The Scottish government is set to announce a new push to ensure people with severe learning disabilities and enduring mental health problems are no longer cared for in inappropriate institutions like hospitals.

There are more than 200 people with “very complex” needs who are either stuck in hospital or in placements far away from their homes, according to Scottish government documents.

Some health boards recorded some patients were delayed for more than three years in mental health wards, an investigation by the Ferret found.

An interim report, approved by the Cabinet Secretary for Health and COSLA and seen by healthandcare.scot, details a range of changes to kickstart a longer-term shift into community care. Final proposals are expected to be published in the next 12 weeks.

The government is also looking at a national register of people with the most complex care needs, alongside a £20m fund that health and social care partnerships can draw on when they are moving individuals back into their own communities that was announced earlier this year.

A 2018 report by respected academic Dr Anne MacDonald found there were likely to be more than 700 people placed ‘out-of-area’, around 10% of whom were actually outside Scotland, in England or Wales, and another 70 delayed in hospital.

Dr MacDonald concluded there was no simple solution and an “overall change in culture and approach” was needed.

The process received further impetus during the pandemic when the rapid discharge of people from hospital was concentrated mainly among people who were waiting for a care package, not those who were unable to be moved because of what are known as ‘code 9’ delays – often relating to adults with a learning disability or severe mental health problems.

Papers considered by a Scottish government group to tackle the problem that were released following a freedom of information request admit there can be a “disconnect” between different services.

One document on “complex delays” in hospital patients says individuals can be “lost in the system”, adding that, in some circumstances, “care placements are not revisited or reviewed regularly”.

The new fund would provide “transition costs” to facilitate a long-term shift away from institutional care, including bringing home people outside of Scotland.

This would be backed up by a national register of people with the most complex needs, while each local area would have a named official responsible for overseeing changes.

The idea has been discussed with officials from England, where a £62m pot of money has already been allocated to discharge people with learning disabilities from hospital.

However the documents caution that a similar fund, for the reshaping of older people’s care, failed to achieve the long-term shift that was desired.

Speaking to healthandcare.scot last week, the head of an independent commission said it was impossible for people to live full and happy lives in inappropriate institutional care.

Charlie McMillan, of the Scottish Commission for Learning Disability, said this group had been “left at the margins” during the pandemic.

Read more: Scots with learning disabilities "invisible" in virus;" Covid learning disability deaths three times higher; Researchers: policy needed for patient ‘missingness'; Fears over ‘smokescreen’ day service cuts; Scheme for GPs to help lost patients extended

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