It was a little-heralded anniversary last week. Eleven years since the BBC aired its programme about the horrendous abuse meted out to people with learning disabilities and autistic people at Winterbourne View, a ‘specialist’ inpatient unit (NOT a residential care home – the persistent confusion about this in much of the media coverage speaks volumes). Rightful Lives marked the anniversary like this on twitter.
Has nothing really
changed at all in the intervening 11 years, with the panoply of policies,
progress reports, rebranded initiatives when previous ones have not met their targets,
meetings, deep dives, reviews, flow charts, workshops, more reviews, and days,
weeks and years of people’s lives living in spaces beyond human rights and dignity (not to mention the amount of public money that must have been spent on officials
to get a ‘grip’)?
There are many ways to try and answer this question. One thing I’ve been doing sporadically is to look at the official monthly statistics published by NHS Digital about autistic people and people with learning disabilities in inpatient units, to see if they reveal any tangible evidence of change over time (or at least since 2015, when some of this information began to become available). The last time I went through a comprehensive ‘report card’ on inpatient units was in Spring 2019, in a series of four blogposts (the link to the first one of these is here). I’m going to update this information in a short series of blogposts this week
I will not cover in detail the issue of the overall number of people in these inpatient units (I went through this record of failure against the succession of targets the government set for itself here about a year ago, and little has changed since). I want to look again at some of the other statistics that give us some clues about what has been happening with Transforming Care and its successors eleven years on from Winterbourne View.
These blogposts will focus on information produced publicly by NHS Digital from one of two datasets. It uses data from the Assuring Transformation dataset – for this dataset, health service commissioners provide information (sometimes retrospectively) on the number of people with learning disabilities and autistic people in specialist inpatient services and on various aspects of what is happening with or to people. I’ve collected some of the information into six-month or yearly blocks, and some of the information I report for every six months rather than every month (both you and I would not survive that amount of information…). This means that most of the information goes up to March 2022. In this post I have not used information from the Mental Health Services Dataset (MHSDS), which reports information collected by mental health service providers concerning people identified by them as a person with learning disabilities or an autistic person – this has been published monthly starting more recently than the Assuring Transformation dataset and is less detailed about processes. In different ways both datasets are partial – Assuring Transformation does not include a lot of people in mainstream mental health inpatient units, and some big independent sector inpatient service organisations are not yet reporting aspects of their activity to the MHSDS.
The differences between these datasets matter, and it is no surprise that government only reports data from Assuring Transformation (which reports 2,100 people in inpatient services at the end of February 2022) rather than the MHSDS (which reports 3,505 in inpatient services at the end of February 2022).
As with the previous series, these four blogposts will focus on:
- Who is going into inpatient
services?
- How far are people from home, and how long are people spending
in inpatient services?
- What planning and review is
happening in inpatient services?
- What is happening about
people leaving inpatient services, and where are they going?
So – much of the
focus of the various iterations of the Transforming Care programme and its rebranded successors 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?
The first thing the graph shows us is, pre-COVID, the overall number of admissions to inpatient services was increasing, from 1,810 admissions in 2015/16 to 2,250 admissions in 2018/19. The total number of admissions dropped to 1,745 admissions in Oct 2019 - Sept 2020, when COVID-19 hit, but even through 2020/21 increased again to 1,830 admissions. In total, there have been 11,570 admissions to these inpatient units in the last six years - we don't know how many of these are the same people being admitted more than once or different people being admitted.
The second thing to notice is that a large proportion of admissions (the red chunk) are actually transfers from other hospitals (mainly other inpatient services of various types), running consistently at well over 20% of all admissions. The third thing I want to mention is that more than one in six admissions (the lilac chunk) are re-admissions, where people had previously been in an inpatient service less than a year before. Finally, the purple chunk shows that just over half of admissions to inpatient services (60% in 2020/21) are people who have not been in an inpatient unit for at least a year (or maybe never).
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 five one-year blocks (starting in October 2016, through to September 2021).
In 2020/21, almost half of people (860 people; 48%) were admitted from their ‘usual place of residence’ and 43% of people (760 people) were admitted from other inpatient and/or hospital services, particularly from ‘acute beds’ (which includes people being transferred from mainstream mental health inpatient services). A further 95 people (5%) in 2020/21 were admitted from ‘penal establishments’ and 30 people (2%) were admitted from residential care services. Although there have been fluctuations over time, the picture in 2020/21 looks rather similar to the picture for 2016/17.
Overall, despite a temporary dip in admissions almost certainly related to the COVID-19 pandemic, it seems like the pressures are as bad in 2020/21 as they were in 2016/17 and continuing to build, for which inpatient services are being used as a response. Building The Right Support in 2015 promised effective community support for people - so why six years on are the number of people being admitted to inpatient units from their 'usual place of residence', or the number of people re-admitted within a year of leaving an inpatient unit, virtually unchanged? If inpatient units are supposed to be better-placed to meet the needs of the people being put in them, why are so many people still being passed around different inpatient units?
Have any changes in admissions resulted in changes to the legal status or the ward security of people with learning disabilities and autistic people in inpatient units? A persistent argument has been that people on MHA Part III sections (particularly those with legal restrictions) and people in higher security places are more likely to need to remain in inpatient services, so the number of people in these categories should not change even if the number of people in inpatient units reduces overall.
The graph below shows the number of people in inpatient units at the end of March each year from 2016 to 2022, broken down by the legal status of people in inpatient units according to Assuring Transformation data.
The most common legal status for people in inpatient units is a Part II section, where the number of people has dropped by 20% from 2016 to 1,040 people in March 2022. The next most common legal status is a Part III section with restrictions, where the number of people has dropped by 14% from 2016 to 535 people in March 2022. Less common are people with Part III sections without restrictions (which dropped by 39% from 2016 to 235 people in March 2022), people not subject to the Mental Health Act (which dropped by 44% from 2016 to 155 people in March 2022), and people in other sections (35 people; unchanged from 2016 to 2022). It is clear that reductions in the number of people in inpatient units have reduced for people with almost all types of legal status from 2016 to 2022.
The picture is similar when looking at ward security, as the graph below shows. The most common level of ward security is 'general', where the number of people in 'general' ward security dropped by 22% from 2016 to 1,035 people in March 2022. The next most common level of ward security is 'low secure', where the number of people dropped by 34% from 2016 to 555 people in March 2022. Together, people in 'general' and 'low secure' places were 79% of all people with learning disabilities and autistic people in inpatient units in March 2022.
The number of people in medium secure inpatient units also dropped by 41% from 2016 to 305 people in March 2022, with smaller numbers of people recorded in high secure units (60 people) and Psychiatric Intensive Care Units (50 people)
Clearly, reducing the number of people in inpatient units does not need to exclude people on Part III sections or people on low or medium secure wards.
Overall, is this a record of sustained progress?
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