When Julie Newcombe visited her learning disabled son, Jamie, he was subdued and nursing a swollen arm.

Staff at the care unit in the south of England where he had been living for a few weeks said that Jamie, 23, who has autism and intermittent mental health issues, became distressed and hit a care worker.

Giving evidence to parliament in December, Newcombe told MPs that his arm was subsequently broken by a support worker in a restraint. “The arm was wrenched up behind his back until the bone snapped,” she said. “He was not taken to accident and emergency for 24 hours even though his arm was completely swollen.”

Jamie spent a year in the privately run locked rehabilitation unit in 2015. These units are meant to provide therapeutic care on locked wards in the community, and support people moving from long-term inpatient care into their local area. Before rehab, Jamie was in psychiatric intensive care and then in a hospital-style assessment and treatment unit (ATU), having been sectioned under the mental health act at 18, when his residential care broke down.

But Newcombe says Jamie’s care did little to help him live in the community again – and that the rehab activities mainly included being taught to cook and clean. She adds: “I visited every day and was allowed to take Jamie out … we’d go shopping or to the cafe, but inside rehab, he was restrained and locked away.”

Newcombe, who co-founded the human rights campaign Rightful Lives to champion the interests of people with learning disabilities and autism, and to highlight cases where they have been breached, says local authorities and clinical commissioning groups use these secure units instead of finding adequate support for people in the community. “Locked rehab is a handy extra step in the system when you want to keep people locked up,” she says. “It’s a tempting alternative to moving people back to the community.”

Last week’s NHS long-term plan included a new target to reduce the numbers in ATUs by half compared to 2015 levels (when there were around 3,000 people in such units). After the 2011 Winterbourne View abuse scandal exposed the reality of some ATUs, the government promised to move all inpatients into community-based housing within three years under its transforming care programme. That target was missed.

‘After the 2011 Winterbourne View abuse scandal exposed the reality of ATUs, the government promised to move all inpatients into community-based housing within three years. That target was missed.’ Photograph: Tim Ireland/PA Archive/Press Association Images

Despite being designed for temporary care and assessment while long-term support is organised, many residents have been there for more than two years. Progress has been slow and latest figures show that 2,350 people still live in ATUs. And the avoidable death of Connor Sparrowhawk in an NHS-run ATU in 2013 underlined the failures in these units.

Now, campaigners fear the looming deadline to discharge patients from ATUs, together with a separate government-commissioned review of the use of restraint, prolonged seclusion and segregation for people with mental health problems, a learning disability and/or autism, will simply lead to more people being discharged into equally restrictive places such as locked rehab units.

Last week, the Commons’ joint committee on human rights quizzed NHS England and the Care Quality Commission (CQC) regulator as part of its inquiry into conditions at learning disability units.

And figures seen by the Guardian show that at one ATU in the two years up to April 2018, almost 50% of people left to go into privately owned “independent hospitals”, which can include locked rehab placements. Far fewer people (roughly 15% each) move into supported living, residential care or to an NHS hospital. Campaigners want more scrutiny over where people go after ATUs.

NHS Digital figures show increasing numbers of people moving to places classed as “other” types of care(compared with those going to residential or community care, for example). What “other” includes is not defined, raising concerns about what type of care this is.

Chris Hatton, professor of public health and disability at Lancaster University, says: “Without transparency, it’s possible to game the statistics to make the ‘transforming care’ numbers look good while consigning people to invisibility in places that feel very similar to inpatient units.”

Lib Dem MP and former health minister Norman Lamb says the rush to move people out of ATUs risks creating a revolving door of discharge and readmission. This is because “you discharge people to inappropriate or unacceptable settings that don’t actually enhance their quality of life”.

‘It’s possible to make the ‘transforming care’ numbers look good while consigning people to invisibility in places that feel very similar to inpatient units,’ says public health professor Chris Hatton. Photograph: Anna Gordon

This was the experience of Alexis Quinn. Quinn, who is autistic, spent five months in locked rehab in southern England in 2015 after more than three years in an ATU, psychiatric intensive and acute mental health care. She calls locked rehab “an oxymoron”: “How can you rehabilitate someone into community life when they are locked up?”

The CQC has previously warned against the use of locked rehab for mental health patients, while the Royal College of Psychiatrists does not accept it as a type of care. “The facilities appear to be defined by having a locked door rather than the specific type of rehabilitation service they offer,” says Rajesh Mohan, chair of the rehabilitation and social psychiatry faculty at the RCP.

Residential homes for learning disabled or autistic people can be just as oppressive. Tom Richardson, 17, (not his real name) has severe learning disabilities and spent 18 months on and off in one ATU in the north of England in his early teens. His initial discharge to a privately run group care home failed as Tom found it overwhelming. After another ATU spell, he went to a small, private care home. He was the sole resident, there was an office by the entrance and some staff wore suits. Tom’s mother, Amy, says: “We were shocked. We felt that the care wasn’t therapeutic but focused on physical restraint and seclusion.”

A year later, council commissioners asked local supported-living provider Orbis Support to take over Tom’s support and move him from the care home to the community. Nigel Devine, its operations director, says: “It’s 100% possible to come out of an ATU and move into a real, proper home”. Over a number of months, four staff built a rapport with Tom and found a housing association bungalow on a residential street near some shops. Tom has lived there with 24-hour support for almost a year. His mother says: “We’ll go out near his place and pass someone in the street, he’ll know them and they’ll say hello. It’s an absolute turnaround.”

Tom’s experience shows a successful move to the community is possible, but there is an additional concern.

While there is a new target to reduce ATU use in the NHS long-term plan, there is nothing to replace the transforming care agenda after March. Steve Scown, chief executive of voluntary sector support provider Dimensions, says: “Without such a central focus, who’s going to make sure we’re not seeing people being transferred into privately owned and managed long-stay institutions?”

An NHS England spokeswoman says it is investing £75m to improve specialist community support for learning disabled and autistic people: “Treatment and care reviews are in place to ensure the right care and support is provided to help people live as independently as possible and close to their family and friends.”

Back in Surrey, Jamie Newcombe is now living in a flat in a residential care development in Surrey. He is happy, says Julie, although deeply affected by his locked rehab experience: “When he’s anxious or upset, he’ll shout about what happened when his arm was broken.” Eventually, she says, her son hopes to move closer to home in London: “Jamie has a human right to a family life.”