Social care commissioners are still over-reliant on residential care for people with learning disabilities – this denies people their basic rights and entitlements and wastes public money
In 2001 Valuing People – at the time the new national policy for people with learning disabilities – expressed a clear vision for the future based on independence, rights and opportunity for all. This vision was reiterated in 2009 in Valuing People Now – a revised three-year strategy. We can only assume that this new strategy was necessary because councils and their partners had failed successfully to deliver the objectives of the original policy.
The Valuing People Now delivery plan made a commitment to extend the range and availability of housing and support. However, today many people with learning disabilities were still either living with family and friends or in a registered care home. Even worse, there are still people living in hospital – the most restrictive of environments – who should not be there.
Councils still spend £2.2 billion on residential care services compared with £1.1 billion on supported living. The proportion of the total adult social care learning disability budget which is spent on residential care has remained relatively constant over the last five years – 40.8% in 2010/11 and 38.2% in 2014/15. Planned reductions in expenditure in 2015/16 are greater for support at home (£23 million) than residential care (£17 million) (Association of Directors of Adult Social Services 2015).
All of this demonstrates that change does not happen simply because there is a political and professional consensus that it should do so. Services for adults with learning disabilities remain resistant to change in spite of the best policy intentions. While there has been progress in many areas, there remains considerable scope for shifting the balance from residential care services to supported housing.
A policy commitment to the principles of rights, independence and choice is long-established in learning disability services. Supported housing gives professionals and the people that they support the best chance of putting these principles into action. This model has significant advantages for the individual when compared to residential care: security of tenure in one’s own home; the right to choose who provides support; the right to choose who to live with; rights to full welfare benefits. Supported housing developments can be specified to meet individual requirements – e.g. behaviour that challenges – and be equipped with personalised technology to reduce dependence on paid support.
As if all of this is not enough, supported housing will help councils save money. Local authorities continue to spend more than they should on residential care placements for people with learning disabilities. In the financial years 2013/14 to 2015/16 Valuing Care reviewed the costs of 520 placements on behalf of nineteen commissioning authorities. Annual spend on these cases was £49 million. Detailed analysis of the costs revealed that commissioners were paying a total of £7 million (14.6%) above the value for money model price. There are significant profits/excessive margins in learning disability residential care placements – better commissioning or alternative services could release an average of 14.6% of the package costs in this sample.
This problem simply does not arise in supported housing. The commissioner specifies the number of hours of support that are required and pays for them at a fixed hourly rate. The commissioner then works in partnership with the providers of support and adaptive technology to minimise dependence on paid support over time.