Health and care bosses in the North East have said a "radically different" plan is needed to "support people with the most complex needs" such as severe learning disabilities and autism.
In light of media coverage focussing on how people around the UK can be trapped in secure hospital accommodation for long periods after being admitted to hospital, the North East and North Cumbria NHS Integrated Care Board (ICB) has highlighted that patient spend too long in hospital, while neurodiverse children are at risk of being given unregulated placements or sent to hospitals, among other issues.
According to the report, across the North East and North Cumbria, of 151 adults and 9 children in learning disability hospitals with the most complex needs, 39 "have been identified as no longer needing to be in hospital". The report explains how this is due to a range of factors - including difficulty attracting highly skilled care staff.
The report also identifies how local authorities budgets for commissioning care do "not reflect the actual costs of retaining this highly skilled workforce in a stable way". As a result, this leads to people with complex needs seeing "multiple placement breakdowns, interruption to relationships and continuity of care".
These breakdowns can cause patients to suffer crises - and force NHS and local authority commissioners to go "off framework" and use providers who, according to the report "are not as robustly quality assured and who can charge up to £45per hour". The report suggests that in the next three years there will be a need for a huge increase in provision for those with the most complex needs.
It states: "Modelling suggests that this additional requirement will be closer to 150 complex care developments across the next three years."
The issue of workforce - specifically staff leaving the care sector - remains a huge issue. "Like other regions there is a significant migration of staff from the care industry to the retail and service sector compounded by the aftermath of the pandemic and Brexit," the report says. "All providers on NENC complex care frameworks cite the lack of suitable applicants and the difficulties in retaining staff on competitive salaries as the major reason for placement failure".
The report identifies the following issues in care for those with the most complex needs:
"Too many people in hospital unnecessarily for too long"
"Over reliance on inpatient services"
"Neurodiverse children at risk of being placed in residential, unregulated placements, or hospital"
"People in unsuitable community placements"
"People, particularly adolescents [sic] at risk of entering the criminal justice system"
However, it explains that the ICB will "make step changes over the next two years to improve the outcomes for people, address the market conditions and secure a workforce to deliver highly complex care packages". This will include creating a "regional registry" of complex care providers, considering investment in intensive support teams, and working with those who have lived experience of receiving mental health and learning disability care.
The Twisting Ducks theatre company - made up of those with learning disabilities and autism - also presented a film highlighting issues including the stark fact that those with learning disabilities die, on average, 15 to 20 years earlier than others.
Welcoming the report, ICB chief executive Samantha Allen said: "There's a table with a number of numbers, and I think it's really important that we recognise that behind each number is a person. These are people currently receiving our services.
"We are very committed as an ICB to look at discharge pathways and getting people home to their communities. We recognise that work on this has been underway for some time but we have quite a bit more to do."
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