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Learning Disability Census: new analysis including anti-psychotic medication use and physical 'incidents' for inpatients

April 29, 2014: • Two thirds of inpatients with learning disabilities in specialist units2 are given anti-psychotic medication

• A third of all these patients subject to hands-on restraint

New analysis of the 2013 Learning Disability Census3, commissioned in response to events at Winterbourne View Hospital4 is published by the Health and Social Care Information Centre (HSCIC) today. This report provides further information on inpatients with learning disabilities5 in England, being treated in specialist units2, following publication of the initial findings in December 2013.

The census shows that two thirds of these inpatients (68 per cent or 2,220) had been given anti-psychotic medication6 in the 28 days preceding the census. Of these, 93 per cent (2,064) had been given them on a regular basis7.

Over half of all the patients (57 per cent or 1,841) had experienced an 'incident' during the three months preceding the census date. Incidents were defined as self-harm, an accident, physical assault on the inpatient, hands-on restraint or seclusion. A greater proportion of women than men experienced each of these types of incident.

Administration of anti-psychotic medication appears to be associated with an increased likelihood of experiencing hands on restraint. 40 per cent (889 of 2,220) of those given these drugs had experienced at least one episode of hands on restraint, compared to 22 per cent (221) of the 1,030 patients who were not given this type of medication.

This report also contains information relating to patient experience of care including ward accommodation, uses of the Mental Health Act (1983), and information on the commissioning and provision of learning disability services including costs and care planning. It also provides more detailed information on a geographical basis and additional service user profile information.

As previously reported in the December 2013 publication, the majority of the inpatients were aged between 18 and 64 (2,994 or 92 per cent). Nearly one in five (18 per cent or 601) had been inpatients for three months or fewer, compared to three fifths (60 per cent or 1,949) who had been inpatients for a year or more. Among the 1,949 who had been in hospital for a year or more, 572 had been inpatients for five or more years (29 per cent).

Chair of the HSCIC, Kingsley Manning said: "The Learning Disabilities Census, and this further analysis, is an important contribution to understanding how episodes such as those seen at Winterbourne View Hospital can be avoided in the future.

"This further analysis of the census data will aid understanding of the experience of inpatients with learning disabilities nationally, and is an important benchmark.

"It is crucial that service providers have accurate data about complex issues such as these, to help them to develop their understanding and improve their services for patients. Providing this sort of data is a key role for the HSCIC."

Read the full report here: http://www.hscic.gov.uk/pubs/ldcensusrepsep13 

Notes to editors

1. The Health and Social Care Information Centre (HSCIC) was established on April 1 2013 as an Executive Non Departmental Public Body (ENDPB). The trusted source of authoritative data and information relating to health and care, HSCIC plays a fundamental role in driving better care, better services and better outcomes for patients. It supports the delivery of IT infrastructure, information systems and standards to ensure information flows efficiently and securely across the health and social care system to improve patient outcomes. Its work includes publishing more than 220 statistical publications annually; providing a range of specialist data services; managing informatics projects and programmes and developing and assuring national systems against appropriate contractual, clinical safety and information standards.

2. Information on the definition of specialist units can be read here: http://www.rcpsych.ac.uk/pdf/FR%20ID%2003%20for%20website.pdf 

3. For more information on the Learning Disability Census, including a full list of the details of the questions asked of providers, see here: http://www.hscic.gov.uk/ldcensus

4. A May 2011 BBC Panorama programme broadcast footage of apparent abuse by staff of inpatients in Winterbourne View Hospital, many of whom had learning disabilities.

5. Inpatients included in this report were individuals with diagnosed or understood learning disabilities who were receiving treatment and care in NHS and independent sector hospitals in England. Additionally, the inpatients may have been receiving care for mental health needs, have needs associated with autism spectrum disorder and/or may have presented 'behaviour that challenges'. There is no set clinical definition for behaviour that challenges. One academic definition is: "Culturally abnormal behaviour(s) of such an intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour which is likely to seriously limit use of, or result in the person being denied access to, ordinary community facilities." Ref: Emerson, 1995, cited in Emerson, E (2001, 2nd edition): Challenging Behaviour: Analysis and intervention in people with learning disabilities. Cambridge University Press.

6. Anti-psychotic medications, previously known as major tranquilisers, are a range of medications that are used for some types of mental distress or disorder - mainly schizophrenia and manic depression (bipolar disorder). They can also be used to help severe anxiety or depression.

7. Data providers were asked to distinguish whether patients were considered to be receiving ant-psychotic drugs on a regular basis, whether they had received them on a 'pro re nata' (as needed) basis during the 28 days preceding the Census, or both.

8. Responses were received from 104 NHS and independent providers in England and provide a snapshot at 30 September 2013. Of the 106 providers (58 NHS and 48 private) that were in scope for the census, information was received from 104 providers. Cross-referencing with other available data sources on the number of providers was undertaken to ensure as comprehensive coverage as possible. More information on data quality and completeness can be found on the associated data quality report on this page: http://www.hscic.gov.uk/pubs/ldcensusrep1213

9. Initial findings on the September 2013 census were published in December 2013, with further analysis being published today. The census will be re-run in September 2014 in order to identify change and particularly, where appropriate, reductions in inpatient care in favour of more suitable community care and support options.

10. Transforming care: a national response to Winterbourne View hospital can be found here: https://www.gov.uk/government/publications/winterbourne-view-hospital-department-of-health-review-and-response.

11. Percentages have been rounded to the nearest whole number for ease of use. For more precise figures please view the whole report at http://www.hscic.gov.uk/pubs/ldcensusrepsep13

For media enquiries or interview requests please contact the press office on 0300 303 3888 or media@hscic.gov.uk

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