Winterbourne View 12 years on - 2023. 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/NHS England, and updating a series of blogposts I last updated in 2022 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 whether people’s needs are being regularly reviewed, and whether people are having regular, effective Care and Treatment Reviews (CTRs).

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 2023. 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 2023, half of people (49%) had had a review in the past 12 weeks, and almost a quarter (22%) between 12 weeks and 6 months ago. However, a further quarter (13%) last had a review between 6 months and a year ago, and another 11% had last had a review over a year ago. The figures for March 2023 are a big improvement on March 2022, but figures do fluctuate from year to year.

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), now extended to Care, Education and Treatment Reviews (C(E)TR) . The graph below reports the last time people in inpatient services had had a C(E)TR, from March 2017 to March 2023. The graph shows that the vast majority of people in inpatient services have had a C(E)TR at some point (90% of people in March 2023), and that this coverage has increased from 82% of people in March 2017. Perhaps one concern is that in March 2023 12% of people last had a C(E)TR more than a year ago, a proportion that has stayed fairly consistent over the last four years.

The graph below shows when people are next scheduled to have a C(E)TR. Again, there are improvements from March 2017 to March 2023, where the proportion of people with no scheduled future C(E)TR dropped from almost half (46%) to 8% of people. For a further 12% of people in March 2023 the date for their scheduled C(E)TR had passed without a C(E)TR 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. Care and Treatment Reviews are being done, but what difference are they making?