Resettlement of Long-Stay Patients from Learning Disability Hospitals

A Report published today by the Comptroller and Auditor General, Kieran Donnelly, examines the extent to which the Department of Health, Social Services and Public Safety has made progress in resettling long-stay patients with learning disabilities. Three learning disability hospitals remain in Northern Ireland: Muckamore Abbey Hospital (Belfast Trust); Longstone Hospital (Southern Trust); and Lakeview Hospital (Western Trust).

In 1995, a decision was taken by the Department of Health, Social Services and Public Safety (the Department) to resettle all long-stay patients from the three learning disability hospitals in Northern Ireland to community accommodation offering a better life for the patient.

Resettlement is only pursued where it offers “betterment” for the patient in that it is clinically appropriate, meets the patient’s needs, has the potential to better the life of the patient and is in line with the wishes of the patient’s family.

The Department’s original target for the resettlement of all long-stay patients from learning disability hospitals was 2002. However, by that time, only half of patients had been resettled and none of the three hospitals had been closed to long-stay patients. At March 2009, 256 long-stay patients remained in the three learning disability hospitals. Three quarters of these had been in hospital for 10 years or more. Almost ten per cent had been in hospital for 50 years or more. The latest long-term target is that by 2013, no-one remains unnecessarily in hospital.

As part of the resettlement programme, all children were resettled by March 2009.

Since the initial 2002 deadline, various other deadlines have been set. While we accept that targets can be varied for a number of reasons, in our view the continual revision of time targets has hindered the momentum of the resettlement process. The Department pointed out that it has set annual resettlement targets and has exceeded these in recent years. The Department considers that it is making good progress towards the 2013 target.

Boards and Trusts told us that delays in resettling patients arise primarily because of a lack of sufficient resourcing for alternative forms of provision. Within Northern Ireland, expenditure on learning disability services per head of population has been significantly lower than elsewhere in the United Kingdom and, as a result, progress in resettling patients has been much slower. However, the Department’s view is that relative expenditure on learning disability services in Northern Ireland is reflective of the £600 million under-funding of health and social care services when compared with England.

Of the 200 or so long-stay patients resettled in the six years to March 2009, almost 55 per cent were resettled to either a nursing home or residential home setting. Trusts told us that alternative accommodation options were often very limited and, in view of the level of care required by resettled patients with learning disabilities, transfer to nursing or residential homes sometimes offered the most viable way forward. As a result, those long-stay patients who required and requested supported living options, remained in hospital.

In 2002, the Department initiated a major, wide-ranging and independent review of the law, policy and provision affecting people with mental health or learning disability needs in Northern Ireland, known as the Bamford Review. A number of proposed resettlement schemes do not comply with the recommendations of the Bamford review in that they provide for more than five beds per unit for people under 60 years of age. A decision to fully comply with Bamford recommendations will have cost implications which will have to be weighed up against the wider health benefits.

The Department considers that, with careful and sympathetic management, resettlement can be successful for all patients – regardless of the length of time the individual has spent in hospital. Indeed, a review of cases shows the success of resettlements to date. Of the 157 patients resettled in the five year period to March 2008, only two were so unsettled in their new environment that they were returned to hospital.

The view that all long-stay patients can be resettled successfully is not shared by all. The Society of Parents and Friends of Muckamore fully supports the resettlement of delayed discharge patients and those long-term patients who want to be resettled. However, it believes that patients with the most complex needs, who receive a high quality of care, should not be resettled into the community where this is against the patients’ wishes and the wishes of their families.

Patients with the most complex and challenging needs have still to be resettled and community provision for this level of need has not yet been fully tested. We consider that a proactive response to Bamford’s recommendations, and appropriate resources, will be critical in ensuring that any resettlement of the most complex cases is a positive experience for all concerned.