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Local support for people with a learning disability

Good progress has been made by the Department of Health and NHS England in setting up a programme to close hospital beds for people with a learning disability, but the programme is not yet on track to achieve value for money, the National Audit Office has found.

In 2015, the Department and NHS England set up the Transforming Care programme to move people out of mental health hospitals more quickly. Early indications are that the programme is making progress in reducing the number of people in mental health hospitals. Transforming Care Partnerships reduced the overall number of people in mental health hospitals by 11% from October 2015 to December 2016. Programme partners do not yet, however, have confidence that Partnerships can close the planned number of beds by 2019. As of December 2016, 60 beds had closed since April 2016, out of 136 due to be closed by April 2017, and between 900 and 1,300 beds will need to close by 2019.

The NAO found that programme partners must resolve a number of complex challenges if they are to achieve the ambition of a substantial shift away from reliance on inpatient care. One of the key mechanisms designed to manage the flow of patients into mental health hospitals is not working effectively, and money is not yet being released from mental health hospitals quickly enough to help pay for extra community support. Between £135 million and £195 million annually will need to be made available to pay for health and social care support in the community for people with learning disabilities discharged from mental health hospitals. Unless the funding is released for local services this will be an unfunded pressure on local authorities and clinical commissioning groups. NHS England has recognised that it will take time for money to move from hospitals to community support. To help in the short-term, it has provided £30 million revenue funding over three years, to be match funded by partnerships and £100 million of capital funding.

In addition, partnerships are struggling to put in place appropriate accommodation quickly enough. Providing specialist accommodation can take over 12 months. A small number of people have been delayed leaving hospital because there was not suitable accommodation in the community or in residential care homes. According to the NAO, unless solutions to these problems are developed, there is a risk that progress seen to date will not continue throughout the length of the programme.

In supporting the wider learning disability community, central and local government spend £8 billion each year. In real terms, between 2010-11 and 2013-14 spending on adult social care fell by 8.4% while spending on learning disability services increased by 2.1%.

According to the NAO, there have been some improvements, for example in the numbers of people with a learning disability in settled accommodation. Most of the national measures focus on activity, rather than outcomes, although there are encouraging signs of progress. The proportion of people living in their own home or with family has increased from 70% in 2011-12 to 75% in 2015-16. However, the proportion of people with a learning disability in paid employment has remained consistently low, and is currently 5.8%, even though some local authorities have been able to secure employment rates of more than 15%.

"Too many people with a learning disability have been kept for too long in mental health hospitals. We welcome the steps the Department and NHS England have taken to set up a bed closure programme.The Department and its programme partners, however, have not yet put in place the necessary conditions to make the programme a success, such as community-based accommodation. They are, therefore, not yet on track to achieve value for money through the programme.”

Amyas Morse, head of the National Audit Office

Notes for Editors

People with a learning disability and/or autism in a mental health hospital (December 2016)

Adults aged 18 to 64 with a learning disability who use local authority learning disability services (2015-16)

Estimated annual spend by government to support adults with a learning disability (2015-16)

Exposure of abuse of people with a learning disability at Winterbourne View

October 2015
Publication of Building the Right Support which introduced the Transforming Care programme to move people out of mental health hospitals into the community

The programme partners' ambition to reduce beds by, in mental health hospitals for people with a learning disability by 2019

Employment rate of people with a learning disability in 2016

Reduction in the number of people with a learning disability and/or autism in mental health hospitals from October 2015 to December 2016

Number of beds closed by December  2016 out of intended 136 bed closures by April 2017


  1. Press notices and reports are available from the date of publication on the NAO website. Hard copies can be obtained by using the relevant links on our website.
  2. The National Audit Office scrutinises public spending for Parliament and is independent of government. The Comptroller and Auditor General (C&AG), Sir Amyas Morse KCB, is an Officer of the House of Commons and leads the NAO, which employs some 785 people. The C&AG certifies the accounts of all government departments and many other public sector bodies. He has statutory authority to examine and report to Parliament on whether departments and the bodies they fund have used their resources efficiently, effectively, and with economy. Our studies evaluate the value for money of public spending, nationally and locally. Our recommendations and reports on good practice help government improve public services, and our work led to audited savings of £1.21 billion in 2015.

PN: 15/17