“Creative budgeting” is needed to ensure a new model of care for people with learning disabilities – proposed in the wake of the Winterbourne View scandal – becomes a reality, LGC has been told.
A new draft service model was published last week by NHS England, the Local Government Association and the Association of Directors of Adult Social Services.
The model said inpatient care for people with learning disabilities and/or autism and a mental health or behavioural condition should be “very rare”. Instead there should be more support in the community, including help for parents to care for children at home, and a greater use of personal budgets.
The paper said NHS and local authority commissioners should use the guidelines to plan services and budgets for 2016-17 with the intention of making a “significant shift” to community-based services over the next 18 months and allowing the closure of inpatient beds.
The guidance follows the Winterbourne View abuse scandal which highlighted the numbers of people with learning disabilities or autism who spend years locked away in inappropriate hospital placements.
Senior social care figures told LGC the draft model contained many positive measures, but warned difficulties in moving funding from NHS inpatient care to NHS and local authority community services could prove a challenge.
Helen Sumner, assistant director for transforming care at the LGA, told LGC there was “no lack of will or commitment” to making the changes outlined in the new guidance, which is not mandatory in the current draft.
She said: “It is ambitious and do-able but there are real challenges in there in terms of how the money will work.
“We already know we spend quite a lot of money on care that could be more individually suited to people. There is no denying there will need to be very creative thinking and creative budgeting to make the transformation of service models.”
An NHS England board paper, published last week, said the costs of future services and the transition to greater use of community care would be met from current spending.
It said money may have to be shifted via pooled budgets and NHS-funded dowries for people discharged after very long spells in hospital. The paper said NHS England intended to issue further guidance on how the finances would work, including the dowries, in the autumn transformation plan.
The transformation plan, which will be out by October, covers the national transformation of services including bed reductions and plans for workforce development.
At present, only five fast track areas announced in June – Greater Manchester and Lancashire; Cumbria and the North East; Arden, Herefordshire and Worcestershire; Nottinghamshire; and Hertfordshire – get additional money to help them move people with learning disabilities and mental health conditions out of inpatient beds and into community services.
Andrea Pope-Smith a social care consultant and former joint chair of the Adass learning disability network, said other areas of the country also needed a “properly structured programme” including funding to help them move people from hospital to community services.
Progress on moving people with learning disabilities out of inpatient care has been slow. The original target, following Winterbourne View, to move people out of inappropriate inpatient placements by June 2014 was missed and so the Transforming Care programme was set up in summer 2014.