Local authorities' failure to strategise is today blamed for the high numbers of people with learning disabilities, autism and/or mental health conditions 'living' in long-stay inpatient care.

Around 3,000 individuals with untreatable cognitive conditions remain living in assessment and treatment units or equivalent, seven years on from the Winterbourne View scandal.

A further 60,000 with mental health needs were detained under the mental health act in 2016, the last year for which records are available.

Today's 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.

It says the problem has not been a lack of community-based care providers, but rather the fact that there was not a strategic approach to identifying appropriate support for each person.

Other problems identified 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 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.

"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," said Rhidian Hughes, VODG chief executive.

"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."

Izzi Seccombe, Chairman of the Local Government Association’s Community Wellbeing Board, said: “We are working with health and other partners to develop and implement plans in their area to ensure they are resilient and include a detailed plan for each individual that has been identified as requiring a move under this Transforming Care programme. The LGA is also supporting the development of housing solutions for people with a learning disability or autism and their families."

“However, to maximise the potential of this work, the Government needs to plug the funding gap facing adult social care, which is set to exceed £2 billion by 2020, to ensure personal, reliable care is available to everyone who needs it.”

A version of this article also appears on our sister site, Learning Disability Today.