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On 13 December 2023, the House of Lords is scheduled to consider the following question for short debate:

Baroness Hollins (Crossbench) to ask His Majesty’s Government what assessment they have made of progress made towards achieving the target in the NHS long term plan to reduce the number of people with learning disabilities and autism in inpatient mental health care by 50 per cent by March 2024, relative to 2015 levels.

1. Recent data on the number of inpatients with a learning disability or autism

The latest monthly ‘assuring transformation NHS Digital’ data, which covered the period 1 October to 31 October 2023, provided the following data on the number of inpatients with a learning disability or autism:

  • At the end of October 2023, there were 2,035 people with a learning disability or autism in hospitals in England.
  • Over half of these people had been there for over two years in total (1,110).
  • During October 2023, 80 were admitted to hospital: 50 were first admissions in a year, 15 were readmissions within a year of the previous discharge, and 15 were transfers from other hospitals.
  • In October 2023, 135 people left hospital.
  • Under half of the people in hospital at the end of October 2023 had a date planned for them to leave hospital (910).[1]

2. Government policy on people with learning disabilities and autism in inpatient care

In 2019, the NHS long term plan set a target to reduce the number of autistic people and people with learning disabilities in inpatient care:

By March 2023/24, inpatient provision will have reduced to less than half of 2015 levels (on a like for like basis and taking into account population growth) and, for every one million adults, there will be no more than 30 people with a learning disability and/or autism cared for in an inpatient unit. For children and young people, no more than 12 to 15 children with a learning disability, autism or both per million, will be cared for in an inpatient facility.[2]

In 2022, the government reaffirmed this commitment in its ‘Building the right support action plan’. The purpose of the action plan was to “complement and support” achievement of the target. The action plan set out progress that had been made by the end of May 2022:

  • The inpatient total at the end of May 2022 was 2,010: this was a 30.7% net reduction since March 2015, when there were 2,900 people with a learning disability and autistic people in mental health hospitals.
  • There was regional variation within this, with some integrated care systems (ICSs) having met the long term plan target. For example, six out of 42 ICSs had met the 2023 to 2024 NHS long term plan target.[3]

The government said that, while the data showed there had been “significant progress” in reducing the number of people with a learning disability in mental health hospitals, it “is clear that we still have work to do to bring about a similar reduction in the number of autistic people in inpatient care”. The government pointed to the following data to illustrate this conclusion:

  • The number of inpatients with a learning disability only had decreased by 39% from March 2017 to January 2022.
  • The number of inpatients with a diagnosis of autism (and no learning disability) had increased by 19% from March 2017 to January 2022.

The government said it accepted better support was needed for autistic people. It stated that, in recognition that a different holistic approach to supporting autistic people was necessary, the government had published its 2021 autism strategy. It said the strategy had been backed by over £74mn in its first year, adding:

We invested funding in 2021 to 2022 as part of the wider £31mn from the Covid-19 mental health and wellbeing recovery action plan, to help prevent avoidable admissions and drive improvements to inpatient care provision for autistic people through autism training for staff and funding to adapt environments. We will also build on the actions we have set out in the implementation plan from 2022 to 2024, which we will publish following the end of the first year of the strategy (which runs until July 2022).

The government put forward a draft bill in 2022 to reform the Mental Health Act 1983 (MHA) which would have included provision to stop people being sectioned on account of autism and make it easier for autistic people in hospitals to leave.[4] Specifically, the draft bill contained measures to remove learning disabilities and autism as conditions for which an individual could be detained for treatment under section 3 of the MHA, which allows detention for up to six months and which can be renewed. Despite that draft bill, however, legislation is yet to be introduced. Organisations such as the National Autistic Society have called for the government to press ahead with the bill, arguing that it “is widely recognised that for most autistic people, care in an inpatient unit is rarely helpful—in fact, it can be deeply damaging”.[5] On 5 December 2023, Parliamentary Under Secretary of State for Health and Social Care Maria Caulfield said it was still the government’s intention to bring forward this legislation “when parliamentary time allows”.[6]

The government is also looking to reform the use of long-term segregation of people with learning disabilities and autism in inpatient care. In 2019, the government commissioned Baroness Hollins to chair an independent panel to review the cases of people with a learning disability and autistic people detained in long-term segregation.[7] Part of its aim was to identify the blocks to discharge.[8] The Independent Care (Education) and Treatment Review (IC(E)TR) programme ran from November 2019 to March 2023 and reviewed the cases of 191 people.

On 8 November 2023, the Department of Health and Social Care published Baroness Hollins’ final report, ‘My heart breaks: Solitary confinement in hospital has no therapeutic benefit for people with a learning disability and autistic people’, which summarised the findings of the programme. The report called for the government to publish an annual report on the progress towards ending the use of solitary confinement for people with a learning disability and/or autistic people. It recommended that alternative accommodation should be made available to people at times of acute distress where the community support services did not meet their immediate needs. It argued this would prevent admission or readmission into hospital. It also put forward proposals for pilot schemes for “intensive recovery pods” (homely places of safety in the community) which are “autism friendly, trauma informed and where the person and those supporting them feel safe”.

In response to the report, health minister, Maria Caulfield, said the government was already acting on some of the recommendations.[9] For example, she highlighted NHS England’s ‘Mental health, learning disability and autism inpatient quality transformation programme’. The programme was established in 2022 to “support cultural change and a new bold, reimagined model of care”. One of its aims is to “explore and accelerate different therapeutic offers”, including community-based alternatives to admission.

However, Ms Caulfield said that several of the recommendations would “require further work before they can be delivered”, with some requiring “consideration of more significant reforms, at the relevant time”.[10] The minister noted that the report would be used to inform the next update to the ‘Code of practice: Mental Health Act 1983’ when it is reviewed.

3. Read more

3.1 Policy papers and reports

3.2 Parliamentary material

3.3 Briefings and commentary

Cover image by Freepik.

References

  1. NHS Digital, ‘Learning disability services monthly statistics, AT: October 2023, MHSDS: August 2023’, 16 November 2023. Return to text
  2. NHS, ‘The NHS long term plan’, January 2019, p 53. Return to text
  3. Department of Health and Social Care, ‘Building the right support action plan’, 19 August 2022. Return to text
  4. Department of Health and Social Care and Ministry of Justice, ‘Draft Mental Health Bill 2022’, 27 June 2022. Return to text
  5. National Autistic Society, ‘Number of autistic people in mental health hospitals: October 2023’, 17 November 2023. Return to text
  6. HC Hansard, 5 December 2023, col 200. Return to text
  7. Department of Health and Social Care, ‘All inpatients with learning disability or autism to be given case reviews’, 5 November 2019. Return to text
  8. Department of Health and Social Care, ‘Baroness Hollins’ final report: My heart breaks—solitary confinement in hospital has no therapeutic benefit for people with a learning disability and autistic people’, 8 November 2023. Return to text
  9. Department of Health and Social Care, ‘Letter from Maria Caulfield MP, women’s minister (GEO) and parliamentary under secretary of state for mental health and women’s health strategy, to Baroness Hollins, chairperson of the Independent Care (Education) and Treatment Review’, 8 November 2023. Return to text
  10. As above. Return to text