Report: Learning Disabilities Census, England – Further analysis

This report presents further findings from the 2013 Learning Disabilities Census, following an initial report published on the 13 December 2013.

The principal aim of the Census was to deliver action 17 in ‘Transforming Care: A national response to Winterbourne View Hospital – “an audit of current services for people with challenging behaviour to take a snapshot of provision, numbers of out of area placements and lengths of stay”.

The Learning Disabilities Census was collected on the 30 September 2013, providing an individual record level snapshot of inpatients in receipt of treatment from NHS and independent learning disability service providers on that day. This patient group comprises those with learning disabilities, autistic spectrum disorder and/or behaviour that challenges. Data were collected  via the Health and Social Care Information Centre (HSCIC) on behalf of the Department of Health, the Care Quality Commission, Public Health England and NHS England.

This report contains information relating to patient experience of care including drug administration, incidents, ward accommodation, uses of the Mental Health Act (1983), and information on the commissioning and provision of learning disability services including costs and care planning. It also provides more detailed information on a geographical basis and additional service user profile information.

Key facts

• Survey responses were received from 104 provider organisations on behalf of 3,250 service users who met the inclusion criteria for the 2013 Learning Disabilities Census.
• Over two thirds of service users (68.3 per cent or 2,220) had been given major tranquiliser class drugs leading up to Census day. Of these, 93.0 per cent (2,064) had been given them on a regular basis.
• Over half of the service users (56.6 per cent or 1,841) had been the subject of at least one incident involving self-harm, an accident, physical assault on the service user, hands-on restraint or seclusion during the three months preceding the Census. Proportionally, more females experienced every type of incident than males. There appears to be an association between hands-on restraint and the administration of major tranquiliser class drugs; 40.4 per cent (889) of the 2,220 given these drugs had experienced at least one instance of hands-on restraint compared to 21.4 per cent (221) of the 1,030 who were not given any of this medication.
• Almost half of service users (46.4 per cent or 1,508 people) were in receipt of an active care plan without a discharge plan in place. Around 1 in 20 service users (4.7 per cent or 152 people) were experiencing a delayed transfer of care.
• Almost four fifths of service users (78.0 per cent or 2,536) were subject to the Mental Health Act 1983 on Census day, compared with 22.0 per cent (714 people) who were classed as informal patients. Of those subject to The Act, the majority (99.5 per cent or 2,524) were subject to ‘longer term hospital orders’ (with a duration of greater than 72 hours).
• Care for the majority (86.0 per cent or 2,795 people) of service users cost between an estimated £1,500 and £4,499 per week, with the highest proportion (37.9 per cent or 1,231 people) being in the £2,500-£3499 range. For 11.4 per cent (369 people), care provision was reported to have cost over £4,500 per week per person. Almost a fifth (19.6 per cent or 112) of service users staying 100km or more from home were in high cost placements (over £4,500 per week). By contrast over a third of service users (34.0 per cent or 208) staying within 10km of home were in placements costing under £2,500 per week.