Bubb Report

The Government should draw up a Charter of Rights for people with learning disabilities and/or autism and their families, and it should underpin all commissioning. The Charter should clarify existing rights, and set out new rights we propose below. The mandatory commissioning framework later in our recommendations should require all commissioners to invest in services that make these rights 'real' and easily used.

A 'Life in the Community' Social Investment Fund should be established to facilitate transitions out of inpatient settings and build capacity in community-based services. The Investment Fund, seeded with £30 million from NHS England and/or Government, could leverage some £200 million from other investors to make investment more easily accessible to expand community-based services.

Action on the recommendations above should be accompanied by improved collection and publication of performance data, and a monitoring framework at central and local level. Data on key indicators (such as admissions rates, length of stay, delayed transfers, number of beds by commissioning organisation) should be collected and published. Both local commissioners and national bodies (including NHS England, DH, the LGA and others) should be held to account for implementing our recommendations above – local named lead commissioners by local people, NHS England and central Government, and national bodies through existing governance structures (such as the Transforming Care Assurance Board chaired by the Minister for Care and Support).

The Government should respond to 'the Bradley Report Five Years On', to ensure that people with learning disabilities and/or autism are better treated by the criminal justice system.

People with learning disabilities and/or autism and their families should be given a 'right to challenge' decisions to admit or continue keeping them in inpatient care. They should receive independent expert support to exercise that right, including high-quality independent advocacy.

NHS England should extend the right to have a personal budget (or personal health budget) to more people with learning disabilities and/or autism, including all those in inpatient care and appropriate groups living in the community but at risk of being admitted to inpatient care.

The Government should look at ways to protect an individual's home tenancy when they are admitted to hospital, so that people do not lose their homes on admission and end up needing to find new suitable accommodation to enable discharge.

The Government and NHS England should require all local commissioners to follow a mandatory commissioning framework. The funding and responsibility for commissioning services for this group should be devolved as much as possible from NHS specialised commissioning to Clinical Commissioning Groups. Learning from the strengths (and weaknesses) of the Better Care Fund, a mandatory framework should then require the pooling of health, social care and housing budgets, and mandate NHS and local government commissioners to draw up a long-term plan for spending that funding in a way that builds up community services, makes the Charter of Rights above real, and reduces reliance on inpatient services. NHS England, central Government and local government representatives such as the Local Government Association and Association of Directors of Adult Social Services should support and assure the drawing up of local commissioning plans, and unblock systemic barriers (including Ordinary Residence rules and eligibility for Continuing Health Care). There should be a named lead commissioner in each area, working collaboratively with a provider forum and people with learning disabilities and/or autism and their families.

Community-based providers should be given a 'right to propose alternatives' to inpatient care to individuals, their families, commissioners and responsible clinicians.

The commissioning framework should be accompanied by a closure programme of inappropriate institutional inpatient facilities. This active decommissioning should be driven by a tougher approach from the Care Quality Commission, local closure plans, and closures led by NHS England where it is the main commissioner. NHS England should come to a considered, realistic view on what is possible – but then it should set out a clear timetable not just for reductions in admissions or inpatient numbers, but for closures of beds and institutions.

Health Education England, Skills for Care, Skills for Health and partners should develop a national workforce 'Academy' for this field, building on the work already started by Professors Allen and Hastings and others. The Academy should bring together existing expertise in a range of organisations to develop the workforce across the system.