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 2023 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. Care planning within inpatient units and various types of review have been a regular policy lever that NHS England have tried to pull, although rigorous evidence for their success or otherwise has not yet been completed.
Care plans
In 2022, the information collected about care plans for people in inpatient units changed. Information about care plans from March 2015 to March 2021 is in the graph below. By March 2021, just over a quarter of people (26%) were recorded as not needing inpatient services, with almost all of these recorded as working towards discharge. More people (40%) were recorded as needing inpatient services and having an active treatment plan, and a third of people (33%) recorded as needing inpatient services and not dischargeable. Over time, there had been drifts downward in people recorded as being dischargeable and drifts upwards in people recorded as not dischargeable.
From March 2022 onwards, the recorded categories have changed, but the trends over time seen up to 2021 have speeded up. By March 2026, over two thirds of people (68%) were recorded as having an active treatment plan but without a discharge plan in place. Only 9% of people in March 2026 were recorded as clinically ready for discharge (this category seemed to replace the delayed transfer of care category in 2025, which dropped from 11% to 0% in a year) - are there now no more delayed transfers of care out of inpatient units?
Reviews
For example, in March 2026 almost a quarter of people (23%) had had a review in the last 4 weeks, and a further 20% of people had had a review in the last 4-8 weeks, a big improvement from what seems like a bit of a low point in March 2022. It was also the case that in March 2026 14% of people had last had a review 26-52 weeks ago, a further 14% of people had last had a review over a year ago, and for 10% of people there was no review date scheduled, All these figures have worsened over the last few years.
This might reflect the pattern we've seen in the first two blogposts, where more people with learning disabilities and autistic people are being admitted to inpatient units. with many people potentially in inpatient units for shorter periods of time (with the potential for a revolving door). At the same time, there seems to be a group of people with learning disabilities and autistic people who have been in inpatient units for very long periods of time, and for whom reviews might be happening less frequently or not at all.
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 2026.
While the majority of people have had a C(E)TR at some point (83%), there seems to be a consistent draft away from people in inpatient units having regular C(E)TRs in the last five years, including people not having had a C(E)TR at all, from 5% of people in March 2021 to 17% of people in March 2026.
The graph below shows when people are next scheduled to have a C(E)TR. There is a similar worsening picture over the last years, with the percentage of people with no scheduled C(E)TR increasing from 4% of people in March 2021 to 29% of people in March 2026 and the times of scheduled C(E)TRs drifting longer in all categories.
Extra information relatively recently added to the Assuring Transformation dataset shows that in March 2026 there were 230 admissions to inpatient units of people with learning disabilities and autistic people, 170 new admissions and 60 transfers from another hospital. Of these, a C(E)TR or a Local Area Emergency Protocol (LAEP) was completed for only 40 (17%) of these admissions.
Commissioners of these services are also supposed to be doing regular 'oversight visits'. For children (aged under 18) who had been in an inpatient unit for at least six weeks, in March 2026 more than half of them (56%) had had an oversight visit in the last six weeks and a further 37% of children had had an oversight visit more than six weeks ago, leaving 22% of children without an oversight visit so far.
Similar figures are available for adults in inpatient units. For adults who had been in an inpatient unit for at least eight weeks (I don't know why an extra two weeks is added for adults compared to children), over a third (37%) had had an oversight visit in the last eight weeks and a further 53% had had an oversight visit more than eight weeks ago, leaving 9% of adults without an oversight visit so far.
In terms of scrutiny and support, in March 2026 30% of people with learning disabilities and autistic people in inpatient units did not have either an Independent Mental Health Advocate (IMHA) or an Independent Mental Capacity Advocate (IMCA). The percentage of people without an IMHA or an IMCA had increased from 20% in March 2022.
Overall there are signs that people with learning disabilities and autistic people are less likely to be having regular reviews or to have an independent advocate, while their care plans are indicating people aren't getting out any time soon.
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