What is happening to people with learning disabilities and autistic people in inpatient units under Covid-19? Early signs from Assuring Transformation

In this blogpost I’m going to take a quick look at the latest NHS Digital data released on 16^th April 2020 about people with learning disabilities and autistic people in inpatient units. I’m going to focus on the Assuring Transformation data, which is the fairly restricted dataset NHS England uses when reporting on the Transforming Care programme designed to reduce the number of people in inpatient units and support more people effectively outside of inpatient units.

I’m focusing on this dataset because the reporting is rapid – the data released today has been provided by commissioners for March 2020 – although because commissioners can and do report retrospectively the information will be incomplete. I want to see if there are any early signs that Covid-19, or the way that services are responding to it, is making any difference to what’s happening with people in inpatient units. Most health service commissioners are still reporting information – 94% of commissioners for March 2020 (not all commissioners, as they can report retrospectively, report data every month), which is comparable to much of the past year.

In terms of the total number of people recorded as being in inpatient units, this dropped from 2,170 people in February 2020 to 2,095 people in March 2020. On the face of it this looks like the biggest monthly drop in numbers of people for at least a year (and probably longer), but the number of people reported to be inpatient units in March 2020 is likely to increase as more people are added to this total retrospectively. Most of this apparent decrease has come in NHS inpatient units (1,120 people in Feb 2020 vs 1,050 people in March 2020) compared to independent sector units (1,030 people in Feb 2020 vs 1,005 people in March 2020).

If we take this reduction in the number of people in inpatient units at face value, why might it be happening?

Well, the headline numbers on the number of admissions (people going into inpatient units and also people transferred between inpatient units) suggests a substantial drop in the number of admissions in March 2020 (90 admissions) compared to February 2020 (130 admissions) and much of the previous year (between 145 and 195 admissions per month). Of the 90 people admitted in March 2020, for 55 people it was the first admission to an inpatient unit in at least a year (compared to 70 people in Feb 2020), for 10 people they had previously been in an inpatient unit less than a year before (vs 25 people in Feb 2020), and 25 people were directly moved from one inpatient unit to another (vs 30 people in Feb 2020). In March 2020, 40 people had been admitted to the inpatient unit from their ‘usual place of residence’ (vs 60 people in Feb 2020), 5 people from a ‘temporary place of residence’ (vs fewer than 5 people in Feb 2020), 20 people from ‘acute beds’ (vs 35 people in Feb 2020) and 20 people from an ‘other hospital’ (vs 25 people in Feb 2020). Relatively few people admitted had a pre-admission Care and Treatment Review (30 people in March 2020) and no-one had a post-admission Care and Treatment Review. Are these the beginning signs of inpatient units admitting fewer people?

The other thing to look at is how many people are being ‘discharged’ from inpatient units and what their destinations are. Mercifully, the number of deaths of people in inpatient units recorded in these figures (as a type of ‘discharge’, which is rather crass) in March 2020 remained, as it has in all other individual months, an asterisk (this means that were anything between 0 and 4 deaths in the month). This will repay particularly close attention in the coming months.

Overall, 185 people were ‘discharged’ from inpatient units in March 2020 – this is an increase on February 2020 (170 ‘discharges’), but within the fluctuating number of discharges recorded month by month over the previous year (between 160 and 205 in any one month). In the world of Assuring Transformation a ‘discharge’ can actually mean a transfer direct to another inpatient unit – this happened to 20 people in March 2020 and is the lowest figure recorded for any single month in the past year (and probably longer). The number of people being discharged to ‘community’ settings (120 people in March 2020) is within the fluctuations recorded over the previous year or so (between 105 and 155 people in any one month). 10 people went to ‘independent living’, 50 people went to ‘supported housing’, 35 people went to their ‘family home with support’, and 20 people went to ‘residential care’ – similar figures to previous months. Finally, 45 people in March 2020 went to a mysterious ‘other’ setting, a much higher figure than in February 2020 (25 people) and a higher monthly figure than any month over the past year or so.

Overall, with retrospective reporting and March being early in the Covid-19 pandemic in England, the Assuring Transformation data does not show signs of drastic upheavals in the inpatient unit system or detectable consequences (yet) of Covid-19 on autistic people and people with learning disabilities in inpatient units. There might be some early signs of inpatient units hunkering down in preparation for Covid-19, and the increase in people discharged to ‘other’ places needs investigation. It will be worth following this dataset (and the MHSDS, which has a longer time lag to the release of information) closely to see what is happening to people.