“Why can you do it and we can’t”
At this year’s NHS Confederation Mental Health Network Annual Conference, I was invited to speak on a panel exploring how we can better support people with a learning disability and autistic people to move from hospital to the community.
It’s a conversation we urgently need to have.
Earlier this month, PSG research published in The Times highlighted a staggering 86% rise in emergency admissions for autistic children. Across the country, people with complex needs are still being placed in inappropriate long-stay hospital settings or out-of-area placements, often far from home, with little focus on long-term recovery or quality of life.
At Positive Support Group, we see the impact of this every day, and we also see what’s possible when we work together to design services around people that need them.
During the panel, a thoughtful question was asked by an attendee from an NHS organisation we work with. She said: “We gave you all our ‘Reds’ on the Adult Discharge Support Register, and you did an incredible job. But my question is: how come you can do it, and we can’t?”
It’s a big question. And it’s one we hear versions of all the time. It speaks not just to service delivery, but to the frustration many professionals feel when they know what good looks like, but find themselves unable to deliver it inside the current system.
Here’s how I answered.
We’re set up differently
PSG was created specifically to support people with the most complex needs to live well and safely in the community. That focus shapes everything we do. Unlike statutory services, which have to cover a huge range of populations and pathways, we’ve built our infrastructure entirely around a single question: how do we help people with the highest support needs live the lives they want, outside of institutional settings?
Because of this, we’re able to do things differently. We can build and adapt teams quickly. We can straddle health and social care without getting caught between the gaps. We’re not working within fixed financial years or rigid staffing structures. And, crucially, we’re not only there for the transition—we stay involved, and we follow up. We check in months later to see if the plan is still working, and we adjust if needed. That continuity makes a huge difference.
We’re a service, but also a training organisation that leaves a legacy
Another key difference is that while we’re a service provider, we are also a training organisation. Supporting people with complex needs requires skills that evolve with the person over time. Where many systems struggle to keep pace with changing needs, we’ve built the agility to respond in real time. We notice emerging themes early, we commission or design new training fast, and we embed that learning across our teams.
But we don’t stop there. We also train families, support workers and local teams, so that the right practices stay in place even after we step back. One commissioner recently described it as a “legacy of quality,” and I think that’s a fair way to put it. Our goal is not to embed dependency, it’s to raise the standard, leave the knowledge behind, and build capacity wherever we work.
Transition, not just discharge
Another reason for PSG’s success is the way we think about the problems we are solving. An example of this is how we think about getting people out of hospital and safely into an appropriate setting. As a sector this is important, and we must need to shift the narrative from “discharge planning” to “transition and settlement”.
Discharge is a logistics process: how do we get someone out of hospital?
Transition is a life process: how do we help someone build a meaningful, sustainable life in the community?
At PSG, we plan for a person’s first hour, first day, first week, first month post-hospital. Those early moments are so important and can often determine whether someone ends up thriving in the community, or cycling back into crisis. That’s what keeps people out of hospital and that’s what makes transitions stick.
Specialist work needs specialist infrastructure
PSG is built specifically for a population that statutory services often struggle to support. We don’t try to cover every type of need. Instead, we go deep on a very particular kind of complexity. We’ve designed our entire organisation around meeting it.
That includes having the right people in the room. Our teams are multidisciplinary by design, combining clinical psychology, behavioural expertise, nursing, speech and language therapy, and other professions depending on the needs of the person. This gives us the flexibility to tailor support, not just apply a one-size-fits-all model.
We also adapt as needs change. Once, our referrals were predominantly people with learning disabilities. Now, we’re seeing more autistic individuals, eating disorders, gender dysphoria, and increasingly complex mental health needs. Our infrastructure allows us to respond to those shifts, without having to rebuild the system each time.
Behaviour support works – but it’s not all we do
There can be a perception that behavioural support is too narrow, or not always appropriate for the full range of needs people may present with.
While this can be the case our outcomes often tell a different story. At PSG, we know we reduce the risk of harm for 97% of the people we support - and that’s not by chance. It’s because our behavioural support isn’t rigid or standalone. It’s embedded in a broader, multidisciplinary approach that is person centred, meeting the individual where they are at.
We combine behaviour analysis with input from psychology, nursing, speech and language therapy, and other areas as needed. So yes, behavioural support is a core part of what we do, but it is part of a system that’s person-centred, evidence-informed, and grounded in real life. The question we ask is always, what support does this person need to live well? We then build that team and support around the individual.
Why Can We Do It?
So, back to the question: Why can we do it, and others can’t?
Because we’re set up to do it.
Because we’ve made complexity our core business.
Because we’re designed specifically for the people we serve.
Because we’re relentlessly focused on what works—for real people, in real communities.
And because we know that helping someone move out of hospital isn’t just about where they live—it’s about how well their support wraps around them, how connected they are to community, and how prepared the system is to walk with them long after the move.
