Address NHS clinicians’ underestimation of social care

Paul is a 29 year old man with severe autism. Before moving to our Transforming Care service, he’d been in a secure setting for nine years.

Paul needs three-to-one support, 24/7, and has an adapted property with padding on the walls to stop him harming himself – yet since moving to the service, his behaviour and life have been transformed.

Life has also improved for his family – he now lives in the same borough rather than hundreds of miles away.

This is a Transforming Care success. It is what NHS England had in mind when, in 2015, it introduced its agenda for significantly altering the way people with learning difficulties are looked after. Yet with just seven months until the deadline by which the NHS and its partners committed to making meaningful progress, Look Ahead believes there are too few Pauls – and the statistics back this up.

Figures cited by Norman Lamb MP in a Parliamentary debate in July, show that, as of May this year, there were still 2,400 people with learning difficulties and/or autism trapped in assessment and treatment units, 41 per cent of whom are over 50km away from home.

In order to hit NHS England’s minimum target of reducing the number of individuals in secure settings by 35 per cent, 900 beds need to be closed by March 2019 – it is currently around 500 short of this figure.

Speed of the transition process

Progress has been slow, and in Look Ahead’s experience, this is in large part due to clinicians questioning social care professionals’ ability to manage risk, and their lack of confidence in social care to do its job and successfully bring people back into the community.

Seven years on from the Winterbourne View scandal, we must not lose sight of the reasons why the Transforming Care agenda was launched. There must be a successor programme which refreshes agencies’ commitment to helping people with learning difficulties and/or autism to lead more fulfilling lives.

We must not lose sight of the reasons why the Transforming Care agenda was launched

This next agenda must focus on the speed of the transition process, specifically the point at which responsibility needs to be handed over to social care professionals, supported by community based clinicians.

Social workers vs NHS clinicians

As a not-for-profit provider, we are often stuck in the middle of negotiations between social workers – who believe an individual should be discharged – and NHS clinicians – who struggle to believe their patient will receive the necessary care outside an institution.

Indeed, we’ve known it take up to 10 months to transfer suitable individuals from hospital settings to the community, with NHS professionals clinging to the belief that they will not cope, even though all of the risk assessments have indicated otherwise.

Look Ahead’s Nimrod House in Newham is our most notable service in this space. A Care Quality Commission registered, accommodation based scheme, it enables individuals to live in the community with the support of care workers, friends and family.

Not only are Nimrod House residents living more fulfilled lives closer to their loved ones, their new model of accommodation, care and support saves public money. For example, one resident’s placement at Nimrod House is 17 per cent cheaper than his previous placement in a high security hospital, where he spent nearly 18 years, far away from those close to him.

Following in Nimrod’s footsteps

A National Audit Office report on the progress of Transforming Care, published in 2017, found local partnerships were “struggling to put in place appropriate accommodation quickly enough”. This was echoed by the VODG report issued in May which set out clear recommendations for speeding up progress.

As a specialist housing association that owns its properties, we’re able to focus on the end result: seeing individuals thrive in a community setting. However, for other organisations, the costs involved in offering this kind of accommodation, care and support could be prohibitive.

In order to ensure the next Tranforming Care agenda succeeds, clinicians must see environments like the one at Nimrod House with their own eyes

During the transition process, we often have to swallow the cost of holding spaces in our open for months while clinicians and social care professionals go back and forward between themselves.

In order to ensure the next Tranforming Care agenda succeeds, clinicians must see environments like the one at Nimrod House with their own eyes, and understand why they lead to a better quality of life for their patients.

Building brick by brick

At Look Ahead, we’re doing what we can to kickstart this process. We welcome clinicians into our schemes, and we’ve been working with Health Education England to set up pilot placements for nursing associates as part of their training. The first one starts early next year.

We also need to be better at independently evaluating and celebrating success. Look Ahead has commissioned the Housing Associations’ Charitable Trust to do conduct an independent evaluation of our Nimrod House service, the results of which will be published later this year.

While it seems unlikely that the current Transforming Care agenda’s deadline will be met, everybody involved must recognise that it provides us with the bones of a great idea

Finally, public and private providers in our sector must give clinicians confidence in our risk processes. At Look Ahead, we also manage a forensic mental health service in East London, and we’ve been able to gain commissioners’ and customers’ confidence in our risk management approach. We have to achieve more of the same with clinicians in the Transforming Care space.

While it seems unlikely that the current Transforming Care agenda’s deadline will be met, everybody involved must recognise that it provides us with the bones of a great idea.

Let’s now build momentum as quickly as possible, so that people like Paul don’t spend the rest of their lives behind closed doors, instead of living.