Flagship learning difficulty programme branded a "failure"

Former coalition care minister Norman Lamb fears that not enough has been done to set up new community services to support patients being discharged from hospital as part of the Transforming Care Programme.

NHS England set out plans in 2015 to close 35 to 50 per cent of inpatient beds for people with learning difficulties and autism and provide alternative care in the community by March 2019.

Mr Lamb’s comments come after it emerged that a number of Transforming Care Partnerships have not set up specialist 24/7 multidisciplinary teams to support some of the most challenging adults and children with learning difficulties to live in their own homes.

Provisional figures from NHS England, seen by HSJ, reveal that as of quarter three of 2017-18 of the 48 Transforming Care Partnerships:

• 35 had intensive support services to look after adults 24/7 in their own homes across their region;
• 23 had intensive support services for children and young people for their whole footprint;
• 19 had adult community forensic services in place across the whole TCP; and
• 14 had a CYP community forensic services across the footprint in place.

Mr Lamb, who established the programme following the Winterbourne View scandal, said the lack of provision in the community will lead to patients being discharged from beds only to be reinstitutionalised.

He added: “It’s a failure, a serious failure. We are forced into this really uncomfortable position of actually being worried about the closure of beds because of the consequences that they have not done enough to prepare community services to take these people.”

The most recent figures from NHS Digital show that there were 2,400 learning difficulties patients in inpatient beds in May 2018, a drop of 475 from the March 2015 baseline of 2,875.

This means to hit the minimum target of a 35 per cent cut in bed numbers to 1,869 NHS England and clinical commissioning groups will have to decommission 531 beds in the next nine months.

Mr Lamb warned that as the deadline for hitting the target approached there are fears beds could be closed without suitable services in the community.

He added: “Beds are being closed with little preparation [in order] to hit the target.

“They have failed on the transformation and so they are panicking to hit their bed numbers so you then get all sorts of irrational behaviours where they are trying to get people out of units either transporting them long distances to another bed which is not acceptable or discharging them into the community without proper preparation.”

HSJ revealed in April that a number of areas were facing “unplanned costs” and that if bed closures continued at the current rate the target will be missed.

In response to a Freedom of Information Act request from Mr Lamb, NHS England said in March this year it was planning to decommission 922 beds between March 2017 and March next year.

This includes 372 of the 1,095 low and medium secure beds across 23 sites, and 550 of the 1,200 beds commissioned by CCGs.

Dan Scorer, head of policy at learning disability charity Mencap, called for NHS England to revise and improve the programme beyond March 2019.

He added: “Serious concerns exist about the lack of current community provision, including a skilled workforce, and without this NHS England’s two pronged target to transform care is unlikely to be met.

“It is clear to us that care has not and will not be transformed by next March.”

An NHS England spokeswoman said more needed to be done to bolster community provision and that the cash released from decommissioning beds will be transferred to local areas to invest in community services.

She added: “Reducing the numbers of people with learning difficulties in hospitals and specialist units is a priority for the NHS and we are well on track to deliver the promised reduction of at least one third by March 2019.

“However, there is more to be done to strengthen support services which is why the money that will be released through decommissioning these inpatient beds this year is being transferred to local health bodies to invest in community teams, including forensic, crisis prevention and those focused on supporting children.”