Winterbourne View 11 Years On. Report card 3: Planning within inpatient units

This blogpost is the third of four looking at the Transforming Care/Building The Right Support programme through the prism of the national statistics regularly produced by NHS Digital, and updating a series of blogposts I last updated in Spring 2019 on the same issues.

The first blogpost looked at statistics on the number of people being admitted to inpatient services,  where they were being admitted from, and the legal status and ward security of people in inpatient units.

The second blogpost looked at how far people were from home and how long they were staying in inpatient services.

This blogpost will focus on what the statistics are telling us about planning within inpatient services, using statistics from Assuring Transformation. If Transforming Care/Building The Right Support has made progress, 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 2021. Information in this form is not now being published.

By September 2021, 15% of people were labelled ‘not dischargeable', down from 21% in March 2015. The proportion of people with an active treatment plan but no plan to leave has increased over time (from 39% of people in March 2015 to 45% of people in September 2021). The proportion of people actively working towards a plan to leave with a plan in place has dropped slightly over time, from over a third (35%) in March 2015 to 32% in September 2021. Delayed transfers of care have gradually crept up over time, and are now standing at 7% of people in September 2021. 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 to leave inpatient services, then the proportion of ‘undischargeable’ people left in inpatient services will go up.

But it does mean that, after 10 years of concerted government policy, there are 560 people (almost 40% of people) in September 2021 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 March 2022. The graph generally shows that things seem to improve at times when there is more government/NHS England attention or pressure, but without that pressure reviews begin to drift again. By March 2022, a third of people (33%) had had a review in the past 12 weeks, and almost a quarter (23%) between 12 weeks and 6 months ago. However, a further quarter (25%) last had a review between 6 months and a year ago, and another 18% 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 March 2022. The graph shows that the vast majority of people in inpatient services have had a CTR at some point (92% of people in March 2022), and that this coverage has increased from 70% of people in October 2016. Perhaps one concern is that 11% of people last had a CTR more than a year ago, a proportion that has stayed fairly consistent over the last three years.

The graph below shows when people are next scheduled to have a CTR. Again, there are improvements from October 2016 to March 2022, where the proportion of people with no scheduled future CTR dropped from over half (55%) to only 6% of people. For a further 9% of people in March 2022 the date for their scheduled CTR had passed without a CTR happening.

Overall there are signs that more people in inpatient services are having both regular reviews and Care and Treatment Reviews, although reviews often drift back to lower levels outside times of particular pressure being applied. 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 almost 40% of people in inpatient units whose care plan says they don’t need to be there. Care and Treatment Reviews are being done, but what difference are they making?