Dimensions response to the Government’s Building the Right Support action plan

The long-awaited Government action plan `Building the Right Support’ has been published. It aims to speed up discharges and reduce admissions to inpatient mental health hospitals.

It’s been 11 years since the abuse and neglect through misuse of restraint and overmedication at Winterbourne View was exposed by the BBC. Since then there has been a series of human rights breaches and abuse scandals at a number of institutions including Whorlton Hall and Cawston Park.  Yet, little has changed: at Christmas there were still more than 2000 people locked up in hospitals with the average length of stay more than five years.

After such a long hiatus, the question on everyone’s lips is: what’s different about this plan?

A Delivery Board:

A Delivery Board chaired by the Care Minister aims to bring together representatives from government departments and organisations across systems.

Mental Health Bill:

This plan builds on the recommendations in the Mental Health Bill that neither a learning disability nor autism can be considered mental health disorders requiring compulsory treatment.

Investment:

Speeding up discharges for people with a learning disability and autistic people supported by extra targeted funding of more than £90 million in 2022/2023, including:

• £40 million investment from the NHS Long Term Plan to continue to improve the capacity and capability of crisis support for autistic people and people with a learning disability in every area of the country
• £30 million of funding to continue putting key workers in place for children and young people with the most complex needs
• A £21 million community discharge grant to local authorities, which will help people with a learning disability and autistic people to be discharged.
  But is this funding adequate to make a significant difference? It’s worth noting that currently 48% of people whose care plan detailed a ‘delayed transfer of care’ had a lack of suitable housing provision as a reason for their delayed discharge.

The report’s analysis of funding flows acknowledges that:

Training:

The Health and Care Act 2022 brought in a new requirement for registered providers to ensure their staff receive specific training on learning disability and autism, which is appropriate to their role. There are also proposed new duties on commissioners to ensure there are the right community-based services in their area and there is better monitoring of risk of crisis at a local level.

Inpatient facilities are here to stay:

The report doesn’t rule out inpatient care but states that it should be of a high quality, the least restrictive and for the shortest time possible.

Lack of effective financial monitoring:

In September 2021 the DHSC commissioned RedQuadrant to undertake an analysis of funding flows associated with Building the Right Support. Responsibility for the delivery of the programme’s aims has rested with Transforming Care Partnerships (TCPs) and TCPs have reported BtRS performance information, but this did not include financial information.

The report states:

Its recommendations call for comprehensive financial monitoring which covers 2 broad areas:

1. Costs relating to all people who are admitted to inpatient care, those within inpatient care and costs of post-discharge care – this should include the total costs of care and support packages over time, and the share of funding between NHS and councils, and
2. The investment levels in preventative and crisis services, again capturing both NHS and council spend where practicable. Further thought will need to be given around standard definitions to ensure consistency of reporting throughout local systems. It is also acknowledged that this will need to be applicable across both NHS and social care systems.

Better support for children and young people

The report discusses a perceived ‘cliff edge’ of support for young people – particularly autistic young people – at the point of transition to adulthood (age 18) where personal social care may not be appropriate, but other support is needed. This often results in crises developing without early intervention and support, with the prospect of escalation to the point where crisis admissions to hospital or an ATU is the result. There are insufficient levels of local and flexible services and or support available to families with autistic children that can be made available at times of crisis to avert the risk of hospital admission. It recommends making it easier to access community support by increasing the amount and range of supported housing options available.

You can also read our 11-point plan to limit hospital admissions and accelerate discharges.