Mental Health Matters: Transforming Care not transformative

Not pulling the punches on failure

This week a former coalition minister branded NHS England’s flagship learning difficulty programme a “failure” after it emerged that local health economies were struggling to set up specialist community services.

Norman Lamb did not pull his punches when speaking about the Transforming Care Programme, which as care minister he helped to set up following the Winterborne View scandal.

Mr Lamb is not alone in fearing that not enough has been done to set up new community services to support patients being discharged from hospital, because it’s clear that progress has been much slower than leaders would like.

HSJ understands NHS England is frustrated with the progress, and has hauled leaders from struggling areas down to London to demand to know what they are doing to improve.

It is looking more and more likely that the system will miss the target set by NHS England to close 35 to 50 per cent of inpatient beds by March 2019 and provide alternative care in the community instead.

Picking the low hanging fruit

While the number of inpatients has dropped from 2,875 in March 2015 to 2,400 in May this year, the system needs to close more than 500 beds if it is going to meet the lower end of this target. Having taken three years to shut 475 beds, it now seems unlikely that NHS England and clinical commissioning groups can shut that many in nine months.

One of the reasons often given for the slow progress is that once the low hanging fruit was picked it was always going to be tricky to move the more complex patients.

Part of the problem comes from making sure there is suitable accommodation and support for them in the community; last year HSJ revealed that many areas did not have intensive support and forensic services.

But a bigger part of the problem is the costs being incurred, with Greater Manchester looking at an additional bill of nearly £8m over its previous costs. HSJ has heard of care packages running above £1m for individual patients, which is a huge pressure on already cash strapped commissioners.

The repeated off the record message from provider chief executives is they will do what is right for patients, the subtext being that if there is not support for them in the community they will be kept in inpatient beds.

This will frustrate progress even further, but while the goal of moving patients out of institutions is a worthy one, it is right that it is done in the correct way with them being given the right support in the community.

Not a transformation in care

With March 2019 now less than a year away, there are fears that Transforming Care Partnerships will try to rush patients out of hospital to hit the target, even though they are likely to be readmitted without proper community support.

More worryingly for the future, despite the reduction in people with learning difficulties in inpatient units, the number of children in inpatient units has more than doubled from 110 to 250 from March 2015 to May this year.

At the same time, despite the bed closures, the average length of stay in inpatient units has remained the same at nearly five and a half years.

This has led campaigners to point out that despite movement on some fronts, the Transforming Care Programme has not led to a transformation in care.

This is why NHS England’s announcement this week of an extra £75m for the project is very desperately needed.

While £23m of this new money is from the transformation fund, the rest is being released through the decommissioning of specialist beds in 2018-19, with more than 400 closed so far.

But the biggest question is how the cash will be used to drive changes and what the timescale will be.