2.26 The government and NHS England recognised that performance has been slow and have changed the delivery, accountability and monitoring systems. In April 2014, NHS England identified the need for plans to ensure that people have effective care and treatment reviews and set a level of ambition for discharges which the NHS, working with local partners, could deliver. In addition, the Department asked NHS England, in May 2014, to put together an action plan and publish it by the end of August. The plan was presented to the Transforming Care Assurance Board in September 2014.
2.27 The Department replaced the Post Winterbourne View Project Board with the Joint Improvement Programme Board. When it became clear the central objective would not be achieved, it established a Senior Sponsors Group in May 2014. The group is chaired by its senior responsible officer and includes representatives from NHS England, the LGA, CQC and the Association of Directors of Adult Social Services. It aims to strengthen governance by replacing the Joint Improvement Programme Board with the Transforming Care Assurance Board. The new board first met in September 2014, and will give feedback to the Learning Disabilities Programme Board.
Care services for people with learning disabilities and challenging behaviour Part Two 31
2.28 In July 2014, NHS England commissioned Sir Stephen Bubb to assess how they might implement a national commissioning framework, delivered locally. The framework would help to increase the community provision needed to move people with learning disabilities or autism out of inappropriate hospital care. The November 2014 Bubb report recommended:13
•
introducing a Charter of Rights for people with learning disabilities;•
giving people with learning disabilities and their families a right to challenge decisions and request a personal budget;•
that local decision-makers follow a mandatory framework showing who is responsible for which services, and how they will be held to account, including improved data collection;•
introducing a planned closure programme of inappropriate institutional inpatient facilities;•
better training and education for NHS, local government and provider staff; and•
setting up a social investment fund to build community service capacity.2.29 In August 2014, NHS England had set a new ambition, to be delivered by 31 March 2015. The ambition was to ‘transfer’ more than half of the 2,615 people who were inpatients on 1 April 2014 to more appropriate care settings. NHS
England communicated the ambition to its regional directors in late September 2014. In October 2014, NHS England appointed a programme director and programme leaders to address slow progress. Local commissioners queried whether the 50% ambition was specifically discharges from mental health hospitals, or transfers to a more appropriate inpatient setting or a combination of the two. NHS England confirmed in November 2014 that the ambition was for discharges from mental health hospitals.
2.30 We found no evidence that the clinical commissioning groups, local authorities or mental health hospitals that we visited knew of the ambition. It can take up to 18 months to plan a patient’s discharge. There are therefore limited prospects for significantly increasing the rate of sustainable discharges by 31 March 2015. The LGA said that, even with adequate funding and good local relationships, it takes time to plan and deliver support for those with challenging behaviour in the community. It was concerned about balancing well-intentioned plans, with ensuring the right community provision is in place.
13 Transforming care and commissioning steering Group. Winterbourne View: time for change, November 2014. Available at: www.england.nhs.uk/wp-content/uploads/2014/11/transforming-commissioning-services.pdf
32 Part Two Care services for people with learning disabilities and challenging behaviour
2.31 NHS England said that around 400 of these inpatients had been discharged in the first 7 months, and it expects to discharge a further 900 in the remaining 5. However, NHS England has not provided comparative discharge or readmission rates. Nor has it said why it thinks the number of inpatients has remained unchanged. The expectation in the 2012 Concordat was that a new generation of inpatients did not take the place of people then in hospital. Without comparative discharge and readmission rates, this ambition may simply be continuing the normal turnover rate in the patient population.
2.32 There was no central implementation plan, risk assessment or mitigation plans for NHS England’s new ambition. However, NHS England said that during our work:
•
regional directors have been made accountable for progressing the new ambitionand ensuring that it is delivered in a planned manner;
•
the national learning disability programme team has developed protocols for care and treatment reviews used to identify patients for whom there is no clinical need for inpatient care; and•
it worked with the LGA and the Association of Directors of Adult Social Services to address gaps in communication to clinical commissioning groups and local authorities.2.33 NHS England had also requested monthly data returns from its commissioners between July and September 2014. Since October, it has increased the frequency of returns to fortnightly to monitor progress against its new ambition. NHS England told us that the data is based on management information and soft intelligence. They told us that it is not as robust as the quarterly data and is not validated or published, but used to show NHS England’s Management Board the indicative transfer position of patients in between the quarterly published data. For this reason, we have not used this data in our report.
Care services for people with learning disabilities and challenging behaviour Part Three 33