Recommendation 2

HM Government · verbatim extract Not Addressed

We accept this recommendation in principle. We agree that having clarity over the respective costs of providing community support for autistic people and people with a learning disability and costs associated with inpatient care is critical. This will help ensure that funding can be used most effectively to support people with a learning disability and autistic people to live independent, free and fulfilled lives in their community. We note the practical challenges in providing a complete assessment of costs as proposed by the Committee. We are committed to improving our understanding of these costs and have set out the work we are taking forward to achieve this below. In addition, we set out how we have invested additional funding for community support provision and established a system to support financial transfers from secondary health care to community support, including to local authorities, to ensure continuity of support. Funding for community support for people with a learning disability and autistic people who have been admitted to inpatient hospital, or who are at risk of admission, can be drawn from a wide range of sources across different organisations. Each person’s support can be drawn from multiple funding sources and comprise different services drawn from 4 The treatment of autistic people and people with learning disabilities: Government Response the NHS and local authorities. This makes costing community support challenging, with the added complexity that each person’s support is personalised and typically cannot be compared with another’s. An individual’s package of support may draw on both revenue and capital spending, which adds further complexity. Examples of funding sources include: • Funding by local NHS Commissioners. In 2021/22, local NHS commissioners (Integrated Care Boards (ICBs) from 1 July 2022) invested £2.3bn to provide health care for people with learning disabilities and autism, in several different areas, including the following. A breakdown of spending by individual funding streams isn’t available as allocations are determined locally or determined on a case-by case basis: Ȥ NHS Continuing Health Care (CHC) which is a package of NHS-funded ongoing care for adults with the highest levels of complex, intense, or unpredictable needs who have been assessed as having a primary health need. Operational delivery of CHC is the responsibility of ICBs, with oversight from NHS England (NHSE). We have provided detailed statutory guidance, the National Framework, on the process for determining eligibility for CHC for an individual. Children and young people may also receive a ‘continuing care package’ if they have needs arising that cannot be met by universal or specialist services alone. Ȥ Funding under a Funding Transfer Agreement (FTA) (up to 31 March 2021) or Pathway Funds (after 31 March 2021). Under the Pathway Fund arrangements, funding is made available to invest in community services in line with costs released from provision of specialised mental health inpatient care. This is a transfer from NHS England or NHS -Led Provider Collaboratives as commissioners of specialised mental health services, to local health systems. Ȥ Aftercare as set out in Section 117 of the Mental Health Act places a duty on both health and social care commissioners to provide access to free aftercare services to people who leave hospital, who have been detained under the Mental Health Act. Ȥ Dowry payment, which is funding made available to support the ongoing care of inpatients with a stay of five years or longer on 1 April 2016, and who remain in inpatient care, to support them to move into the community. Arrangements for this payment are described within the NHS England Pathway Fund guidance. • National NHS funding: Ȥ Dedicated funding through the NHS national programme on Learning Disability and Autism which seeks to deliver the NHS Long Term Plan commitments for people with a learning disability and autistic people. There is £70m of national programme funding for 2022/23 supporting development of community services including keyworkers for children and young people. (This is described in further detail below). The treatment of autistic people and people with learning disabilities: Government Response 5 • Funding from local authorities which is used to meet general and specialised social care needs. Local authorities spend a significant amount on learning disability and autism services each year. For example, in 2020/21, £6.3 billion gross expenditure was spent on the long and short term adult social care support for people with a learning disability. Comparing this figure to gross expenditure in 2019/20, the aggregate spending has increased by 3.4%. There is a lack of comparable data for long and short term adult social care support for autistic people at present. • Grant funding to Local Government from Central Government: Ȥ Community Discharge Grant, which is additional funding we are providi