The Scottish government is allocating more money to try to meet its long-running commitment that Scots with complex needs should be cared for close to home and not in inappropriate hospital settings.

More than seven years after the publication of the landmark Coming Home report on out-of-area placements and delayed discharge for people with learning disabilities and complex needs, the government has published a new action plan to try to support some 400 people still affected.

When Coming Home was published in November 2018, its author Dr Anne MacDonald estimated there were likely to be more than 700 people placed ‘out-of-area’ – around 10% of whom were in England or Wales – and another 70 delayed in hospital.

The research into inappropriate care for people with learning disabilities and complex needs had been commissioned by the Scottish government in response to concerns raised by the 2016 Mental Welfare Commission report, No Through Road.

The government set a goal of significantly reducing delayed discharge and inappropriate out-of-area placements for adults by March 2024 by strengthening community services, developing commissioning and service planning, and workforce development in positive behavioural support.

In 2022 a national ‘Dynamic Support Register’ was set up to improve monitoring of those at risk of hospital admission or inappropriate placements under the Coming Home Implementation Report, a progress review of the original recommendations.

Four years on, 391 people on the Dynamic Support Register are currently recorded as being in the urgent category.

The Scottish government has now published the Coming Home Action Plan, written by a short life working group established by the government and local authorities’ body COSLA to address outstanding recommendations of the 2022 report.

The latest document sets future priorities and is accompanied by an additional £20 million towards bespoke support, home adaptations, equipment and technology to enable people to return to their communities.

Dr MacDonald chaired the working group behind the latest update. She says she hopes delivering the remaining actions will make a real difference to the lives of people with learning disabilities and complex support needs:

“The Action Plan is focused on changes that will support people to live well in their local communities, to have choice and control about where they live, and to have their human rights upheld.”

Scotland’s Minister for Social Care and Mental Wellbeing, Tom Arthur MSP says Scotland cannot allow people to spend longer in hospital than they need to, or to stay far from home just because they have more intensive support needs:

“We are beginning to see progress. The latest data shows that fewer people are delayed in hospital or placed in care settings far from home – but there is more to do. 

“I am pleased to see this £20 million funding bringing total investment in delivering the Coming Home agenda to £40 million since 2021.

“Real change is delivered locally and this Action Plan, alongside additional investment, provides a strong framework for that.”

Sustained investment

Councillor Paul Kelly, COSLA’s Spokesperson for Health and Social Care added:

“We have worked closely with the Scottish government, local government, integration authorities, the NHS and third sector partners to develop the Action Plan and set out how we will jointly address these long standing issues. I am grateful for the significant commitment and time that all partners have invested in producing the Plan. We now need to maintain that drive and collective focus as we move into delivery.

“Sustained, additional investment across the whole system will be crucial to ensuring that people with learning disabilities and complex needs can return home as quickly as possible.”

 

Read more: New push to help patients "lost in system"; Landmark moment for Coming Home campaign

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