AUTISM AND LEARNING DISABILITY CARE
An arbitrary number What is the current state of autism and learning disability care following demands for the CQC to scrap its requirement for all units to have no more than six beds? Kathy Oxtoby reports
T
housands of people with autism and learning disabilities are living in inappropriate settings. And it is all down to an arbitrary figure – six. So says Care England, which has called on the government to drop the cap on care home learning disability places. According to the charity that represents independent care providers, the limit of six places for adults with autism or learning difficulties in a care home has left more than 2,000 individuals requiring specialist accommodation in hospital or inappropriate assessment centres. “We are concerned this policy is consigning people with learning disabilities and autism to inappropriate services,” says Professor Martin Green, chief executive of Care England. He says the failure of the Department of Health and Social Care’s Transforming Care programme to close 30% to 50% of inpatient beds for those with learning disabilities and/ or autism by March 2019, is largely attributable to the Care Quality Commission’s limit on the number of rooms allowed in a learning disability home.
Unit limitation This unit limitation is having a large-scale impact on individuals and their families. According to the National Autistic Society, a survey of around 11,000 autistic adults and their families in England and evidence sessions in Parliament, published last autumn, found that: • Three in four (76%) autistic adults had tried to obtain mental health support in the previous five years; almost two thirds (64%) of families had tried the same • Six in 10 (58%) autistic adults say they need counselling, but only one in five (21%) get this support. Four in 10 (40%) of families need this support but only one in 10 (11%) get it • Four in five (82%) autistic adults believe the process of getting support from mental health services took too long; over eight in 10 (87%) of families believe this is the case • Only 14% of autistic people think there are enough mental health services in their area to meet their needs; 11% of families think this. The survey was part of an inquiry by the All Party Parliamentary Group on Autism, with support from the National Autistic Society, exploring the impact of the Autism Act 10 years after its introduction.
34
The inquiry heard that as a result of not getting support, many people with autism are becoming isolated and at risk of developing mental health problems. The National Autistic Society says: “Services like social groups, befriending, or help to get people out and about can make a huge difference to autistic people’s wellbeing, but are often not available. Too many develop mental health problems because they can’t get this support early enough and, as a result, an increasing number end up in mental health hospitals miles away from their friends and family – and in some disturbing cases, inappropriately restrained, over-medicated and kept in isolation.” The government has acknowledged the need to develop community services for people with a learning disability and/or autism – the NHS England strategy ‘Building the Right Support’ from 2015, set out the target to close up to 50% of the beds in the hospitals by March 2019. However, according to the learning disability charity Mencap, only 22% of beds were closed by that date. The new target of closing 35% of beds by last month has probably not been met, Mencap says. And another target, of closing 50% of beds was published in the NHS Long Term plan last year, to be achieved by March 2024. Data released from NHS Digital shows that in January this year 1,950 adults and 235 children “continue to be locked away”, Mencap says. “There has been little change in the number of admissions with 100 people admitted in January alone. While 140 people remained in hospital when they are ready for discharge, with the main reasons being a lack of social care and housing provision in the community,” the charity says. Mencap says discharge delays continue – that there are 140 people with a learning disability and/or autism who should be back home in their community. There are a high number of reported uses of restrictive inventions – 3,500 in one month, of which 805 were against children. It says this is likely to be just the “tip of the iceberg” as only data for three out of 18 private/independent providers and 28 out of 54 NHS providers was gathered. And the average total length of stay in in-patient units remains at 5.4 years. The charity is concerned that “there is still no robust cross-government strategy to ensure that health, social care, education and housing work together to stop inappropriate admissions and get people out of inpatient units”.
2,185 inpatients were in hospital at the end of January 2020*
32% of inpatients last had a review of their care over six months ago (700 people)*
HealthInvestor UK • April 2020
