John Taylor1 is an experienced responsible clinician looking after offenders with intellectual disabilities and/or autism presenting with complex needs. I can accept the perceptual position he has taken on some of the challenges outlined in his editorial. However, his assertion that underpinning Transforming Care is an assumption ‘that the hospital is always bad, and community is always better’ is inaccurate. We have explicitly said that some people will need specialist in-patient care, treatment and support at times. When this is needed, we should strive to deliver better quality care, a reduction in restrictive practices, therapeutic environments, improved patient experience and reduced lengths of stay. At the start of the national learning disability programme, we had a five-fold variation in the ‘need for admission’ to a mental health/learning disability bed across the country. This has now reduced to a three-fold variation. The National Health Service (NHS) Long Term Plan (www.longtermplan.nhs.uk/wp-content/uploads/2019/01/nhs-long-term-plan.pdf) is explicit about its focus on increasing investment in intensive, crisis and community support and improving the quality of in-patient care across the NHS and independent sector.
Conflict of interest
I am the clinical lead for the national learning disabilities programme in England