Transforming Care report card 3: Planning within inpatient units

This blogpost is the third of four looking at the Transforming Care programme through the prism of the national statistics regularly produced by the ever excellent @NHSDigital, and updating a series of blogposts I wrote towards the end of 2017 on the same issues.

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 when people were in inpatient units, how far were they from home and how long were they staying in inpatient services.

This blogpost will focus on what the statistics are telling us about planning within inpatient services, just using statistics from Assuring Transformation. As Transforming Care moves towards a close (or not), its effects should be felt through the inpatient care plans people have, whether people’s needs are being regularly reviewed, and whether people are having regular, effective Care and Treatment Reviews (CTRs).

The first graph below shows the details of care plans for people according to inpatient services, from March 2015 through to September 2018. By September 2018, almost a third of people (31%) were labelled ‘not dischargeable’, up 10% from 21% in March 2015. The proportion of people with an active treatment plan but no plan to leave has stayed pretty static over time (41% of people in September 2018). The proportion of people actively working towards a plan to leave with a plan in place has dropped over time, from over a third (35%) in March 2015 to under a quarter (23%) in September 2018. Delayed transfers of care have gradually crept up over time, and are now standing at 5% of people in September 2018. From these figures, it is impossible to tell whether these changes are due to changes in what inpatient services are doing, or changes in who is in inpatient services. For example, if Transforming Care is being effective in supporting ‘dischargeable’ people (nice phrase) to leave inpatient services, then the proportion of ‘undischargeable’ people (even nicer phrase) left in inpatient services will go up.

But it does mean that, towards the end of Transforming Care, there are well over a quarter of people (28% in September 2018) in inpatient services when, according to their care plans, they don’t need to be there.

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 September 2018. The graph generally shows that things seemed to get worse in 2016 but improved again in 2017 and was maintained through 2018. By September 2018, well over a quarter of people (29%) had had a review in the past 12 weeks, and almost a quarter (23%) between 12 weeks and 6 months ago. However, almost a further quarter (22%) last had a review between 6 months and a year ago, and another 23% had last had a review over a year ago.

 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). The graph below reports the last time people in inpatient services had had a CTR, from October 2016 to September 2018. The graph shows that the vast majority of people in inpatient services have had a CTR at some point (91% of people in September 2018), and that this coverage has increased from 70% of people in October 2016. Perhaps one concern is that 14% of people last had a CTR more than a year ago, a proportion that has stayed fairly consistent over time.

The graph below shows when people are next scheduled to have a CTR. Again, there are improvements from October 2016 to September 2018, where the proportion of people with no scheduled future CTR dropped from over half (55%) to around one in six people (17%). For a further 15% of people in September 2018 the date for their scheduled CTR had passed without a CTR happening, a proportion that is gradually creeping up.

Overall there are signs that more people in inpatient services are having both regular reviews and Care and Treatment Reviews. There are still large numbers of people in inpatient services who have not had any sort of review for a long time, however, and there are still well over a quarter of people in inpatient units whose care plan says they don’t need to be there.