Breaking the Barriers: How We Can Help People Leave Long-Stay Hospitals

At Catalyst Care Group , we are constantly thinking about how we can do better for autistic people and people with a learning disability who are stuck in long-stay hospitals. The recent NIHR report, "Why Are We Stuck In Hospital" highlights many of the barriers that we’ve been grappling with for years - complex, persistent, and frustrating for everyone involved. Yet, having heard Jon Glasby who led this research with his team, it also presents opportunities for professionals and commissioners to make meaningful changes.

Why Are People Still Stuck in Hospitals?

More than a decade after the Winterbourne View scandal, the same issues are keeping individuals in institutional settings. These people are often ready to leave but can’t because the right community support isn’t there. This study breaks down these barriers, and while they’re not new to us in the sector, it’s clear that more needs to be done.

Lack of Appropriate Housing

One of the key findings of the study is the critical shortage of suitable housing. I’ve seen many individuals who are essentially stuck in hospital because their needs can’t be met by the housing options available in the community. These aren’t just physical needs - many people need homes designed for sensory sensitivity or space for round-the-clock care teams. We talk about “moving into the community,” but without the right housing, that transition is impossible.

As commissioners, this should be a top priority. We need to invest in specialised housing, working with local authorities and developers to ensure there are homes that can accommodate people with varying needs. This means building or adapting properties that meet those very specific requirements, ensuring safety, accessibility, and dignity.

Inconsistent Care Coordination

Another challenge we see time and time again is poor care coordination. Discharge plans often get delayed simply because services aren’t working together. Healthcare, social care, and housing services all have their roles, but they don’t always communicate effectively. As a result, even when someone is ready to leave, they end up staying in hospital because the support services are misaligned or under-prepared.

Whilst we are trying to communicate, somebody is losing valuable time in their life.

For us, integrated care pathways are the solution here. Commissioners need to push for systems that enable seamless coordination across sectors. Bringing healthcare, social care, housing, and the voluntary sector together under a single care plan is crucial. It’s not enough to just have a plan; it needs to be actionable and focused on quick, efficient discharge without leaving any gaps in care.

Inadequate Community Support

Even when housing is available, the support services often fall short. Families and carers tell us they’re worried that community services won’t be able to handle the complexity of their loved one’s needs. The truth is, they’re often right. Staffing shortages, under-funding, and a lack of specialist training mean that community services are struggling to deliver the level of care that’s needed.

If we want to break the cycle of hospital stays, we need to focus on building robust community services. This means investing in training for staff, making sure they are equipped to deal with the specific challenges that come with supporting autistic people and people with a learning disability. It also means offering better pay and career progression for care workers - we believe that professionalising this workforce is key to improving outcomes for individuals leaving hospital.

Legal Complexities

The legal system is another obstacle. In many cases, individuals are held under restrictive care orders that take far too long to resolve. I’ve seen families go through agonising delays because the legal framework is so complex. Simplifying these processes should also be a priority. We need more streamlined, straightforward systems that empower individuals and families to move forward with community placements without unnecessary delays.

What We Can Do

So, where do we go from here? As professionals and commissioners, we need to step up and tackle these barriers head-on. Here are some of the actions I believe we can take:

1. Invest in Housing: Make it a priority to commission and develop housing that is fit for purpose, particularly for those with complex needs. We need homes that promote independence and dignity.
2. Push for Integrated Care Pathways: We need to break down the silos between healthcare, social care, and housing. Commissioners should focus on creating truly integrated care pathways, ensuring that all services are aligned around the individual’s needs.
3. Strengthen Community Support: This means investing in the workforce. Care providers need better funding, more staff, and advanced training to manage the complexities of supporting people in the community.
4. Simplify Legal Processes: We need to make it easier for people to leave long-stay hospitals by simplifying the legal frameworks that currently hold them back. Advocacy and reform are critical to this process.

Moving Forward

The NIHR study reinforces what many of us in the sector already know - there are too many people who are ready to leave hospital but can’t, through no fault of their own.

This isn’t just about policy or procedures. It’s about real people, whose rights and dignity are on the line. As professionals, it’s our responsibility to make the system work for them - not the other way around.

Let’s take this research and use it to drive meaningful change. Because we can, and we must, do better.

We are always here to discuss issues and new ways of working. Just drop me a line.

Love,

Ash

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