Last Updated on August 2, 2016

People with a learning disability and/or autism will be supported to lead more independent lives and have greater say about the support they receive under a national plan published today to radically improve learning disability services. Central to the progress set out by the plan over the next three years will be new, high-quality, community-based services.

Hundreds of people with a learning disability and/or autism are expected to benefit from new, better care options in the community instead of hospitals, with more never being admitted in the first place.

The plan predicts that, as these services are put in place, there will be a reduction of up to 50% in the number of inpatient beds, meaning that some units will close altogether.

In particular, a key plank of plans developed in Lancashire and Greater Manchester will be to close and re-provide services offered by Calderstones, the only remaining standalone learning disability hospital trust in England.

Building the right support: A national implementation plan to develop community services and close inpatient facilities is being published today by NHS England, the Local Government Association (LGA), and the Association of Directors of Adult Social Services (ADASS). The plans it contains have been developed with significant contribution and constructive challenge from people with learning disabilities and/or autism, their families and carers, and a range of commissioners, providers, voluntary sector and representative groups.

It represents a key milestone in the ongoing cross-system Transforming Care programme, which has seen a number of reforms including the roll out of Care and Treatment Reviews and an upcoming consultation response on strengthening the rights of individuals.

While local areas will be able to design bespoke services with those who use them, the plan sets out the need for:

• local housing that meets the specific needs of this group of people, such as schemes where people have their own home but ready access to on-site support staff;
• a rapid and ambitious expansion of the use of personal budgets, enabling people and their families to plan their own care, beyond those who already have a legal right to them;
• people to have access to a local care and support navigator or key worker, and;
• investment in advocacy services run by local charities and voluntary organisations so that people and their families can access independent support and advice.

To achieve the shift from inpatient to community-based services, Building the right support sets out three key changes:

• Local councils and NHS bodies will join together to deliver better and more co-ordinated services – 49 new local Transforming Care Partnerships will work with people with lived experience of these services, families, carers and key local stakeholders to agree robust implementation plans by April 2016, and then deliver on them over three years. They will be made up of clinical commissioning groups, NHS England’s specialised commissioners and local authorities, and will cover the whole of England.

• Budgets will be shared between the NHS and local councils to ensure the right care is provided in the right place – A new financial framework will aim to speed up discharges, particularly for those who have been in inpatient care the longest, and make better use of resources so that services can be increased and improved. Central to the new framework will be the opportunity for local pooled budgets which encourage better use of resources for all people in a local area with learning disabilities and/or autism. Funding guidance will also be reformed to enable swift discharges. For people who have been in hospital five years or more, specific payments will be made by the NHS to local authorities to enable their needs to be met in the community.

• National guidelines will set out what support people and families can expect, wherever they live – A new Service Model describes what good services should look like, framed around nine principles from the perspective of the people using them. It gives people a clear picture of what they can expect from the services they use, while at the same time allowing Partnerships the flexibility to design and commission services that meet the needs of people in their area. The new model, which was co-produced by people using services, commissioners and health and social care system leaders, has been finalised using the feedback from early implementation by six ‘fast track’ areas.

In England, around 24,000 people who have a learning disability and/or autism are classed as being at risk of admission. Although the number of discharges or transfers has increased by 38% over the last year, 2,595 people were in inpatient settings as of 30th September, more than three quarters of whom had been in inpatient facilities continuously for longer than a year.

While these placements are often a necessity in the short-term, in too many cases they are used as a long-term option due to a historic lack of community-based services. These arrangements do not deliver the best outcomes for these people. They are also expensive, costing the health and care system on average over £175,000 per year for often-inappropriate care.

As new and better alternatives become available in the community, the plan predicts a reduction in inpatient beds of between 30% and 50% nationally. In some areas that have relied on inpatient settings more than average, the number of beds which will be commissioned may be reduced by up to 70%.

This should free up hundreds of millions of pounds for investment in community-based support, as well as improving the quality of remaining inpatient units so that they can meet the needs of patients in the new system.

A national NHS England fund of £45m will be available to Transforming Care Partnerships over the next three years to aid the transition, focusing on ensuring that the right support is available in local areas to enable the first discharges. £15m will be available for capital projects, and £30m is available on a match-funding basis for local commissioners to ‘double-run’ services, meaning a total transformation fund of £75m.

Bed closures will be staged, taking place when suitable alternatives are available. Providers such as hospital trusts will be supported by NHS England and others to adapt to the new model, shifting their own services to the community where possible.

Progress made will be reviewed before the end of 2018 with a view to establishing whether the number of beds could and should be reduced further in following years.

Over the summer of 2015, NHS England, the LGA and ADASS supported six ‘fast track’ areas to draw up plans for service transformation, closing some inpatient beds and shifting investment into community support.

A £10m transformation fund was made available to these areas to help fund the fast implementation of their local plans, which have been published alongside today’s national documents. The initial allocation of the fund, to cover workforce development and building capacity in the community, is as follows:

• Greater Manchester – £3.00m;
• Lancashire – £1.32m;
• Cumbria and the North East – £2.06m;
• Arden, Herefordshire and Worcestershire – £825k;
• Nottinghamshire – £1.21m; and
• Hertfordshire – £1.27m.

In a joint statement released today, Professor Rhidian Hughes, Chief Executive of the Voluntary Organisations Disability Group, Professor Martin Green OBE, Chief Executive of Care England, Alicia Wood, Chief Executive of the Housing & Support Alliance, Lisa Lenton, England Director at the Association for Real Change and Sir Stephen Bubb, Chief Executive of the Association of Chief Executives of Voluntary Organisations said, 'We are the organisations that represent voluntary and independent providers of learning disability services in England. We have come together to provide a unified response to the transforming care plans published today by NHS England and their partners.

'Transforming and improving care for people with learning disabilities, and particularly those with behaviour that challenges, is a joint endeavour. The endeavour is a partnership between people who use services and their families, providers and commissioners. There is no one constituency that holds all the answers, but together we can deliver the change people with learning disabilities want and expect.

'The voluntary and independent provider sector is committed to working transparently and collaboratively to support the transforming care programme. We have worked with NHS England and partners to help shape the agenda. But from these words we believe now is the time for action.

'The transforming care programme requires substantial change to be delivered at scale and pace. The task ahead cannot be underestimated and it will not be sufficient to plan services one person at a time. The challenge is to develop person-centred services at a scale that helps large numbers of people move back to their communities and stops people entering assessment and treatment units unnecessarily. For these reasons there need to be significant financial investment, from a range of sources, to re-provide services from in-patient services to community based solutions.

'Alongside service transformation there needs to be workforce transformation. The sector is already experiencing significant challenges with recruitment and retention of staff in an ever-more competitive labour market. The right workforce to deliver person-centred care, including approaches such as positive behaviour support, needs to be planned and delivered in a systematic and coherent way.

'Maximising individual choice is absolutely paramount as people move out of assessment and treatment units. The role of advocacy will be central to this process and whilst community provision is a key offer, we recognise it is one of many options that exist for individuals. We want individuals to exercise independence and control over their own lives.

'Community providers need to ensure that they are building the right organisational culture, values and skills to deliver and support people. This includes enabling people to access personal budgets and individual service funds. Ultimately, as the transformation plan is implemented, providers will need to demonstrate their capability to people with learning disabilities and their families as well as to commissioners.'

For more information, visit the NHS England website here.