A combined health and local government drive to help people with learning disabilities move out of hospitals by next month has been an “abject failure”, Norman Lamb has said in a scathing assessment.
With just one month to go before a key milestone is due to be reached, the care minister has branded progress “distressing”, “frustrating” and “utterly hopeless”.
Set up in the wake of the Winterbourne View scandal, the programme’s first major deadline on 1 June will now be completely missed, Mr Lamb admitted.
He hit out at “institutional inertia” among NHS and local government commissioners which had undermined efforts to hit the deadline. His part in driving the transition programme had been his “most depressing and frustrating” task, he told HSJ in an exclusive interview.
He accused NHS England, one of multiple health and local government organisations which agreed to the June target, of failing to prioritise the transition effort. “A significant proportion” of those who remained inappropriately accommodated in hospitals were NHS England cases, he said. “There hasn’t been enough challenge within commissioners to do this.”
Bill Mumford, the recently appointed director of the Winterbourne View joint improvement programme, told HSJ’s sister title Local Government Chronicle that the original June deadline would “have to be changed”. He was now “redefining where we want to be and the timescales to get there”.
“The sector reacted very strongly, but in doing so perhaps didn’t quite understand enough about the situation of people and the different types of hospital settings,” he added.
“Nobody defined what ‘appropriate’ was, and nobody quite understood what the numbers were.”
He said the programme now aimed to reduce the number of people with learning disabilities in hospital; reduce the length of stay for people that did go to hospitals and make sure those in hospitals had a “positive experience”.
“How we will measure that needs to be thought through,” he added.
The June deadline had been set in a “concordat” signed in December 2012 by the Department of Health, NHS England, the Local Government Association and the Association of Directors of Adult Social Services. It had pledged to “support everyone inappropriately placed in hospital to move to community-based support as quickly as possible and no later than 1 June 2014”.
Mr Lamb said he had been left “completely frustrated”.
“I’ve obviously questioned myself about what more I could have done,” he said. “What really upsets me is that when you have a whole load of organisations who signed up to the concordat… I felt that [as these] organisations [were] committing to something, one had a reasonable expectation that they would deliver, or aim to deliver.
“But to then discover that it’s business as usual in too many places I find very distressing, so it makes one somewhat cynical about this.
“The abject failure of some people in the system to do the right thing and change the model of care just makes me all the more determined that we see this through, even though it will take longer than I originally hoped,” he said.
Mr Lamb said he had twice raised the issue with new NHS England chief executive Simon Stevens since he took over the top job on 1 April. “I think he shares my view about the complete unacceptability of this,” Mr Lamb said.
Data from NHS England showed that, by the end of December, 1,932 people did not have a transfer date identified.
An separate report by the LGA said the figures “confirmed that the hospital discharge programme is seriously adrift from the original national milestones”.
Asked why the programme had failed to meet its targets, Mr Lamb cited the lack of information about placements and the difficulties of transferring funding from NHS England to local commissioners.
A mechanism must now be put in place to allow funding transfer when people with learning disabilities were moved from hospital settings, he said.
Mr Lamb said many clinicians were still choosing to place people in institutional settings.
“We have to understand better why there are so many cases where clinicians have decided that institutional care is the right setting when there are many people working in learning disability services who believe that institutional care for many of these people is not the right setting,” he added.
The minister said he felt “ashamed” when talking to families about how they felt ignored by commissioners and providers. Families and patients refused the offer of a transition from a hospital to community setting coul be offered a “second opinion” from a third party clinician, under one proposal under consideration, he indicated.
Senior local governmet figures questioned the original target. One described it as “completely unrealistic and plucked out of the air”. But Mr Lamb insisted his original deadline was “absolutely appropriate”.
He had been “unhappy” with the progress of the transition programme until Mr Mumford had been drafted into work on the Winterbourne View joint improvement programme in January.
“At one stage I was presented with regional summaries for what the position was around the country,” he said.
“I just said that was utterly hopeless. It sort of covers the great and the awful. It tells you absolutely nothing.”
Professor Juliet Beal, NHS England’s director of nursing, said: “A detailed plan, with key performance indicators, will be presented to the NHS England Board in May 2014.
“This will reflect comprehensive regional plans at CCG level indicating numbers of patients and projections for reducing the inpatient numbers.”
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