Finding suitable homes for people with learning disabilities or autism is one of the biggest challenges in making sure that they are not left to live their lives in hospital, councillors have been told.
The NHS in Lancashire and South Cumbria is part-way through a programme to halve the number of inpatients with a learning disability who are being housed in hospital beds on a long-term basis.
An increase in the number of recent admissions and “overly ambitious” discharge dates mean that the target - due to be met by March 2019 - is likely to be missed.
But Rachel Snow-Miller, director of mental health commissioning at the region’s Integrated Care System (ICS), said that difficulty in securing housing for former hospital patients was the main cause of the delay.
“Sometimes housing providers are reluctant to engage with this group of people - they are nervous about having people with a learning disability or autism living in their property,” she told Lancashire County Council’s health scrutiny committee.
Members also heard that companies offering community care services found some individuals “too complex” to deal with. Many providers were demanding anything between six and eighteen months’ notice to supply a care package.
Out of almost 40 operators in the region who look after people with learning disabilities or autism in the community, fewer than half are routinely submitting bids for work.
The ICS is currently trying to stimulate the market, but Ms. Snow-Miller defended the decision to avoid sending inpatients to a residential care setting as a stop gap.
“People will move to the right home and at the right time - why would we move people twice when we can move them once? she asked.
The meeting was also told that there was a risk of a person losing both their home and their care if a residential placement broke down - because both aspects of the service are combined.
Lancashire and South Cumbria set itself a target to reduce the number of people with a learning disability in a hospital bed from 107 in 2016/17 to 58 by March next year.
A total of 56 former inpatients have been successfully discharged, but - after new admissions - the overall figure still stands at 96. Meanwhile, 25 patients previously expected to be discharged within the next three months will now remain in hospital beyond then.
In addition to difficulty in securing housing and care, other reasons for delay include challenges from health professionals about an individual’s suitability for discharge and the need to prepare a person for their new life in the community.
“Some people are resistant to change - if you have lived in the same place for 20 years, and are told that you are no longer going to live in that environment, that [can be] really challenging,” Ms. Snow-Miller said.
A number of patients are also part of the criminal justice system and have to await decisions by the Parole Board before they can be discharged into the community.
Members of the committee requested an action plan outlining how discharge targets would be met.
WHAT LANDLORDS SAY
Responding to the issues raised in the meeting, Chris Norris, Director of Policy at the National Landlords Association, said that tenants with learning disabilities should not be considered a high-risk option for housing providers.
"Landlords are frequently nervous about working with individuals who they believe may present unusual challenges. Unfortunately, people with learning disabilities are too often categorised as such, when it needn't be the case.
"Private landlords generally look to match two criteria when looking for new tenants - ability to pay the rent and capacity to sustain a tenancy over the long-term. Whilst it is true that an individual with a learning disability may benefit from some additional support in their day-to-day lives, there is no evidence to suggest that they are any more likely to default on rent payments.
"In reality, households in need of additional support are highly likely to represent low-risk, highly sustainable tenancies. The key to ensuring access is to make sure that tenancy support is available for tenants and to provide some assurance for landlords."
PRIVACY WITHIN A COMMUNITY
Plans to reform housing facilities for people with learning disabilities or autism will allow them privacy and support, the man in charge of reforming adult social care has said.
Lancashire County Council intends to reduce the number of people living in shared house schemes and instead move them into developments which increase their independence.
“We were asking people to share what were sometimes quite confined spaces,” Ian Crabtree, director of adult social care transformation, said. “Now, we’re looking at having more individual flats for people, but in a congregated setting."
Proposals to be discussed when the authority sets its budget next February will see an investment of just over £1m in the transfer, as part of a plan to save almost £4m from the current bill for shared housing and residential care.
COULD CALDERSTONES STAY OPEN LONGER?
A hospital housing people with learning disabilities in Lancashire could still be needed beyond the date which it is due to close.
The facility at Whalley, near Clitheroe, is expected to shut in 2020 as part of a nationwide plan to end the practice of keeping people with learning disabilities or autism in a hospital setting.
The head of NHS England, Simon Stevens, is reported to be taking a “personal interest” in progress towards the closure of the site, formerly known as Calderstones. Now part of Mersey Care NHS Foundation Trust, the hospital is currently home to just under 100 patients, down from around 300 three years ago.
A new medium secure unit being built at Maghull on Merseyside is on track to open in time to accept patients from Whalley in two years' time. But it is not yet known where low secure services will be based after the old Calderstones site shuts.
“We haven’t got permission from NHS England to keep the unit open beyond 2020 [so that] the low secure services can continue being provided while [an alternative is] built somewhere else,” Mark Hindle, operations director at Mersey Care told Lancashire County Council’s health scrutiny committee.
Provision of 14 assessment and treatment beds and 10 rehabilitation beds is currently being sought in the Lancashire and South Cumbria area. If no existing option can be found, a new facility will have to be built on a site which already offers other learning disability services - a process which could take “several years” committee members were told.
Ian Crabtree, Lancashire County Council’s director of adult social care transformation, said the focus is now on NHS facilities providing any necessary immediate help and not as long-term places for an individual to stay.
“The old institutional settings - like the Royal Albert Edward, Calderstones and Brockholes - were where people lived. The distinction now is that hospitals are where people [with learning disabilities and autism] go for treatment,” he said.