This blogpost is the final one of four looking at whatever remains of the Transforming Care programme through the prism of the national statistics regularly produced by NHS Digital/NHS England, updating a series of blogposts I last updated in 2023.
The first blogpost looked at statistics on the number of people being admitted to inpatient services, and where they were being admitted from.
The second blogpost looked at how far people were from home and how long they were staying in inpatient services.
The third blogpost looked at planning and reviews for people within inpatient services.
This final blogpost will focus on the number of people leaving inpatient services (charmingly called ‘discharge’) and what is happening leading up to people leaving. Getting people out of inpatient units has arguably been the major focus of activities under the Transforming Care/Building The Right Support banner, with less focus on preventing people going into inpatient services in the first place (as we've seen, admissions are rising) or what happens to people while they're in inpatient units.
Again, 15 years on from Winterbourne View the impact of these programmes should be visible in the number of people getting ready to leave, how well people’s plans to do so are developing, and how many people are actually leaving to places outside inpatient services.
The first and most obvious question is whether people in inpatient services have a planned date to leave. The graph below shows the proportion of people in inpatient services with a planned date for transfer, from March 2015 to March 2026 (according to Assuring Transformation data). There have been some fluctuations over time but there is an overall trend of things improving up to March 2019, and things worsening year on year to March 2026, where the figures look worse than in March 2015. In March 2026 there was no planned transfer date for the vast majority of people in inpatient units (81%), compared to 43% of people in March 2019 and 50% of people in March 2015. In March 2026, only 6% had a planned transfer date within 6 months, compared to 23% of people in March 2019 and 18% of people in March 2015.
Well, if people are leaving the inpatient unit to go home in some sense then my expectation would be that the person’s local council should be aware of the plan to leave. The graph below shows information from Assuring Transformation based just on those people with a plan to leave – for this group of people, are councils aware of the plan? Over time, the proportion of people with a plan that their council is aware of dropped substantially from 2015 to 2019, improved again up to March 2023, and has been drifting downwards ever since. By March 2026 the proportion of planned transfers where the council was aware (57%) was still lower than it was in March 2015 (69%). Of concern is that in March 2026 for 27% of people with a planned transfer it wasn’t known whether the council was aware of the plan or not, again worse than in March 2015 (7%).
As we've seen from other blogposts in this series, more people with learning disabilities and autistic people are being admitted to inpatient, with some possibly staying for shorter periods in general security wards, while others seem to be in higher security wards for very long periods of time. For both of these groups, is planning carefully for a person leaving to have a fulfilling life beyond the inpatient ward no longer seen as possible or relevant?
There are other signs too of an absence in planning for people to leave. The Assuring Transformation statistics report whether a range of people (the person themselves, a family member/carer, an advocate, the provider clinical team, the local community support team, and the commissioners) have agreed the plan to leave. For those people with a plan to leave, the graph below reports the proportion of their plans that have been agreed by different people, from March 2016 to March 2026. Over time, the proportion of plans agreed by anyone and everyone potentially involved has plummeted. Only 16% of plans had been agreed by the person themselves in March 2026, compared to over two thirds of people (69%) in March 2016. Similar drops are reported for the proportion of family/carers (from 60% to 13%) and advocates (from 64% to 15%) agreeing the plans.
The figures for professional groups agreeing transfer/discharge plans are similar. By March 2026, transfer plans had been agreed by a minority of provider clinical teams where the person was supposed to be moving to (from 83% in March 2016 to 17% in March 2026), a minority of local community support teams in the area the person was supposed to be moving to (from 69% to 16%) and a minority of those commissioners who are reporting the information the graph is based on! (from 83% to 17%). To what extent are these actually feasible and sustainable plans that will result in a better life at home for people in inpatient services, and what are their chances of breaking down?
The final graph in this blogpost series is one of the most important – how many people have actually been transferred from inpatient services, and where have they gone? The graph below adds up monthly ‘discharges’ from inpatient services in the Assuring Transformation dataset in ten yearly blocks, from October 2015 through to September 2026. Some of the details of where people have been 'discharged' to have changed in the AT dataset recently, but it can still consistently be summarised in the broad categories of 'Another hospital' (the red columns), 'Community' (the blue columns) and 'Other' (the purple columns.
The first thing to say is that overall the number of people ‘discharged’ from inpatient services increased from 2015/16 (2045 people) to 2017/18 (2,265 people), decreased to 1,875 people in 2021/22 (the COVID-19 pandemic undoubtedly had an impact on the number of people leaving inpatient units), increased slowly to 1,995 people in 2023/24, and jumped to 2,475 people in 2024/25. This increase roughly matches the increased number of admissions we've seen in a previous blogpost.
Of the people who have been 'discharged', 18% (435 people) in 2024/25 were actually transferred straight to another hospital, the biggest percentage of transfers direct to other hospitals since 20% of people in 2018/19. The most common type of place to be discharged to was 'Community' (79% of people in 2024/25; 1,950 people), which in 2024/25 was mainly a person's family home - both in numbers and percentages this has rapidly increased in recent years. Is this a positive trend, or a sign of crisis-driven revolving door admissions and discharges with little planning or support?
Where did everyone else go? In 2024/25, there were also another 90 people (4%) who moved to an ‘other’ location - these numbers and percentages have been steadily reducing over time.
None of these past four blogposts gets to the heart of what this failure has done to countless people and those close to them since the BBC Winterbourne View programme was aired (and in the years and decades before then). Years of failing to get to grips with the fundamental problems has seemingly led to policymakers more or less giving up on their early ambitions after Winterbourne View. Over time there is more churn of people with learning disabilities and autistic people into, out of, and around within the hospital system, within a context of poorer support for people in distress outside hospitals. Is this success?
No comments:
Post a Comment
Note: only a member of this blog may post a comment.