Transforming Care - history and future

What is Transforming Care?

In May 2011, the BBC Panorama documentary Undercover Care: The Abuse Exposed revealed shocking abuse taking place at Winterbourne View Hospital, a private hospital for people with learning disabilities. The documentary also drew attention to the fact that many people with learning disabilities and autistic people were being detained in inpatient services, not because they needed to be there for ‘assessment and treatment’, but because the failure to provide support in their communities meant that there was nowhere else for them to go.

Following the Panorama documentary, Winterbourne View Hospital was closed, and the Care Quality Commission (CQC) carried out a national review of similar services – finding that nearly half of them did not meet CQC’s standards for welfare, care, and safeguarding.

The Transforming Care programme was set up in 2012 in response to the abuse at Winterbourne View and the CQC’s findings. The programme’s aim, as well as the aim of its successor Building the Right Support, was to ensure that people with learning disabilities and autistic people could get the right support in their local communities, rather than being inappropriately admitted to hospital.

Timeline

2011

• BBC Panorama documentary exposes abuse at Winterbourne View Hospital
• Winterbourne View is closed, and criminal investigations follow

2012

• CQC publishes Learning disability services inspection programme: National overview
• Department of Health publishes Transforming care: A national response to Winterbourne View Hospital – plan commits £2.86m to develop community support
• First target announced: to review every person with a learning disability in an inpatient setting by June 2013, with everyone who was inappropriately placed moved out by June 2014

2013

• Local Government Association (LGA)-led Joint Improvement Programme set up and tasked with delivery of the Transforming Care actions

2014

• First set of Transforming Care targets missed
• Transforming Care and Commissioning Steering Group, chaired by Sir Stephen Bubb, publishes Winterbourne View – Time for Change: Transforming the commissioning of services for people with learning disabilities and/or autism highlighting the lack of progress

2015

• National Audit Office publishes Care services for people with learning disabilities and challenging behaviour, a highly critical report on the lack of progress made by the Transforming Care programme
• In evidence given to the Public Accounts Committee (PAC), Simon Stevens (Chief Executive of NHS England) commits to developing a programme to reduce the number of people with learning disabilities in inpatient beds
• NHS England, LGA and ADASS (Association of Directors of Adult Social Services) publish Building the Right Support
• Second target announced: to move 35-50% of people with a learning disability and/or autism out of institutions and into the community by March 2019

2017

• Following commission by Department of Health, Dame Christine Lenehan (Director of the Council for Disabled Children) publishes These are our children
• National Audit Office publishes a second report on the Transforming Care programme, Local support for people with a learning disability, concluding that a number of unresolved complex challenges remain
• Following commission by Department for Education, Dame Christine Lenehan and Mark Geraghty publish Good intentions, good enough? A review of the experiences and outcomes of children and young people in residential special schools and colleges

2018

• NHS England appoint Ray James as lead for Transforming Care
• Following commission by the Prime Minister, Sir Simon Wessely publishes his Independent Review of the Mental Health Act

2019

• Second target missed
• Third target announced: 35% of people to be moved into the community by March 2020
• NHS Long Term Plan commits to introducing keyworkers for all children and young people with learning disabilities/who are autistic in hospital by 2023/24 and commits to action on reducing restrictive interventions, investing in intensive, crisis and forensic community support (including all areas to have 7-day specialist multidisciplinary and crisis services), and reducing lengths of stay and out-of-area placements
• Fourth target announced: by March 2024, there should be no more than 30 adult inpatients per million with learning disabilities/who are autistic in hospital, and no more than 12-15 children per million – a reduction of 50% compared to March 2015 (when data began)
• BBC Panorama uncovers physical and psychological abuse at another private hospital, Whorlton Hall, originally part of the same chain as Winterbourne View Hospital
• Children’s Commissioner publishes Far less than they deserve: children with learning disabilities or autism living in mental health hospitals
• Joint Committee on Human Rights publishes The detention of young people with learning disabilities and/or autism criticising the violation of human rights of people with learning disabilities and autistic people in inpatient units
• Secretary of State for Health and Social Care announces Independent Care (Education) and Treatment Reviews for all people with a learning disability and autistic people in long-term segregation in hospital, with Baroness Hollins appointed to chair an independent Oversight Panel to oversee this process

2020

• Third missed target
• Joint Committee on Human Rights publishes Human Rights and the Government’s response to COVID-19: The detention of young people who are autistic and/or have learning disabilities
• CQC publish a review of restraint, segregation and seclusion in care settings: Out of Sight – Who cares?
• Baroness Hollins and the Independent Care (Education) and Treatment Review Oversight Panel publish interim findings and recommendations

