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interview

‘Better lives and not in hospitals’

Ray James is the first ever national director for learning feedback from people about the quality
disability at NHS England. He talks exclusively to Seán kelly of their lives and their experience.”
What needs to be done to get people
about his vision with a community focus out of ATUs and, crucially, reduce the
numbers going in?
A priority will be “strengthening the
ay James has a crowded in-tray. At the time he left the authority late capacity and capability of community-
among many other issues facing last year, he says “there was an inpatient based services, in particular intensive
rthe first national director for count of three people [with learning support, crisis support, community
learning disability at NhS england are the disabilities and/or autism] for a forensic services and community learning
transforming care programme to reduce population of 325,000” and two of those disability teams”, he says.
the number of inpatients in assessment three had planned move-out dates. This sounds like good news to the many
and treatment units, worsening mortality James gives lots of credit to staff in who have been concerned by the
rates and a workforce crisis. enfield for this and is clear why he reductions in precisely those services.
Shortly before this interview, a friend believes the system can change. He also plans to link teams so they
told me she felt sorry for James. She is the can support each other better. Can he
mother of a young man with autism and a transfer funding from inpatient to
learning disability. “ If we didn’t spend community services?
Why did she feel sorry for him? because, “Yes,” he says, adding the caveat that
she said, he is the fall guy for Transforming money on a bed, what “you need the services to be functioning
Care, the national programme with an would we spend it on? well in the community to be able to
ambitious target of halving the number of What if we were to invest discharge people but also to support and
people learning disabilities and/or autism avoid the admissions”.
living in inpatient settings such as earlier in parents? So far, he says, NHS England has
assessment and treatment units (ATUs). ” provided £10 million a year (over two
Transforming Care is entering its third years) to be matched by funding from
and final year seemingly a long way from He thinks the frequent focus on local bodies. “That’s £40 million and I
achieving this. As the lead officer for the inpatient numbers alone is too narrow. expect there to be a bit more signalled.
final year, my friend suggested, James’ “The programme is often judged in a I also expect us [NHS England] to be
role will be to carry the can. relatively binary way about inpatient clearer about moving some of the money
He is ready for the charge. numbers … there are some other up front now rather than areas waiting,”
“There has been about a 16% reduction important strands as well,” he says. He he says.
in the number of inpatients over the past mentions annual health checks and “the He thinks some matters could be
three years,” he says. If this much change work we are doing around trying to learn addressed in a better way. One is
happened anywhere else in the NHS, from deaths” within the Learning workforce supply and training. He
“people would be trying to learn from it”, Disabilities mortality Review (LeDeR) promises “a particular effort around the
he says – although he agrees that there is Programme) as well as the STOMP support and care market to ensure that
“much to be done”. programme, which aims to reduce the we’ve got people with the right skills and
James is progressing with the unnecessary prescription of psychotropic behaviours”. He wants staff who can
2018-19 plan and promises major drugs (CL 31(2): 20-21). provide positive behavioural support
decommissioning of inpatient beds in the “Fundamentally, I’d like more people (PBS) and who can also, for example,
next year. Some parts of the country have with a learning disability challenge levels of antipsychotic
already got the numbers down to the to say that they are medication
targets in Building the Right Support (the leading better lives and prescribed.
National Plan for Transforming Care) but not in hospitals,” he says.
James says that there is wide variation. “There might be all sorts Autism overlooked
“There is about a five-fold variation in of other kinds of metrics Another area
the level of bed provision per head of that people would look requiring attention is
population. There’s about a 15-fold to but, for me, the autism.
variation in the rates of admissions. headline is direct “I don’t think we
“So there is definitely more work to do have had a significant
but there are clear signs that things are Of the Learning Disabilities or a distinct enough
Mortality Review: “I hope
heading in the right direction. Our the work that we are focus on autism and
challenge is not only about pace but also doing around learning understanding the
about reducing the variability.” from deaths might be one issues around that,”
James is on secondment for two years of the places where we says. “Of the children
(with a possible extension) from his post get some evidence to help and young people in
as director of social services at enfield us prioritise” inpatient beds, 60%
Council. have a diagnosis of

12 Vol 31 No 4 | Summer 2018 community Living www.cl-initiatives.co.uk