Written Statement: Review of Adult Learning Disability In-Patient Provision Managed or Commissioned by NHS Wales

Today, I am publishing the report of a comprehensive review of all Welsh adults with a learning disability being cared for in specialist in-patient hospitals either commissioned or provided directly by NHS Wales. The review was commissioned by the Welsh Government’s Chief Nursing Officer as part of our cross government programme: Learning Disability – Improving Lives. 

The scope of the review covered all Welsh adults with a diagnosis of a learning disability being cared for in in-patient beds provided or commissioned by NHS Wales; this included beds within NHS England and NHS Wales, and beds in the independent hospital sector.

The review was undertaken by the National Collaborative Commissioning Unit (NCCU) and involved an in-depth audit of all 169 individuals in specialist units at the time of the review. Each patient record, including clinical notes and prescription charts, were audited and the review team spoke with clinical staff and those patients with the capacity and who wished to participate. In addition, the review team consulted with advocates and All-Wales People First.   

We are committed to ensuring people can access specialist learning disability services as close to home as possible. The majority of individuals (81%) are being cared for in Wales. Thirty-one individuals are being looked after in English hospitals, including ten individuals situated in high or medium secure units.

At the heart of the Welsh Government’s Improving Lives programme, launched in 2018, is the fundamental premise that individuals with a learning disability have the right to lead fulfilling, independent lives at home or as close to home as possible. Where specialised intensive care is required in hospital, it should be safe, effective and high quality with a focus on supporting the individual to return home as soon as it is safe to do so.  There are specific actions in the programme for health boards, local authority housing and social services, often working at regional partnership board level, to develop integrated housing, health and social care models of support and ensure an appropriate level of specialist provision is available for those with more complex needs.  Progress is being made across Wales and many areas have made use of the Welsh Government’s Transformation Fund and the capital and revenue streams of the Integrated Care Fund to re-structure existing services and develop new approaches to integrated care at the community level.

The review did not identify anyone who needed removing from their current placement, however, it did identify a number of individuals who would benefit from an assessment to consider less intensive support in a community setting. The report and recommendations provide a baseline of detailed information to support health boards, local authorities and regional partnership boards to strengthen local provision of supported care and focus on those aspects of service quality that require improvement. 

The Chief Executive of All Wales People First acknowledges in his Foreword to the report that we have made much progress in Wales to support people with a learning disability and the majority live in their community with effective care.  However, as he rightly points out there is still more to do to ensure that where someone needs intensive support in a specialised unit, that care is first class and focused upon helping that individual return home as soon as it is safe and appropriate to do so.

The NCCU is already working with health boards and providers to address some of the key issues identified and will be monitoring this remedial work closely.  At the local level, health boards will be implementing, as a priority, action plans to address the recommendations. This will complement the work health boards have already been doing to assess and strengthen existing specialist and community provision, such as establishing crisis prevention teams and creating additional community based supported care.

At the national level, we will be bringing all of our partners together from the Third Sector, statutory services, families, carers and service users. This powerful combination of lived experience and professional expertise will be harnessed to develop national solutions and guidance to ensure best practice and clinical standards are embedded in all aspects of learning disability specialised services.    

In Wales we have a robust monitoring system that ensures all specialist learning disability units are audited at least annually; this will continue. This report highlights some positives in the system and shines a light on those aspects of service that need strengthening and improving. It provides the opportunity to build on progress made and ensure one of our most vulnerable groups of people are cared for in a safe, dignified environment appropriate to their needs with high quality therapeutic treatment and care. 

I will be monitoring progress and will provide an update in the autumn. 

National care review of NHS learning disability hospitals provision