overall there were inpatient services at 269 different postcodes. Because the 2011 database did not have confirmed data on the number of ‘overnight beds’ in their services, I couldn’t make comparisons over time about whether the overall number of inpatient places had changed from 2011 to 2016.

By trying to match postcodes (and names/addresses of services – yes I really am that sad) I tried to investigate the stability of inpatient services for people with learning disabilities from May 2011 to August 2016. I was particularly interested in what happened to services registered as hospitals in 2011 but not in 2016 – by 2016 were they now registered as a different type of service?

Of the 83 different independent sector inpatient services (by postcode) registered as hospitals in May 2011, 60 of them (72%) were still registered as hospitals in August 2016 (including one that was now being run by the NHS). Of the 23 services not registered as a hospital by 2016:

• 13 were not registered as a service for people with learning disabilities.
• 8 were now registered under a social care organisation (often under the same umbrella organisation as in 2011) as care homes, almost all as care homes with nursing registered for people with learning disabilities and people with mental health needs. The total number of places in these services was 200, ranging from 5 places to 126 places.
• 2 were now registered under an independent healthcare organisation (often under the same umbrella organisation as in 2011) as care homes with nursing, with a total of 24 places.

Furthermore, there were 34 independent sector inpatient hospital services for people with learning disabilities that were not registered as such in 2011 but were registered in 2016.

Looking at NHS inpatient services registered for people with learning disabilities in 2011, 126 out of the 187 (67%) were still registered as hospitals in August 2016 (including 2 that were now being run by the independent sector). Of the 61 services not registered as a hospital by 2016:

• 51 were not registered as a service for people with learning disabilities.
• 2 were now registered as NHS community hospitals.
• 4 were now registered under a social care organisation as care homes without nursing, with a total of 38 places.
• 4 were now registered as NHS care homes, 2 with nursing and 2 without nursing, with a total of 32 places.

Furthermore, there were 48 NHS inpatient hospital services for people with learning disabilities that were not registered as such in 2011 but were registered in 2016.

What does all this postcode nurdling amount to? There are a lot of numbers flying around so I've tried to summarise it in one diagram below.

In terms of the number of services registered with the CQC as hospital services for people with learning disabilities, overall the number of services has hardly changed from the Winterbourne View programme to now (although we don’t know if the number of inpatient places has changed, for example if new hospitals are smaller than the ones they've replaced).

There are signs of a steady withdrawal of NHS inpatient services alongside a steady drift towards independent sector inpatient services. There is quite a lot of ‘churn’ in which services are being newly registered as specialist inpatient services – this is likely to reflect both the NHS and particularly the independent sector building or developing/registering new specialist inpatient services. There are also a lot of former specialist hospitals in 2011 (18 of them across the NHS and independent sectors, with a total of 294 places) that have been re-registered as care homes for people with learning disabilities in 2016. Have these services genuinely changed their function and clientele? How many of the potential 294 people in these services were there when the service was ostensibly a hospital in 2011, and how are their daily lives different as a result? A real transformation of care, or plastical? (a highly relevant word from the wonderful book “Imagionality: Michael’s loveable fun of dictionaries” by Michael Bernard Loggins (2007 – Manic D Press: San Francisco).