Ministers ignore funding call as progress on institutional care grinds to a halt

Ministers have ignored calls from their own consultants to invest more money in cutting the number of people with learning difficulties and autistic people in inpatient mental health settings, despite new figures showing progress has ground to a halt.

The figures show there were 2,010 inpatients at the end of May, compared with 2,005 at the end of March and 2,040 at the end of last August.

The consultancy report* was published alongside a new “action plan” for implementing the government’s Building the Right Support programme, which aims to ensure people with learning difficulties and autistic people have the right support in place to live an “ordinary life” in the community rather than being forced into mental health institutions.

The action plan brings together cross-government work and previous funding announcements, but it appears to offer no new action and no new funding.

The Department of Health and Social Care (DHSC) says in the action plan that while it has made “significant progress” in reducing the number of people with learning difficulties in mental health hospitals by 39 per cent from March 2017 to January 2022, the number of inpatients who are autistic but have no learning difficulty has increased by nearly one fifth over the same period.

The independent report for DHSC, by consultancy RedQuadrant, agrees that there has been some progress since 2015 in reducing the number of people in inpatient mental health settings.

And it says the “moral case” for change remains “overwhelming”.

But it points to the financial model behind Building the Right Support, which is based on using the savings from reducing inpatient care to fund accommodation and support in the community.

The report warns that the savings generated by inpatient bed reductions “are unlikely to be sufficient to meet the costs of many people still to be discharged from inpatient care”.

And it says that “the rate of reduction has not been fast enough to meet stated ambitions and it is acknowledged by most that more needs to be done”.

It also points to the need to address the “continued high admission rates” into inpatient mental health units, particularly of autistic people.

And it warns of “insufficient levels of local and flexible services [and] support available to families with autistic children that can be made available at times of crisis to avert the risk of hospital admission”.

The RedQuadrant report concludes that the government will need to set up a ring-fenced fund to ensure “appropriate levels of investment” in addition to any savings released from inpatient bed reductions.

The report adds: “It will be important that the fund can be demonstrably seen as leading to new and expanded preventative and crisis services by NHS and council partners and is not able to substitute for existing areas of spend.”

But although care minister Gillian Keegan (pictured) briefly referenced the RedQuadrant report in a written statement to MPs, she failed to mention its call for increased funding.

The action plan also mentions the RedQuadrant report, but it too fails to mention the recommendation for more government funding.

DHSC denied that the figures showed that progress had ground to a halt, and it declined to explain why it had not announced any new funding, despite the call in the RedQuadrant report.

It also disputed that Keegan had misled MPs by failing to mention in her written statement the call for increased funding or RedQuadrant’s conclusion that “the rate of reduction has not been fast enough to meet stated ambitions”.

And it declined to explain why the action plan did not mention the RedQuadrant call for more funding and its conclusion about the rate of reduction.

DHSC has been unable this week to point to any new funding in the action plan.

But a DHSC spokesperson said: “In the Building the Right Support action plan, we have set out funding we are providing to strengthen community support, prevent avoidable admissions and support discharges.

“This includes a £40 million investment from the NHS Long Term Plan to continue to improve capacity and £30 million of funding to continue putting keyworkers in place for children and young people with the most complex needs.

“A £21 million Community Discharge Grant to local authorities will also help people with a learning disability and autistic people to be discharged appropriately.”

Two years ago, the Equality and Human Rights Commission (EHRC) began legal action against DHSC – which is still ongoing – over its repeated failure to address the “distressing and horrific” treatment of people with learning difficulties and autistic people in mental health hospitals.

The commission said it had lost patience with DHSC’s failure to move people out of “inappropriate and unlawful” inpatient care and into homes in the community.

Yesterday, an EHRC spokesperson said: “It is unacceptable that, more than a decade after action was first promised, hundreds of people with autism and learning disabilities are still being detained in hospitals when they could be receiving community care.

“We are now carefully considering the DHSC’s action plan and will announce next steps as soon as this is complete.”

Less than three years ago, Disability News Service pointed out that measures introduced by the then health and social secretary, Matt Hancock, to address the treatment of autistic people and people with learning difficulties in mental health hospitals were strikingly similar to failed government measures announced in 2012.

*Building the Right Support: An analysis of funding flows

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