Opinion: saving money and rebuilding lives will come from releasing thousands from hospital

Ahead of the public cuts announcement due to be delivered next week, Chris Hampson Chief Executive of Look Ahead, a charitable housing association supporting people with complex needs across London and the South-East, offers his views about how the government can save money and support the NHS. 

As Prime Minister Rishi Sunak enters his second week in the job, there are tentative signs the political tumult of the past few weeks is stabilising. 

However, despite a measure of political calm, the economy remains in trouble.  Against the backdrop of rising inflation, tax increases and a cost-of-living crisis, people are awaiting the Chancellor’s autumn statement with bated breath. The mood music from government is inescapable – cuts to public spending are on the way. 

As they come, it is those already experiencing mental ill health that I fear for the most.  Mental health care is always one of the services to suffer most. Even prior to the pandemic NHS mental health services were under strain. Initially reported by Dennis Campbell for The Guardian, over the last 12 years, the number of beds in NHS mental health hospitals has fallen by a quarter. This comes despite demand skyrocketing, with the number of people in touch with NHS mental health services rising from 117,000 in 2016 to 141,000 in 2021.

A lack of investment, decreased resources, fewer hospital beds and a workforce shortage all threaten the NHS’s ability to deliver adequate care to those with severe mental health conditions and learning difficulties.

The present strain on the system is unsustainable, with thousands of beds taken up by long term in-patients with learning disabilities or autism. As I write, there are more than 2,000 children, young people and adults with these conditions detained under the under the Mental Health Act of 1983. Some of these patients have been institutionalised for more than 20 years. 

Not only is this an extraordinary financial burden to the NHS, but it is also actively detrimental to the individuals themselves. Often patients admitted to hospital or secure unsuitable setting are sent hundreds of miles away from their home, causing trauma to both them and their families.

Recently we supported a man in his 30s (we’ll call him Paul) with multiple conditions including a learning disability, obsessive compulsive disorder and autism.  Paul was living in a secure residential facility in Yorkshire for over 10 years – some 150 miles from his family near London – and having initially expected his stay to be very short-lived.  

What is clear to us at Look Ahead, is that long-term mental health hospital or institutional stays are an inappropriate (and inexcusably expensive) way of providing these patients with the care they need. Instead, it is community care that is the name of the game. 

In the case of Paul, we worked with his family, NHS England and the local council to find him a suitable home, which has been purchased an adapted for him.  He has been actively involved in designing this new environment, choosing flooring, decorations and furniture.  In short, he has been empowered just as anyone else his age would be.

In our services, we see every day the lifechanging positive effects living in the community with the correct support can have. Patients improve far quicker with loved ones nearby and in a place where autonomy and support are combined to give patients the best possible chance at an independent life. 

Yet for this to occur and to relive the burden on the NHS, Rishi Sunak’s new government must make good on its promise in its recent ‘Building the Right Support’ plan to empower councils to invest in suitable community-based supported housing and social care.

With demand on local councils’ provision of social care at an all-time high, it is critical that NHS funding which would have gone on mental health care in a hospital setting is diverted to local authorities who can commission alternative care.  There is also a clear need for the NHS and social care provision to work hand-in-hand, collaborating and sharing risk in the interest of patients rather than batting complex patients and problems away in the hope another part of the system will deal with them.

The whole sector must stand together in holding the Health & Social Care Secretary and ministers to account on their commitments to integrate health and social care.  A critical part of doing so is investing in the supply of supported housing so that patients are not left to languish in hospital, when they could be assisted and empowered in the community.

This country has now seen five prime ministers in just six years.  All have promised in one way or another to tackle the social care crisis, though most regard it as problem for old people.  It is, in fact, an issue for vulnerable adults across our society, most particularly those detained for no good reason and at great expense. 

As fears of recession grow – and the pressures on the healthcare sector intensifies –  neither patients nor the taxpayer can wait for decisive action. Empowering people to live independent lives rather than incarcerating them in hospital is an essential precondition to better, and better value, healthcare.

Words by: Chris Hampson.

Photo by Hush Naidoo Jade Photography