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NHS England publishes data on transfer dates for people with learning disabilities, autism and behaviour that challenges
NHS England is today (Tuesday 18 March) publishing the first set of quarterly data prompted by the Winterbourne View Concordat aimed at getting better care for people with learning disabilities, autism and behaviour that challenges.
Where someone is admitted to hospital the priority from the start should be rehabilitation and returning home.
Following the Winterbourne View enquiry, NHS England agreed to “review all current hospital placements and support everyone inappropriately placed in hospital to move to community-based support as quickly as possible and no later than 1 June 2014” (Winterbourne View Concordat signed December 2012).
To assure the public and the Department of Health that the NHS commitments in the Winterbourne View Concordat are delivered, a data collection for all NHS commissioners was introduced with effect from 9 January 2014.
The data published today is the position as of the 31 December 2013.
Each of the 211 Clinical Commissioning Groups (CCGs) and 10 NHS England Area Teams responsible for specialised commissioning of secure mental health and child and adolescent mental health services were asked to submit information.
The information was on the number of patients currently in inpatient care and whether they have been transferred or there is a planned date to transfer and who had been admitted in the last quarter.
This is the first time that this data has been collected, giving a baseline from a commissioning perspective for measuring progress in future.
The current position is out of a total of 2,577 patients, 260 have a transfer date of which 172 are before 1 June 2014.
The data returns show that the reason why a large percentage of people do not have a planned transfer date is a clinical decision (1,108). Many of these people have very complex needs. Some may be too ill or possibly a danger to themselves or the public. Some patients might have treatment orders or be detained due to Ministry of Justice order.
Where it is agreed that a person should move into the community, it can take several months to find the right accommodation and ensure all the necessary arrangements are in place to support them. For example, patients sometimes require a period of assimilation, with transition to the community phased over a period of months. In addition generic and specialist community based support needs to be in place to support individuals. Commissioners may not be able to set a transfer date until these issues have been resolved. The ideal position will be that when someone is admitted they have a planned transfer or discharge date. Just because there is no planned transfer date it does not mean that people are inappropriately placed; it is about the principle of moving people on in a timely way.
However, NHS England recognises that more progress needs to be made to help more of these people move out of in-patient care into the community. To this end, it is using the latest data to establish, for those people without a transfer date, (i) those who should appropriately be helped to move to community-based settings; and (ii) those for whom the complexity of their needs is such that on-going in-patient care is required. Ultimately, these are decisions for clinicians to make with the full engagement of patients, their families, carers and advocates.
NHS England will be working through local commissioners to drive change to ensure all patients are safe and agree the number of people who, with the right assessment, can be moved into the community. It will be providing additional support to CCGS from the Improving Lives Team established by NHS England, to review the care of former patients of Winterbourne View and other complex cases. It will also develop clinical guidelines to support local areas to provide good quality joint planning and assessment.
Jane Cummings, Chief Nursing Officer for England, said: “Even though many of these patients have complex needs, they deserve a transfer date and to know when they will be returning home. Therefore, it is very important that we collect and publish this information so the public are aware of the progress being made in their local area. We need to be open and transparent without breaching patient confidentiality. We are increasing our efforts and will work with the Winterbourne View Joint Improvement Programme and other partners to escalate the urgency and priority of this programme. This will ensure the inclusion of safety, patient and family choice into the delivery of credible and sustainable care plans.”
Bill Mumford, Director of Winterbourne View Joint Improvement Programme, said: “We are a long way adrift of where we want to be but the data has achieved its purpose: to provide transparency and hold us all to account. The national partnership has to do better and now we’ve established this quarterly reporting we can track our progress. Perhaps more importantly local area partnerships need to use the data relevant to them to aid local decision making and accountability and monitor local activity in support of this particularly vulnerable group of people and their families.”
The documents below are available on our archived website.
- Excel workbook showing the data
- Slide pack to accompany the data
- Disclosure guidance for publishing the data
Surely this data is meaningless. I don’t see that the outcome will ever justify the effort involved in securing it. If only 260 out of approx 2600 (10%) are involved at present what can you learn from that? The vast majority are hospitalised for clinical reasons. Exactly what one would expect. That’s how it should be .Transfer to the community must only be done in the interest of the patient as determined by appropriate clinicians who are responsible for that patient. Not at the whim of some manager or politician seeking to comply with an arbritrary deadline.Transfer should only occur when satisfactory alternative supervision is in place and this could and should take a little time to arrange.I don’t see that comparison of this data over time will ever achieve any worthwhile purpose. There will always be a large number of patients who need hospital care based on clinical need. The question should be are the clinicians making the right judgement calls and is private care provision, where providers are primarily concerned with making a profit, ever going to be in the best interests of the patient >
The scandal at Winterbourne View was not just about criminal abuse. It also exposed failings in the commissioning and provision of care. There were cases of people being in that care setting for far too long.
The data collection is to ensure people are in receipt of the right care, in the right place at the right time. It will support a challenge if this is not perceived to be the case. It requires the engagement of clinicians who both provide and commission services, social care professionals and managers to ensure this happens for every person.
This is the first of a new approach to data collection to provide assurance that the issues exposed by the scandal are being actively addressed.
At all times it is important that people get the appropriate care and support at the right time and in the right place. This will be based on an assessment of their need. The principle within Transforming Care is that an admission to a hospital setting should be based on rehabilitation and a return home as soon as appropriate. All concerned should be working to the aim of a person going home.
Families still need assurances that those who are detained in hospital and deemed “unfit for discharge” have safeguards and a quality of life that has dignity, inclusion and a pathway to progression. We cannot continue to simply let individuals rotate around the hospital system that has a vested interest in them remaining in-patient. My fear is that politicians will try to grab a headline victory for the majority who can move on and abandon the minority who will be absorbed into the penal system.
The data collection is part of providing assurance to families. Commissioners, providers and the Care Quality Commission will also have a role to play in providing this on-going assurance.
By collecting this data we are openly reporting what is happening. This will support all commissioners to ensure that people receive the right care in the right place at the right time and to stop the provision of inappropriate care.