Out of hospitals and into homes: impacts of planned changes to learning disability care

Sick baby photo

In a major shift of emphasis from in-patient to community-based services, individuals with learning difficulties are to be offered the chance to own their own home, have access to personal care budgets and to customize services they receive. This will be in tandem with ongoing proximity support from designated care workers who will play a more significant role within the framework.

The impact on those in social care jobs will be significant as they will have a greatly enhanced, hands-on role in the scheme. Crucial to the new structure is the ambition to see a reduction of 50% in hospital bed numbers taken up by patients with learning difficulties over the next three years as the care burden is transferred into the community. More than a simple reduction of beds, however, the modernisation plans will see the closure of some units altogether, as they will be replaced by supported housing schemes.

The new emphasis comes from the Transforming Care programme set up in 2012 in the wake of the Winterbourne View scandal which involved staff abusing patients with learning difficulties, NHS England and council leaders will establish local partnerships which will decide how the plans are implemented. Funding for the new scheme will come through combined local NHS and council budgets as well as a dedicated NHS England fund of £45m.

Reactions to the proposals are mixed, but generally optimistic. Jane Cummings, Chief Nursing Officer for England and Chair of the Transforming Care Delivery Board, admitted that society had “failed this group for decades” but is sure that the new plan will “put things right” as well as “make quick, significant and lasting improvements to their lives.”

NHS England Chief Executive Simon Stevens said: “As good and necessary as some inpatient care can be, people with learning difficulties are clear they want to live in homes not hospitals.” However, according to Rob Greig, Chief Executive of the National Development Team for Inclusion, “The objective should be to develop good community support from new, skilled social care providers. Just having closing assessment and treatment beds as a target could lead to poor support being transferred into a community setting.” Other commentators warned of lessons to be learned from the chequered success of the “Care in the Community” programme, which, allegedly, left some people with mental health issues “abandoned to their fate”.

Nevertheless, these plans have been developed in co-operation with people with learning disabilities (including autism), their families, carers, commissioners and other providers, voluntary sector and representative groups and it is expected that significant improvements in the quality of life – and care – will result for all concerned.