Mental Health, Learning Disability and Autism Inpatient Quality Transformation programme

The NHS Long Term Plan has a strong focus on expanding and improving the quality of community care for people with mental health problems, including people with a learning disability and autistic people. As a result, more people are accessing community mental health services than ever before and there remains a real commitment to build on that progress, so that people can access timely, high-quality community support, closer to their families and loved ones.

Many mental health inpatient services across the country are delivering good care and outcomes. They show what is possible and achievable. However, while significant progress has been made, some parts of the country still rely on certain types of poor quality and outdated bed-based provision (including out of area placements).

This programme has been co-produced with key stakeholders from across systems and especially people, families and staff. The programme includes specific consideration of the cultural change required to create and sustain an inpatient environment in which patients and staff can flourish, such as reducing restrictive practice. Ensuring that staff feel supported and proud of the work that takes place within inpatient settings is critical.

All mental health, learning disability and autism inpatient services for children and young people, adults and older adults are in scope of this programme, including specialised inpatient services.

The programme is built upon the cornerstones of good mental healthcare; continuity of care, therapeutic relationships and a relentless commitment to mental health care meeting the needs of all citizens. The programme has five objectives:

Localising and realigning inpatient services, harnessing the potential of people and communities

  • support integrated care boards (ICBs) to have oversight of and report on use of inpatient settings for their population and understand inequalities within this
  • co-create the long-term vision to localise and realign mental health, learning disabilities and autism inpatient services, including alternatives – and the service models underpinning them
  • support ICBs and provider collaboratives to develop their local strategies to realign commissioned services in line with the co-created vision.
  • deploy implementation support

For more information see: Localising and realigning inpatient services, harnessing the potential of people and communities

Improving culture and supporting staff

  • co-produce the model and standards for safe therapeutic inpatient care which is trauma-informed, autism-informed and equality-focused
  • deliver a programme of support which includes a focus on leadership and considers ‘ward to board’ requirements to generate cultural change alongside broader workforce development and learning networks
  • co-produce inpatient roles that enable and sustain therapeutic inpatient care, building on good practice where it exists, and reducing administrative burden
  • identify the longer-term workforce requirements to deliver the vision in full

For more information see: Improving culture and supporting staff

Supporting systems and providers facing immediate challenges

  • establish a mental health, learning disability and autism Strategic inpatient forum connecting national and regional directorates which brings together existing support offers and identifies gaps where they exist
  • through the Straetgic Forum, ensure the most challenged mental health, learning disability and autism inpatient units (NHS and independent sector) have an appropriate support package in place
  • align support offers available to systems and providers facing immediate challenges in the context of the NHS operating framework
  • strengthen the metrics in the NHS oversight framework to account for mental health, learning disability and autism inpatient quality
  • support provider collaboratives to provide quality recovery support to their local providers

Reducing restrictive practice through least coercive care

  • support models of care which reduce the use of force and restriction through enabling ‘easy in, easy out’
  • research and identify ways to stop mechanical restraint, long-term segregation and other harmful forms of restrictive practice
  • ensure restrictive practice data captured has a focus on protected characteristics including racial inequalities and gender to help identify areas for more targeted intervention
  • ensure all forms of restrictive practices are understood, captured and acted upon linking with key mechanisms such as the Patient safety framework

For more information see: Reducing restrictive practice through least coercive care

How success will be measured

  • a greater proportion of people with mental health needs, including those with learning disability or autism, will be supported in their community, in ways that promote their citizenship and human rights
  • a greater proportion of those who do need hospital support will access it closer to those who know and love them
  • improved patient experience
  • improved staff experience in mental health, learning disability and autism inpatient services
  • more timely, expert and co-ordinated support for services when they need it, with feedback from people, their families and staff enabling earlier identification of challenged services