From Hospital to Home: Reducing Long-Term Detention

In August 2025, the National Autistic Society published its latest Assuring Transformation data on the number of autistic people and people with learning disabilities in mental‑health hospitals across England.
The figures make sobering reading: 2,025 people are detained, with 73 % of them having an autism diagnosis.
Among these, 225 are children and young people under 18.

Despite government promises to close inpatient beds, the number of autistic people without a learning disability in hospitals has risen by 142 % since 2015.
On average, people stay 4.6 years in hospital, far longer than they need clinically and often far from home.

Why do people stay so long?

Long-term hospital stays are rarely due to medical need alone.
Several systemic issues keep people locked in:

• Lack of community placements: Many local areas do not have suitable housing, skilled support teams or funding to deliver 24-hour care.
  Commissioners struggle to find providers who can meet complex needs, particularly when behaviour that challenges is involved.
• Risk aversion: Clinicians and local authorities sometimes delay discharge because they fear the consequences of a placement breaking down. Without clear accountability and robust risk‑management plans, decision‑makers may feel safer keeping someone in the hospital.
• Legal barriers: Under the Mental Health Act, people can be detained for treatment or for public protection. Navigating the legal processes, such as discharge tribunals and Ministry of Justice permissions, can be lengthy and adversarial.
• Poor discharge planning: Discharge is too often treated as an afterthought. Families may not be fully involved in planning, and transitions between health, social care and housing providers are disjointed.

These factors lead to “delayed discharges”, where someone could safely live in the community but remains on a hospital ward.
NHS England notes that in recent safe‑and‑well-being reviews, 41 percent of people in hospital had care and support needs that could be met elsewhere.

 

What does good discharge planning look like?

NHS England has set out five key elements to help people leave the hospital successfully:

1. Treat delayed discharge as harm: Local systems should see every unnecessary day in hospital as a risk to a person’s physical and emotional wellbeing and prioritise discharge accordingly.
2. Use existing frameworks: Tools such as the 12-point discharge plan and Care (Education) and Treatment Reviews (C(E)TRs) clarify roles and ensure collaboration across health, social care and housing.
3. Co‑produce plans: Discharge arrangements must be developed with the individual, their family and advocates so that support reflects their aspirations and cultural needs.
4. Engage all partners early: Commissioners, providers, regulators, and, if there are legal restrictions, the Ministry of Justice should be involved from admission so there are no last-minute delays.
5. Maintain a focus on wellbeing: Throughout an inpatient stay, teams should plan for discharge, address the person’s mental and physical health and ensure that support during the transition is in place.

The role of personal health budgets

Personal Health Budgets (PHBs) and direct payments can be powerful tools to unlock delayed discharges. They allow individuals to design bespoke support packages—employing personal assistants, purchasing specialist therapies or arranging supported living. Because funding follows the person, PHBs can bridge the gap between health and social care budgets and give families greater control over who provides their care.

At HomeCareDirect, we specialise in supporting people to use their PHBs to choose their own staff.
Our nurse-led team provides clinical oversight of the support package, with dedicated staff to assist with recruitment, training, payroll and compliance so that individuals can recruit personal assistants who understand their needs and culture.
This reduces reliance on agency staff and helps build stable, trusting relationships, critical factors in preventing readmission.

Looking ahead

Reducing long-term detention requires system-wide change: investment in community services, skilled staff, accessible housing and flexible funding.

But it also needs cultural change.
People with learning disabilities and autistic individuals have the right to live in homes they choose and receive hospital care only when necessary.
Personal health budgets, nurse-led community providers and genuine co-production can make that a reality.

HomeCareDirect remains committed to advocating for discharge when it is safe and supporting people to build fulfilling lives in their communities.