We’re just 9 months from the end of Transforming Care. Whilst information suggests that its aims will continue as the ‘learning disability’ focus in Sustainability and Transformation Partnerships, there isn’t what I would call open, inclusive dialogue about what this future should be.
Nobody seems to be suggesting that the work is done and no-one I speak to has lost the appetite to better support this group of people. The main question for me is: if we are to hold true to the original aims of Transforming Care, what is the data telling us about sharpening our collective effort? The latest numbers pose questions that, through wider debate, could inform what happens next.
Is there a specific problem with support for young adults that providers can help solve? The number of inpatient under 18’s has more than doubled since 2015, from 110 to 250. That’s now over 10% of all patients.
Has the Programme overlooked the specific needs of autistic people? Pleasingly, the number of people admitted with a learning disability has fallen but the number with an autism-only diagnosis has risen from 12% in 2015 to 22% of total admissions.
Why is there less use of people and process to stand up for individuals? Whilst 5% of patients had no advocate in 2015, that figure is now 23%. Where 1% of people didn’t have a care co-ordinator in 2015, it’s now 8%. In 2015, 77% of care co-ordinator reviews happened in the preceding 6 months. It’s now 54% and falling.
Why have Care and Treatment Reviews not successfully replaced care co-ordinator reviews? Overall, 46% of patients have not had a CTR within the mandated past 6 months. Everyone should have one. Yes, 62% of patients have a transfer date, up from 50% in 2015 but I politely question the likelihood of success without a CTR.
I worry about where people transfer to. Roughly the same proportion of people are moving to community living and residential care as in 2015 but 25% now move to ‘other’ establishments (was 6%). ‘Other’ must have once been a last resort classification–what forms of accommodation are now coded to it and are they ‘transformational’?
30% of existing care plans record no need for inpatient care. That’s an improvement from 2015 but 695 people are still locked up unnecessarily. Less than a quarter are working towards discharge and the average stay has risen to over 5 years. Why is this when community placements appear to be working? (There’s no change to the proportion of readmissions or where people are admitted from.) Well, ‘lack of suitable housing’ was cited as a factor in 39% of cases, and ‘waiting for residential care’ in 34% – yet at Dimensions, we have nearly 100 supported living vacancies. Other providers will be similar. Can the NHS work with providers to set up a vacancy register?
Finally, new data shows that 22% of people are placed more than 100km from home, including 60 under-18s. Is this improving or worsening? Why?
Such mixed data suggests that Transforming Care has needed to fight for its place in the NHS spotlight. It was one strand of a forward plan that featured other critical aims. Despite the welcome announcement of £20bn new NHS funding (money that will arrive wrapped in more targets and priority objectives), the fact that money is being injected into health and not social care amplifies my fear that, unless we act quickly and in concert, the aims of Transforming Care’s sequel will need to jockey for position with other goals once again.
I have asked questions without answers because a) I don’t have all the answers (who does?) and b) these questions should be debated more widely, utilising cross-sector expertise. Collectively, we must be able to offer solutions to make whatever follows Transforming Care a bigger success.
