Winterbourne View 11 Years On. Report card 2: How far are people from home, for how long?

This blogpost is the second of four, updating a series of blogposts on various aspects of Transforming Care/Building The Right Support I last updated in 2019. The first blogpost in this updated series looked at who was being admitted to inpatient units, where they were being admitted from, and the legal status and ward security of people in inpatient services. This second blogpost 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. They use information from the Assuring Transformation dataset, provided by NHS Digital.

One of the main policies consistently trumpeted is having crisis and inpatient services close to home. The graph below reports information on the ‘distance from home’ of people in inpatient units, as reported in the Assuring Transformation dataset. The graph firstly shows that the biggest change in how far people are from home, from November 2016 to April 2022, is the huge increase in the proportion of people whose distance from home is recorded as 'unknown' (from 16% of people in Nov 2016 to 31% of people in Nov 2021). This makes interpreting other apparent changes over time difficult, as we don't know how far these extra 'unknown' people are from home (the gaps in the graph are because data on distance from home weren't always published every month). By April 2022, a quarter (26%) of people were reported to be in inpatient units more than 50km from their home. 

How, six years on from the introduction of this dataset, information is not provided for almost a third of people on a supposed 'flagship' indicator, is beyond me.

Another important policy aim of Transforming Care/Building The Right Support is to reduce the length of time that people spend in inpatient units. The graph below shows how long people have been in their current inpatient unit according to Assuring Transformation statistics, from March 2015 through to March 2022. There are very gradual and fluctuating trends over time towards a greater proportion of people being in their current inpatient unit for shorter lengths of time, although in March 2022 13% of people had been in their current inpatient unit for 5 years or longer.

As I mentioned in the previous post, these is a lot of evidence that substantial numbers of 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 March 2022. The extent of people being transferred around can be clearly seen; in March 2022 over a third of people (35%) 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 to September 2019 but increasing from then onwards. The total length of time people have been continuously in inpatient services has increased slightly from 2015 and is now standing at an average of more than 5 years 6 months.

What does this mean? First, it’s obvious that inpatient services have not become radically more local as Transforming Care/Building The Right Support has ‘progressed’, with Assuring Transformation reporting that a quarter of people are more than 50km from home and this information simply not being reported for almost a third of people. The information on how long people are staying in inpatient units reflects the continuing ‘churn’ of people between inpatient units without seeing the outside world, with people still on average spending 5 and a half years continuously in some form of inpatient unit.

Reducing distance from home and length of stay were both supposed to be central to Transforming Care/Building The Right Support – as far as I can tell, these have not improved in the last six or seven years and in some respects may have got worse.