2021

• Following end of Ray James’ tenure as Transforming Care lead, the role is downgraded to part time
• Norfolk Safeguarding Adults Board publishes the Safeguarding Adults Review Joanna, ‘Jon’ and Ben, following the deaths of three people with learning disabilities at Cawston Park Hospital (which closed following a CQC inspection earlier that year)
• Barbara Keeley MP leads a debate in Parliament on the 10th anniversary of the Winterbourne View hospital scandal and progress on moving people with a learning disability and/or autism out of in-patient units (watch the debate or read the transcript)
• Health and Social Care Committee publishes The treatment of autistic people and people with learning disabilities

2022

• Government publishes the Draft Mental Health Bill, which proposes changing detention criteria for people with a learning disability and autistic people
• Government publishes the Building the Right Support Action Plan
• Following abuse of children at 3 residential settings run by the Hesley Group in Doncaster, the National Child Safeguarding Practice Review Panel publishes Safeguarding children with disabilities and complex health needs in residential settings: phase 1 report

2023

• As part of its response to the Safeguarding Adults Review Joanna, ‘Jon’ and Ben, NHS England publishes Safe and Wellbeing Reviews: Thematic Review and Lessons Learnt report, a review of all people with a learning disability and autistic people within inpatient settings – finding that at least 41% did not need to be in hospital
• National Child Safeguarding Practice Review Panel publishes Safeguarding children with disabilities and complex health needs in residential settings: phase 2 report
• Durham Safeguarding Adults Board publishes Safeguarding Adults Review: Whorlton Hall
• Baroness Hollins publishes My heart breaks – solitary confinement in hospital has no therapeutic benefit for people with a learning disability and autistic people, the final report on Independent Care (Education) and Treatment Reviews
• Government publishes response to Baroness Hollins’ recommendations
• Government publishes response to National Child Safeguarding Practice Review Panel’s recommendations

2024

• Fourth missed target
• Government introduces Mental Health Bill into Parliament

2025

• During the Mental Health Bill’s passage through Parliament, Minister for Care Stephen Kinnock commits to working with people with lived experience and other stakeholders to shape a roadmap so that reforms to learning disability and autism detention criteria can be ‘switched on’
• Mental Health Bill passes into law as Mental Health Act 2025, but there are no timeframes for enacting the changes to detention criteria

What have we been doing?

Working in partnership with people with learning disabilities, autistic people, their families, and organisations, the CBF has campaigned for change and to hold the government to account, whilst highlighting how to provide the right support, at the right time in the community for children, young people and adults.

The CBF and Mencap support the Homes Not Hospitals Campaign Families Group, a group of family carers of children, young people and adults with learning disabilities who are, or have been, in hospital. This group campaigns for change so that their relatives and other people with learning disabilities and autistic people can live their lives in their communities with the right support.

Find out more about the Campaign Families

Publications, evidence and briefings

Here you can see some of the work we’ve been involved in over the past 15 years:

2011

The Challenging Behaviour – National Strategy Group produced Time for Action and Time for Action (Easy Read)as a response to the Panorama documentary, setting out a list of actions that would support people with learning disabilities whose behaviour challenges.

2012

The CBF and Mencap published the Out of Sight report, which set out the systemic issues and changes needed.

2014

The CBF, Mencap and the Campaign Families group worked together to publish Winterbourne View: The Scandal Continues, revealing the extent to which the Transforming Care programme had failed to meet its targets and the human cost of this failure.

2016

The CBF, the National Autistic Society and Mencap interviewed families for the Transforming Care: Our Stories report, which set out serious failings of care including individuals being given high levels of anti-psychotic medication when no psychosis was present, unnecessary use of restraint and a lack of staff trained in autism.

2021

The CBF, Mencap, Rightful Lives and Learning Disability England co-produced a report on Transforming Care and its impact on individuals and families for the Health and Social Care Committee. Viv Cooper (the CBF’s Founder and then-CEO) also gave evidence to the Committee, highlighting the experiences of families supported by the CBF.

To mark the 10 year anniversary since the Panorama documentary, a group of families with relatives who were at Winterbourne View published Tea, smiles and empty promises– a collection of family stories. A short film, highlighting some of the stories shared in the report, was also produced.

2024

The CBF and multiple other organisations worked together to produce joint briefings on the need for Mental Health Act reform and for community support, including good practice examples.

2025

The CBF and Mencap supported the Campaign Families Group to share their ideas of what would improve support with NHS England’s Learning Disability and Autism team – these ideas, as well as ideas shared in the May 2025 CB-NSG meeting (which also focused on Mental Health Act reforms and community support) have fed into NHS England’s work to improve community support so that people with learning disabilities and autistic people are no longer detained in hospital.

While the Mental Health Bill (now the Mental Health Act 2025) was going through Parliament, the CBF worked with families and with other organisations to share information and families’ experiences with MPs and Peers, ensuring their views were taken on board by politicians throughout the process.

What next?

The Mental Health Act 2025 is now law, but there is still no roadmap for developing the community support that will enable the changes in it to be enacted. We will continue to work with people with lived experience and other organisations to push for a properly co-produced roadmap so that children, young people and adults can get the right support in their local communities, rather than being inappropriately detained in hospital.