Sunday, 26 November 2017

Transforming Care: How far from home, for how long?

This blogpost is the third of five looking at the Transforming Care programme through the prism of the national statistics regularly produced by the ever excellent @NHSDigital.

The first blogpost looked at the overall number of people with learning disabilities and autistic people identified by the statistics as being in inpatient services. Among other things, this post looked at the different views provided by commissioners (via the Assuring Transformation statistics), who tend to focus more on people in specialist learning disability inpatient services, and mental health service providers (via the MHSDS), who tend to focus more on people with learning disabilities and autistic people in mainstream mental health inpatient services often for short periods of time and for many people apparently for the purposes of ‘respite’. This is important to remember when looking at the graphs to follow.

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

This third post 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. Since the demise of the Learning Disability Census in 2015 we don’t have very good information on how people are being treated, but the Assuring Transformation statistics do help us build up a bit of a picture, particularly in terms of the possible impact of Transforming Care on inpatient services.

One of the main things highlighted by Transforming Care has been having crisis and inpatient services close to home. The first column on the left in the graph below shows the distance from home of people in inpatient units (according to commissioners in the Assuring Transformation dataset) in August 2017. A quarter of people (25%) are in inpatient units within 20km of home, but almost as many people (23%) are in inpatient units more than 100km from home, and for a worrying 14% of people this information isn’t even known.

The graph below also shows information from the MHSDS, which with its focus on short-term mainstream mental health services, presents a very different picture. The middle column in the graph shows that three quarters (75%) of people who were in and out of an inpatient service within the calendar month of August 2017 were within 20km of home, with only 1% more than 100km from home. For those in inpatient services at the end of August 2017, according to the MHSDS (the right hand column), well over half (57%) were in inpatient services  less than 20km from home and 6% were in inpatient services over  100km from home.




 Another important aim of Transforming Care is to reduce the length of time that people spend in inpatient units. The first 5 columns on the left in the graph below show how long people have been in their current inpatient unit according to Assuring Transformation statistics, from March 2015 through to September 2017. There are small trends over time towards a greater proportion of people being in their current inpatient unit for shorter lengths of time, although in September 2017 15% of people had been in their current inpatient unit for 5 years or longer (so far).

Again, the right hand column in the graph shows the equivalent figures from the MHSDS dataset. These figures show that towards half of people (45%) had been in their inpatient unit for less than 6 months, although there were still also 12% of people who had been in their current unit for 5 years or more.

 
As I mentioned in the previous post, there is quite a lot of evidence that many 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 September 2017. The extent of people being transferred around can be clearly seen; in September 2017 over a third of people (36%) 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 gradually falling from March 2015. In contrast, the total length of time people have been continuously in inpatient services has increased slightly and is now standing at an average 5 years 6 months.





So, overall the types of mainstream mental health inpatient service largely reported in the MHSDS are generally close to home with people staying in them for short periods of time. Whether they are effective for the people with learning disabilities and autistic people using them, how people experience these services, whether the people using these services are the same as people using the more distant inpatient services reported in Assuring Transformation where they stay for years – we know very little about any of these questions. Within the largely ‘specialist’ inpatient services reported by Assuring Transformation, to date there seems to have been little change over time in how local these inpatient services are and how long people stay in them.

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