Can the de-hospitalisation of those with learning disabilities serve as a model for the entire NHS’s future?

Edmund Stubbs, 30 October 2015

Calderstones is a 223 bed hospital specialising in care for those with learning disabilities and is the only one remaining with this specialisation in the UK. Its closure has just been announced for next June. This decision follows the BBC’s 2011 Panorama investigation into Winterbourne View, which uncovered extraordinary levels of patient abuse. Its closure is in line with a general move away from institutionalised care for those with mental health problems or cognitive disabilities.

The announcement of the Calderstones closure has been greeted with positive and constructive media coverage. Examples of former patients thriving in community care are cited and the BBC’s social affairs correspondent Alison Holt claims that patients’ families will welcome care for their disabled relatives being based in homes rather than in hospitals. A similar tone is also taken in the national press, highlighting the approval of campaigners for such a move and criticising institutionalised hospital care for such disabled individuals. In a telling example the BBC interviewed a patient’s mother who compared institutionalised care to an indeterminate prison sentence.

Some disquiet is also raised in the media, focussing, in addition to what might happen to the staff of closing institutions, on the fear that community services might not be able to cope with some of the more challenging patients. Such criticism does not, however, generally criticise in principle the closure of specialist hospitals or the widely accepted notion that care in the community is preferable for those disabled individuals who need it. Commentators do however, recognise the importance of having an overall strategy for the gradual integration of ex-patients into society at large.

In short, the media, mirroring public opinion, accepts that treating and caring for people with learning disabilities in the community is a good thing and foresees a time when hospitalisation for such people will not be thought appropriate at all. The view is so widespread as to be now, it seems, effecting policy, turning theory into reality.

This situation is contrasted with the reaction that might be expected should the closure or merger of an acute general medical hospital be proposed in the cause of increased efficiency, or that its services be reduced or re-focussed. Unlike care for those with cognitive disabilities, there seems to be no clear direction or even motivation for moving acute care, or the prevention of its necessity, into the community.

Instead the reverse is the case. Ever more demand is placed on acute intervention resources, and in particular hospitals. Before the recent election, politicians of all parties promised more staff for our hospitals, and much increased funding for the NHS. However, the £8 billion increase finally agreed post election will now likely be spent in bailing out acute provision trusts currently financially overstretched due to the highest ever demand for their services.

There seems little or no popular objection to politicians throwing yet more money at expensive acute hospitals with almost no thought given to how to stop patients ending up in them in the first place, or how, once treated, patients can be safely returned to society.

In fact resources for public health and preventative efforts in the community are presently being cut. This is an absurd situation. The NHS needs a long term vision. Why cannot the de-hospitalisation model for patients with learning and cognitive disabilities provide one? The shifting of healthcare from acute intervention to community and preventative ought be become an equally obvious good thing.

Edmund Stubbs is Healthcare Researcher at Civitas, @edmundstubbs1