Friday, 24 November 2017

Transforming Care - Who is going in?

This blogpost is the second 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.

After this first post focusing on the overall numbers, the rest of the posts will look at four questions:
·        Who is going into inpatient services?
·        How far are people from home and how long are they in inpatient services?
·        Who is going out from inpatient services?

Most of the statistics used will be from the Assuring Transformation statistics, which contain much more detailed information, although there are some comparisons with the MHSDS dataset where possible.

So – much of the focus of the Transforming Care programme has been on getting people out of inpatient units, but the slower than planned reduction in the overall number of people in these units suggests that there are still substantial numbers of people coming into these units. What do the statistics tell us about this?

Every month, the Assuring Transformation statistics report how many people have come into an inpatient unit according to commissioners. The graph below adds these together across two different years, October 2015 to September 2016, and October 2016 to September 2017, 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 the overall number of admissions to inpatient services increased over time, from 1,810 admissions in 2015/16 to 1,955 admissions in 2016/17. For whatever reason (and the reasons are potentially multiple and bewilderingly complicated) the number of people commissioners recognise as being admitted to these units is going up rather than down. The second thing to notice is that around a quarter of ‘admissions’ (the red chunk) are actually transfers from other hospitals (mainly other inpatient services of various types). This churn around the inpatient service system is something that will feature in later posts too. The third thing I want to mention is that around one in six admissions (the lilac chunk, 17%) are readmissions, where people had previously been in an inpatient service less than a year before. Finally, the purple chunk shows that most admissions to inpatient services (59%) are people who have not been in an inpatient unit for at least a year (or maybe never).

The much less detailed MHSDS dataset, with its focus on mainstream mental health inpatient services, reports much higher numbers of people with learning disabilities and autistic people being admitted to inpatient mental health services. In just one month, August 2017, the MHSDS reports 1,560 admissions to inpatient mental services, although most of these admissions are very short term (825 of these 1,560 admissions were out within the same calendar month).

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 a period of a year from October 2016 to September 2017. Around half of people (935 people; 51%) were admitted from their ‘usual place of residence’. However, over a third of people (680 people; 37%) were admitted from other inpatient and/or hospital services, particularly from ‘acute beds’ (which presumably includes people being transferred from mainstream mental health inpatient services). A further 100 people (5%) were admitted from ‘penal establishments’ and 125 people were admitted from residential care services.


Overall, it seems like the pressures are continuing to build for which inpatient services are being used as a response. What these statistics don’t provide, which is much needed, is a picture of how many people are being supported in ways that avoid admissions to inpatient services in the first place, such as support from local community teams. This is also important in trying to understand why so many people are being readmitted to inpatient services within a year of them leaving. Over the year from October 2016 to September 2017, around a quarter of the people admitted to inpatient services (500 people; 26%) had had a Care and Treatment Review (CTR) before admission – of course what we don’t know is how many people had a pre-treatment CTR and didn’t then go into an inpatient unit. Finally, it is important to understand why people are being transferred around the inpatient service system and what impact these transfers have on people and families.

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