Rightfullives reply to the letter from Ray James

National Learning Disability Director NHS England

20th December 2018

Dear Mr James

Thank you for replying on behalf of Simon Stevens, to our earlier communication regarding the Mail on Sunday Investigation.

In your reply you cite Building the Right Support as an indication of the government’s commitment to the rights of people with learning disabilities or autism and you go on to state that:

Significant progress has already been made nationally including a 19% reduction of people in inpatient beds, and we will continue our work in reducing local variation to achieve the best possible outcome by the end of March 2019 and beyond

Whilst any progress is to be welcomed, you will appreciate that the figure you quote falls well short of the targets that were set by yourselves in Building the Right Support - which were a “minimum” 45 -65% reduction in CCG commissioned inpatient capacity and a 25 - 40% reduction in NHS England commissioned inpatient capacity.

We are also unclear as to exactly how you have come to the figure of a 19% reduction in the number of people in inpatient beds, a figure that incidentally had increased to 20% when the Care Minister was asked about the matter on BBC Breakfast. Building the Right Support - the document in which the above targets were set - states that in October 2015 approximately 2600 people were in inpatient beds and according to the Assuring Transformation data for October 2018 - 2350 people were in inpatient hospital. Which would make the reduction in inpatient beds much closer to 9% rather than 20%. So, if you could explain the rationale behind the figure you have quoted it would be greatly appreciated.

Having said all of that, we welcome the fact that learning disability and autism have been made priorities in the NHS Long Term Plan and we also welcome your statement that the principles of Building the Right Support

remain central to the future of specialist services for people with a learning disability, autism or both. People will continue to be supported to receive personalised care and support in the community, in their own homes, closer to their friends and family.

Because whilst the implementation and delivery of Building the Right Support has failed to deliver the hoped-for results, it is clear, that its underlying strategy of strengthening community support is the appropriate one. Although we believe that the commitment should be to move people “close” to their family and friends rather than “closer”. After all for some people , especially people on low incomes, even an hour’s travel can effectively isolate them from their loved ones.

We hope that in drawing up the NHS Long Term plan you will not only have regard to the views of the hundreds of people who have fed into the process but that you will also be transparent about the reasons why Building the Right Support has not matched expectations. We feel that it would be particularly appropriate for NHS England to make publicly available data on:

  1. The reductions achieved by individual Transforming Care Partnerships
  2. How successful TCPs have been in implementing each of the 9 principles of the National Service Model
  3. Results of the commitment to develop a metric for CTR process
  4. The roll out of the Health Equality Framework Tool
  5. The revisions to the Learning Disability Self-Assessment Framework and the Autism Self-Assessment Framework
  6. And the outcomes of the NHS Quality Checkers programme of work.

We believe that the key to progress in getting people out of inpatient hospitals lies in not only sharing good practice but also in being transparent about the things and the parts of the system that aren’t working well and for that to happen transparency and candour are key.

Thank-you for offering to meet us, we would like to accept your offer.


Mark L Brown

(on behalf of Julie Newcombe and Rightfullives)