by Dr Rachel Proctor, ST5 Forensic Psychiatry Trainee, North London.
This article appears in our latest newsletter which can be downloaded here.
There has been a significant reduction in the number of Intellectual Disability and Autism Secure beds across the UK in recent years. This is part of a wider picture of inpatient care for individuals with Intellectual Disability and Autism (ID/A). Between 1988 and 2015 the number of intellectual disability beds in the NHS reduced dramatically, from approximately 33,000 to about 2,500 (NHS England Building the Right Support. NHS England, 2015 (https//www.england.nhs.uk/wpcontent/uploads/2015/10/ld-nat-imp-plan-oct15.pdf). In the wake of the Winterbourne View scandal, NHS England pledged in 2015 to move 35-50% of people with a learning disability and/or autism out of hospitals and into community-based support by March 2019, thereby further reducing the number of patients in the remaining 2500 beds.
However, this goal was not met and the deadline for closing half of these beds was moved to March 2024
(‘Serious concern’ learning disability bed closure target will be missed again | Nursing Times). Secure beds have not been exempt, and related to these broader closures have been the reduction in female ID/A secure beds.
There is a small, diverse cohort of women with intellectual disability and/or autism for whom there has never been appropriate local provision of inpatient services, despite this being clinically important. High rates of placement within the independent sector can impact on the length of stay and quality of care for an already disadvantaged clinical group for a number of reasons, including the likelihood that the individual will be placed far away from their home community and private sector facilities rarely make community service links. The historical reasons for this lack of appropriate service development are undoubtedly related to the small numbers and the need for high staff levels, which leads to increased costs.
Clearly it follows that there must be an additional burden on community services given the number of ID/A bed closures however it is not known whether the money save from these bed closures was funnelled into resourcing this population’s needs in the community. In addition, the bed reduction means that there are waiting lists for the few ID/A beds remaining. Those areas of the country without local beds then have to find out of area beds which are often prioritised for local patients. As a result, there is an increasing frequency in these women being cared for on generic medium secure units, defeating the whole purpose of closing the ID/A beds, the aim of which has been to facilitate care for those with ID/A away from the potentially detrimental environment of a ward.
My involvement in a recent service review of these women within a sector of London has made it clear that there is limited research on the needs of this small cohort of women. If they are going to be managed within generic medium secure settings, likely to be even less able to meet their needs than ID/A specific wards, then the outcomes of such care needs to be interrogated. The repercussions of placement of ID/A individuals within generic services need to be closely examined if we are to avoid future scandals similar to those which have precipitated the current reforms.