Monitoring the quality of care and safety for people with a learning disability and/or people who are autistic in inpatient care

The NHS Long Term Plan made a commitment to making sure that people with a learning disability and/or people who are autistic are safe and are getting high quality inpatient care.

In May 2019, Minister of State for Care, Caroline Dinenage said: “Where it is essential that someone is supported at distance from home, we will make sure that those arrangements are adequately supervised. We cannot have people out of sight and out of mind. That is why we are introducing stronger oversight arrangements.

“Where someone with a learning disability or an autistic person is an inpatient out of area, they will [be] visited every six weeks if they are a child and every eight weeks if they are an adult, on site.

“The host clinical commissioning group will also be given new responsibilities to oversee and monitor the quality of care.”

To do this it is really important that we have good systems in place that work well to find out if there are any problems with someone’s care and to do what is needed to make their care better quickly.

To support this work guidance has been produced through working with people with a learning disability and/or people who are autistic who are currently, or have previously been inpatients, families with lived experience, providers, and the organisations who plan and pay for care – sometimes called commissioners.

Learning disability and autism host commissioner guidance

Where inpatient services are commissioned by clinical commissioning groups (CCGs) specifically for a person this can lead to someone’s care being planned and paid for by more than one organisation.

These organisations could be CCGs, transforming care partnerships (TCPs), sustainability and transformation partnerships (STPs), integrated care systems (ICSs) and even regional teams, and they could be in different parts of the country. To make sure that the care people get is the same quality wherever they are in the country we have published new guidance for the hosting commissioner – that means the CCG in the same area as the inpatient unit will be responsible for monitoring the care people get in the unit.

Responsibility and oversight for people’s care is held by the placing commissioner. The new guidance has been designed to help CCGs, TCPs and regional teams put host commissioner arrangements into place.

Minimum expectations during the coronavirus pandemic

  • Host commissioners should continue to maintain their responsibilities for keeping an oversight of concerns in relation to the provision in their areas.
  • We do not expect host commissioners to visit provider settings during this period, but we do expect them to continue to oversee and accept any concerns raised with them and to follow the agreed process for raising this with the region and if necessary, through the agreed safeguarding processes.
  • All placing commissioners need to make contact with the relevant host commissioners for inpatient services where they have an individual placed.
  • Host commissioners may be in the first instance in a better position to visit their allocated inpatient services rather than placing commissioners due to geographic constraints and on a risk-based approach.

Learning disability and autism framework for commissioner oversight visits to inpatients

Where a person with a learning disability and/or people who are autistic goes into a  specialist mental health, learning disability or autism hospital as an inpatient, commissioners need to be sure that they are safe and that they are being cared for in the best way.

To do this commissioners need to spend time with the people they are responsible for so that they can build a trusted relationship where people and their families and carers feel they can talk and be listened to.

It is the commissioners job to make sure this happens for all of their patients with a learning disability and/or who are autistic who are inpatients in specialist hospitals.

New guidance has been published which will help commissioners and case managers make sure that regular visits take place and support them to know how to share and resolve any concerns they have about someone’s care.

Minimum expectations during the coronavirus pandemic

  • Commissioner oversight visits will continue with adjustments for coronavirus on a risk-based approach: section 15 of the guidance gives information about the additional measures for carrying out commissioner oversight visits during the coronavirus pandemic.
  • Commissioners will use their best endeavours to make sure that face-to-face visits take place, safely, with a minimum requirement that the commissioner will use telephone and/or virtual methods of communication with people that they commission care for.
  • Visits should be prioritised and enhanced for people identified in services where quality concerns have been raised, or where the service has a Care Quality Commission rating of inadequate or requiring improvement.
  • There is no change to the frequency of commissioner oversight visits during the coronavirus pandemic; i.e virtual visits should take place at least every eight weeks for adults, and at least every six weeks for children and young people.
  • There have been no changes to requirements in relation to safeguarding during the coronavirus pandemic

Accessible versions of both of these publications will be published in February which will set out what support children, young people, adults and their families should expect in relation to the visits, and how to raise a concern if the visits are not taking place.