An Overview; Transforming Care - 10 Years On

Updated: Oct 13

A report on the progress of the Transforming Care programme

by Sarah Leanney, R&D Researcher, Safe As Houses

2011 – Time for change

Ten years ago, the BBC’s Panorama programme exposed the abuse of patients at Winterbourne View, an independent hospital for people with learning disabilities and/or autism.

This prompted further inspections by the CQC of 150 hospitals and care homes for people with a learning disability where they discovered inadequate practice in in-patient services including poor person-centred care, limited appropriate activities and a lack of monitoring and learning from incidents of restraint.

2012 – The start of Transforming Care

In response to these findings, during December 2012 the Department of Health launched the policy Transforming Care: A National Response to Winterbourne View Hospital, stating that “Hospitals are not where people should live” and pledged that everyone inappropriately placed in hospital would move to community-based care as quickly as possible, and no later than 1 June 2014.

The policy was accompanied by the Winterbourne View Review: Concordat, an agreement signed by the NHS, statutory organisations and stakeholders committing themselves to the provision of appropriate services for people with learning disabilities.

2014 – Targets missed

In June 2014, when the target to move people to community care had been missed, NHS England commissioned Sir Stephen Bubb, CEO of ACEVO (Association of Chief Executives of Voluntary Organisations) to consider how a new national framework for learning disability services could be implemented.

His report, Winterbourne View - Time for Change (2014), recommended the urgent closure of inappropriate in-patient care institutions after finding that people with learning disabilities were still being placed in long-term institutional care rather than being supported within the community and that there were still more people being admitted to such institutions, than were being discharged.

His comment at that time was “That failing to deliver this new programme is simply not an option. Another deadline, another target, cannot mean another broken promise. There is a commitment to closures and to developing community care”.

2015 – A sense of urgency

Although his subsequent report, Winterbourne View - Time is Running Out (2015) found that although progress had been made, with the number of people being discharged from inpatient institutions greater than the number admitted, it said that the Transforming Care programme “Had not yet delivered tangible benefits in terms of new community facilities or closures”.

Also in 2015, the National Audit Office (NAO) published its report, Care Services for People with Learning Disabilities and Challenging Behaviour, which found that the Government had not met its central goal of moving people out of hospital by June 2014 because it “Underestimated the complexity and level of challenge in meeting the commitments in its action plan”. In response to this report the Chief Executive of NHS England announced that there would now be both a planned closure programme for NHS mental health hospitals and a change in commissioning practices for NHS inpatients within the independent sector, accompanied by a transition plan for the people with learning disabilities within these hospitals from 2016–17.

In October 2015, NHS England, in partnership with the Local Government Association (LGA) and the Directors of Adult Social Services (ADASS), published Building the Right Support, a national action plan created to ensure that with the right services in place people wouldn’t need to go into in-patient hospitals.

Underestimated the complexity and level of challenge in meeting the commitments in its action plan”.

Building the Right Support – the new framework in 2015

Building the Right Support set a number of objectives for NHS England and the 48 newly created Transforming Care Partnerships, comprising CCGs, NHS England commissioners, and local authorities.

This new policy aimed to shift money from in-patient services to the community and was accompanied by £40 million of transformation funding from 2015/16 to 2018/19, to be matched by CCGs, and £20 million in capital funding.

It was intended that the development of a National Service Model, to be put in place by the end of March 2019, and the introduction of a new financial framework would help to resolve disagreements about who was responsible for funding a person’s support.

The National Service Model for Building the Right Support is made up of nine principles and that services should offer:

  1. A good and meaningful everyday life

  2. Person-centred, planned, proactive and coordinated care

  3. Choice and control

  4. Support from and for their families/carers as well as paid support and care staff

  5. Housing

  6. Mainstream NHS services

  7. Specialist health and social care support in the community

  8. Support to stay out of trouble

  9. Treatment in a hospital setting for no longer than they need it

The success or failure of Transforming Care/ Building the Right Support would be measured by the policy’s ability to reduce the number of people detained for assessment and treatment in inpatient hospitals, and the following targets were set for 2019: