Homes not hospitals – making it happen

People with learning disabilities and autistic people are still being kept locked away in hospital settings, despite years of commitments to change.

FitzRoy Chief Executive Angela Murphy reflects on why this is still happening – and what it will take to make ‘homes not hospitals’ a reality.

Over the past few weeks, I’ve found myself coming back to this issue again and again, and I wanted to share some reflections.

People with learning disabilities and autism are still living in hospital settings, often for years, sometimes decades.
There is growing national attention on this issue, including campaigns like those led by Mencap. These are vital in bringing visibility to something that has too often been out of sight and out of mind.

But ‘homes not hospitals’ is not a new idea. For years, national policy has been clear that people should be supported in their communities, close to home – not living in hospital settings long-term. And yet, too often, that promise has not been kept.

As Baroness Casey has already highlighted, too many people are still being left in systems for far too long, and in some cases, effectively forgotten. That shouldn’t be acceptable in any system that claims to support people to live full lives, especially when we know what good looks like. As the Casey Commission continues its work, it will be vital that they focus not only on what isn’t working, but on what we know does – and how we can make that happen consistently.

FitzRoy’s very existence came about because a mother refused to consign her son to an institution, after being told to leave him and ‘get on with her life’.

That challenge still sits at the heart of what we do.

At FitzRoy, I see every day what life looks like when people have a real home.

A home is not just a place to live. It’s somewhere you choose your own furniture, decide what to eat, put the kettle on when you want, and invite people round. It’s where your personality shows.

Some homes are quiet and minimalist. Others are full of colour, music and lots of things people love.

When we get social care right, no two homes or lives should look the same. It is a million miles away from an institutional feel or structure.
When we get social care right, it’s about supporting people to live ordinary lives that give them purpose and bring them joy – relationships, hobbies, work and the routines that shape everyday life.

But we have to be honest – health and social care have not got this right for everyone.
Too often, supporting people to leave long-stay hospital settings is seen as being in the ‘too hard to do’ box.
But these are people’s lives. It should never be seen as optional.

At FitzRoy, we know how to do this.

We’ve worked alongside local authorities and the NHS to support people to move out of long-stay institutions – sometimes after decades – and into homes of their own. It takes time, planning and the right support, working with families, clinical teams and, most importantly, the person themselves.

We build support around the person, taking into account what matters to them, where they want to live and how they want to live.
And when it works, the transformation is extraordinary.

I think of people we’ve supported who spent years and years in hospital settings and are now living in their own homes, choosing how they spend their day and reconnecting with family, building a life that feels like their own.

This is what ‘homes not hospitals’ means in real life.

But we also know this is not happening consistently or at scale, and our challenge now is not understanding what should happen. We already know.

The challenge is making it happen consistently – with the right housing, the right support, a skilled and valued workforce, and funding that reflects the reality of delivering that support. Because this isn’t about moving people out of hospitals quickly and setting them up to fail, but actually taking the time and care to create the conditions for people to live good lives.

Campaigns that raise awareness of this issue are so important. They help bring public attention to something that has been overlooked for too long.

But alongside that, we need to keep showing what works, and what it takes to make it work.

We need to raise our expectations of what a good life looks like, invest in community-based support, and make sure that ‘homes not hospitals’ is not just something we say, but something we are held accountable for delivering.

If we get the systems and the services right, people who have been trapped in institutions – sometimes for decades – have the chance to have a home, and a life that feels like their own. This is what making a difference to someone’s life sounds like.

Ian spent 25 years in institutions.

Now, in his mid fifties, he finally has a place of his own and gets to do the things that so many of us take for granted. Something as simple as being able to answer his own front door or have a barbecue when he wants.

Ian told us: “I haven’t got restrictions, before I had restrictions…I am in a relationship, I can visit her, and if it does go to plan, we plan to go on holiday together. I do nearly everything for myself, I do the washing, sometimes I do the cooking, I do have a bit of support for that kind of stuff.”

I think now, life is just where I want it to be.