Here to help with questions relating to learning disability and its impact on family carers
The following is an analysis of the report which has now appeared in the latest (summer) edition of our newsletter Resnews:
The introduction notes that there are 120,000 people with learning disabilities so severe that they need daily help to perform the most basic of tasks and the isolating effect on people when the right care and accommodation are not available. The report is split into four chapters the first of which looks at accommodation, and notes that access to residential placements has reduced over the last few years with an increase in supported living and more people being looked after by ageing parents in the family home. The case is made for both residential settings and intentional communities (Newton Dee in Aberdeen is used as an example of an intentional community) and supported living arrangements in the wider community. It was strongly noted that in 80% of local authorities studied that there is a definite shift away from residential care to supported living. It is noted that current funding pressures are having such an impact on the residential sector that such care will cease to be available thus impairing personal choice.
Chapter two looks more closely at funding and the problem faced by local authorities to quote “ the CSJ heard that reduced funding has contributed to a lower standard of care provided to adults with a learning disability, and has also reduced the choices available as to how they receive their care. This appears to be the result of an apparent commissioning bias in favour of supported living because the funding system means that placements in these settings create less pressure on Local Authority budgets. At the moment those in supported living can pay for their housing costs using housing benefit and receive DLA or PIP along with means-tested Social Care, however those in residential care cannot receive housing benefit nor the care component of DLA or PIP. Supported living is thus attractive to L A commissioners because it moves people with learning disabilities from a L A social services budget onto the DWP welfare budget. Transferring service users onto the DWP budget is not only attractive because it eases pressure on the local authority finances but because the DWP budget is an Annually Managed Expenditure (AME) budget which means that it is demand led, while Local Authorities have a Department Expenditure Led (DEL) budget, meaning it is a capped sum. In essence the move from DEL to AME is easier because AME budgets are inherently less constrained than DEL.” This all means that while budgets work in this way it is always cost effective for the Local Authority to choose supported living over residential care, rather that looking at the best solution from an holistic perspective.
Chapter three looks at conflicts of interest and how the funding issues are distorting both the assessment of need and the reliable advocacy necessary to help people with learning disabilities choose appropriate provision. In terms of assessments there is a worrying increase in the number of learning disabled adults not having any assessment at all and in cases where an assessment is undertaken once the findings are placed before a funding panel where the amount of funding assigned to meet each need is decided, that these assessed needs are then systematically under funded. The second area of concern is about advocacy which is enshrined in the Care Act and should be available for all who meet the eligibility criteria, however concerns have been raised about the independence of advocated that are employed by Local Authorities.
Chapter four looks at the solution which makes the following recommendations:
Recommendation 1. The regulatory terms “Supported Living” and “Residential Care” should be abolished in favour of a single regulatory term “housing with care”
Recommendation 2. Care providers should differentiate between how much they charge for housing and how much they charge for care costs in order to maximise transparency for service users and user choice between services.
Recommendation 3. Adults with learning disabilities in housing and care should receive housing benefit and both the care and mobility components of DLA/PIP regardless of whether their tenancy agreement is connected to the care they receive.
Recommendation 4. That an independent assessment provider and funding panel be set up, whose assessments and the funding decisions which stem from them are independent of Local Authorities.
Recommendation 5. While not compulsory, we strongly recommend that an adult with learning disabilities be involved in the assessment and funding allocation process. This involvement should be in an official and fully paid manner.
Recommendation 6. The government should change Local Authorities’ Social Care budgets from a fixed DEL budget to a demand led AME budget.
Recommendation 7. That a truly independent advocacy process be established, whose funding and working is separate from Local Authorities.
Recommendation 8. While not mandatory, we strongly recommend that adults with learning disabilities be involved in the advocacy process in an official and fully paid manner.
Recommendation 9. The introduction of a Social Care tribunal, chaired by a legal professional, with medical professionals, carers, social workers and service users present to investigate the detail of assessment and funding decisions which are suspected to be inadequate.
The report concludes with this last sentence: “Social Justice is about giving people the opportunity to shape their own lives for the better and participate fully in society, only by giving those with learning disabilities the options to choose effective support that is right for them will we achieve this in our society”.