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The unintended consequences of NHS England’s Homes not Hospitals report

Steve Scown
Dimensions CEO, Steve Scown, blogs.

NHS England’s report “Homes not Hospitals” recently announced the closure of up to 50% of NHS long stay hospital beds for people with learning disabilities.

A parallel announcement was made of £45m funding over three years for community based support to replace these services.

This has been a long time coming. At long last, deeds may be about to back up words. Winterbourne View may have launched a thousand debates but, until now, meaningful change has been elusive.

As many people continue to enter so called “Assessment and Treatment Units” as leave them. Despite these units being intended for the short term, stays are measured in years, not weeks.

In response, local authorities point to a lack of suitable community based services.

Providers of long term hospitals also have the profit motive, and their “responsible clinicians” can be risk averse and disinclined to recommend discharging people. Isn’t there a conflict of interest if the sustainability of your employer is compromised by your decision to discharge?

30 years ago, when I trained as a learning disability nurse in a high security hospital, very few of the inpatients believed they could live in their own home, be part of their local community, have a job or be in a loving relationship.

But these same people, once out of hospital, have made fantastic progress. Many are living with less support and are exercising choices about when they get support, to do what, and with whom.

Some are contributing to their local communities through voluntary jobs, and contributing to wider society by voting in elections. None of this was thought possible in the days of institutional ‘care’.

So real change, backed up with real funding, is welcome. But the announcement only covers NHS facilities. From what I can see, there is nothing to stop the commissioning of similar, inappropriate beds outside the NHS.

Unless the announcement is given teeth, and a real commitment to developing local community-based services is made, I fear we may yet look back on “Homes not Hospitals” as an opportunity missed.

My second concern is the announcement of a dowry arrangement whereby NHS funding automatically transfers to the local authority for people who have been in an institution for five years.

The dowry itself is a good idea and draws upon learning from previous closure programmes.

But why five years?

A lower threshold – say, two years – would reflect the intended nature of such placements and would allow the local authority to consider a broader range of support options for more people, sooner.

And what of the £45m transformation budget to provide facilities for half (just half!!!) of the 2,600 people currently living in long stay institutions?

Well, Dimensions has considerable experience of how to provide proper support for these people. We know what it takes to provide the support that many will need in order to transition to supported living arrangements.