The report from VODG (Voluntary Organisations Disability Group), Transforming care – the challenges and solutions, addresses NHS England’s policy ambition to enable people to move from inpatient settings, closer to their homes.
The findings are based on the work of VODG’s Provider Taskforce, which is a group of organisations that are collectively responding to the transforming care agenda. The pilot project described in the new report set out to develop support assessment and proposals for 27 people originally from London who had been in inpatient settings for longer than five years.
The report is not a formal evaluation of that work, but offers insights into delivering NHS England’s policy ambition both in London as well as nationally. It also sets out recommendations for more strategic future steps.
Rhidian Hughes, VODG chief executive, said:
“Our pilot work clearly shows that each individual we supported would have been able to live well within a local community, with the right housing and support. However, this aim was often undermined by multiple, often system-wide issues that delayed or blocked a move out of hospital. The focus should be on the best outcomes for the individuals concerned, but this was hampered by challenges such as unrealistic expectations about the costs of high quality community provision and rigid procurement processes.
The problem was not a lack of community-based care providers, but the fact that there was not a strategic approach to identifying appropriate support for each person. Today’s report reiterates VODG’s commitment to focusing efforts on the transforming care agenda.”
The challenges involving commissioners, funders and care providers include:
- delays in hospital discharge plans, including a lack of knowledge in local authorities about potential community support options
- negative attitudes and aspirations towards people supported (for example, referring to people by patient identity number instead of by their name)
- confusion about costs, with commissioners and funders underestimating the cost of initial support immediately after discharge and/or therapeutic support
- a lack of support to families, despite the fact that responsive ongoing support to families is critical to the sustainability of support to their loved one.
The report also identifies three indicative patterns of housing and support needs for those moving from long-term inpatient facilities: bespoke accommodation and support for people to live alone; bespoke accommodation and support within a core and cluster model; shared housing and support.
Solutions that could help reduce delays discharge times and support community-based housing and care options include:
- a pan-London approach to meeting individual needs
- stronger accountability
- clearer communication between professionals
- improved knowledge and information about the cost of high quality care
- earlier identification and sourcing of housing options
- better links with clinical and therapeutic support.
Longer term steps include developing a strategic regional pathway to move people out of hospital or prevent readmission and a detailed analysis of costs and funding arrangements. VODG also advocates the development of a sustainable care, support and housing market to support the current and future needs of people with learning disability and/or autism. In addition, the creation of a care provider network would offer the potential to map organisations’ capacity, skill and ability to deliver appropriate, good quality support for those leaving long-stay facilities.