Management for services for people with learning difficulties: tough financial choices

This appeared on page 47 of the magazine, under the title At what price?

The increased life expectancy for people with learning difficulties is, of course, great news. But, with pressure to improve the quality of services as well as to provide services for more people, management is having to face some difficult decisions, reports Mithran Samuel

Somerset Council is facing massive cost pressures in learning difficulties services.

According to Paul St Quintin, strategic commissioning manager for learning disabilities, the number of independent
placements funded by the council has doubled over the past five years to 250, and is predicted to grow by 35 places a
year between 2006 and 2010.

The average cost of each placement has also grown to £40,000 a year.

Costs are expected to grow at £1m a year between 2006 and 2010 and that is only if the council makes efficiency savings
of over £400,000 per year from 2007 onwards.

Last October, a report by the Association of Directors of Social Services indicated that Somerset’s is far from a unique
tale. It found that increased life expectancy for children and adults with learning difficulties and rises in numbers of people with more complex – and hence expensive – conditions, were driving up costs.

Overall, councils were spending more than half their learning difficulties budgets on residential and nursing care – more than double the spend on supported accommodation placements.

Somerset’s predicament comes despite being, in many respects, a model authority on learning difficulties.

The council supported 500 people in supported accommodation at an average annual cost of £27,000, and 339 in residential care at £38,000 per head in 2005-6, as a result of a commissioning shift in the late 1990s. And its strategy for 2006-10 envisages that 80 of the 140 expected extra places will be in supported living.

Yet, St Quintin says most of the resources released from the shift from residential to supported living were eaten up by
increased demand, particularly from people with more intensive needs.

This is why Somerset’s 2006- 2010 commissioning strategy involves a value-for-money assessment of all accommodation and support providers. While supported provision has been in-house until now, the three-star council is tendering for independent housing and home care providers to achieve the expansion in provision in order to improve choice for users and value for money.

In residential care, the council is taking advantage of a “pricing tool”, developed in conjunction with other authorities in the South West, to benchmark costs and inform negotiations with providers.

In the long-term, St Quintin sees the In Control scheme, in which users are given budgets to organise their own care, as a potential “holy grail” for improving services while simultaneously controlling costs.

Early findings from the evaluation of the 50-plus pilot councils, of which Somerset is one, has found such self-directed support could save money. In another effort to control costs, Croydon, Kingston, Merton, Richmond, Sutton and Wandsworth councils in south west London have come together to jointly commission learning difficulty services.

Merton’s outgoing interim director of community and housing, Jeff Hobden, says the scheme is designed to give the authorities the economies of scale to reshape provision – and fill gaps for people with complex needs. He says individual councils “have not got sufficient volume to go to the market and say ‘can you provide this’”, but collectively they can.

Hobden says that by clubbing together, the councils are offering providers savings from the costs of dealing with multiple
authorities. He adds: “The more likely we are to give them cash savings the more likely they will keep prices down.”

However, for St Quintin, authorities’ efforts to control costs while maintaining, or enhancing quality, in learning difficulties services is ultimately unsustainable: more money has to be found.

He believes the government must do more to provide for the increasing number of premature babies who survive and have learning difficulties: “There hasn’t been a debate about the long-term needs of these children. If we are going to invest in the medical technology [that ensures their survival] we need to fund the support they need through their lives.”

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