Children’s Commissioner: secure hospital admissions

May 20, 2019

Anne Longfield, the Children’s Commissioner for England, has published a new report, looking into how many children are still admitted to secure hospitals.

Far less than they deserve: Children with learning disabilities or autism living in mental health hospitals shows how too many children are being admitted to secure hospitals unnecessarily – in some cases are spending months and years of their childhood in institutions. It warns that the current system of support for those with learning disabilities or autism is letting down some of the most vulnerable children in the country.

The report also found evidence of poor and restrictive practices and sedation, with some children telling the Children’s Commissioner of how their stay in mental health hospital has been traumatic, and parents often left feeling powerless to intervene.

Some of the main findings in the report include:

  • The numbers of these children identified in mental health hospitals is increasing. 250 children with a learning disability or autism were identified in a mental health hospital in England in February 2019, compared to 110 in March 2015.
  • Children are being detained in hospital for too long. Data shows that on average, children with autism and/or a learning disability had spent eight months (240 days) in inpatient care in total. Around one in seven children had spent at least a year in their current hospital spell with their current provider; any could have returned home if support was available.
  • Children are being placed far from their family and home. Data provided to the Children’s Commissioner’s Office reveals that 95 children were staying more than 50km (31 miles) from home. 55 children (nearly a third) were in a ward known to be more than 100km (62 miles) from home.
  • Nearly one in four children had a total length of stay of at least six months and were in a ward at least 50km from home. Around one in ten children had a total length of stay of at least a year and were in a ward at least 100km (62 miles) from home.
  • The quality of care in hospitals is highly variable. Some families told the Children’s Commissioner about the excellent support their children had received, but others had shocking stories to tell.
  • Children’s care is not being regularly reviewed, meaning they may not be getting appropriate care. Data shows around a quarter of children did not appear to have had a formal review of their care plan within the last 26 weeks, and roughly one in seven had not had a review recorded within the last year.
  • Many parents feel they are being shut out of decisions about their children’s care and are not always informed about incidents involving their children. Others told how serious incidents had happened in hospital without families being told. Some families had even faced gagging orders.
  • 75 children with a learning disability and/or autism in hospital were recorded as having been restrained in December 2018. This group received a reported total of 820 incidents of restraint in that month – nearly 11 incidents of restraint per restrained child, on average.

The Children’s Commissioner makes a number of conclusions including:

  • Ministers should launch a cross-government national strategy to ensure the right support is available in every area to stop these children going into hospital.
  • NHS England should actively monitor all children in inpatient settings and cases at risk of admission (for example those in residential special schools), then work with local commissioners to reduce length of stay and reduce the risk of admission.
  • There should be an assessment of the child before admission, in consultation with family and community services, resulting in a clear plan as to why a hospital admission is necessary, what will be treated in hospital and what the child is being prepared for on return to the community.
  • Local authorities need to maintain and make proper use of risk registers.
  • Action needs to be taken to improve the care within hospitals.
  • There is a need for culture change with higher expectations and standards and tougher inspection by the Care Quality Commission.
  • More transparency is needed over restraint approaches.

Anne Longfield, the Children’s Commissioner for England, said, 'A national strategy is needed to address the values and culture of the wider system across the NHS, education and local government so that a failure to provide earlier help is unacceptable, and admission to hospital or a residential special school is no longer seen as almost inevitable for some children. There has been report after report and promise after promise to address this issue and yet the number of children in hospital remains stubbornly high.

'We know more about the lives of these children and the impact it is having on their families, than we did. The onus is now on Ministers, the NHS, the CQC, Ofsted and local authorities to make sure that these most vulnerable of children are not locked out of sight for years on end simply because the system is not designed to meet their needs. Hospital admission must always be in a child’s best interests and as part of a managed process, with clear timescales and a focus on keeping the length of stay as short as possible. This is clearly not happening at the moment and instead we have a system which is letting these children down.'

Tim Cooper, Chief Executive at United Response, said, 'Today’s report on ‘treatment’ methods for children with learning disabilities, some as young as ten years old, lays bare the catastrophic failures within our health and care system.

'...It has been seven years since the Winterbourne View scandal revealed shameful institutional abuse, and six years since Government vowed to end this “normalisation of cruelty” in parts of the care system.

'Yet successive reviews, respected academic studies and NHS data all consistently highlight a failure to meet this pledge.

'...As a dedicated and longstanding provider of bespoke community-based care for young people with learning disabilities and autism, United Response is continually showing how vulnerable people can be supported in making the move from "hospital to home".

'With the right backing, we and other support providers can move even more vulnerable people of all ages back into the community and stop this longstanding problem in its tracks.

'We are ready to work with central and local Government to ensure that people with complex needs are given the tailored support they deserve and in the communities in which they belong.'

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