Demands for a “Wanless” into future services for people with a learning disability and their costs are growing. The Association of Directors of Social Services, Community Care’s A Life Like Any Other campaign, and the new Learning Disability Coalition have all called for a Wanless-style review.
In 2002, Sir Derek Wanless, former Natwest chief executive, produced the report Securing Our Future Health: Taking a Long-term View for the government, estimating how much money health care would need over a 20-year period. As a result, annual NHS funding increased.
His review into providing social care for older people, commissioned by the King’s Fund in 2006, examined costs over a 20-year time frame and the funding needed to provide high-quality outcomes (see “Wanless Review”). However, the government’s intention in tackling this issue is as yet unknown. It should become clearer when the comprehensive spending review is announced later this year.
Meanwhile another Wanless review, again commissioned by the King’s Fund, is under way into mental health care.
Financial pressures on local government mean that annual increases in expenditure in real terms are not keeping pace with growing demand for services for people with a learning disability. According to figures from the Local Government Association last year, 70% of councils provide services only for those with substantial or critical care needs. Many people are suffering service cuts and support that jeopardise their quality of life.
The review of social care for older people provides a possible blueprint for a “Wanless” for people with a learning disability. Overall, it should rigorously analyse the services and support needed to give people with learning disabilities the same chances and choices as everyone else. It should determine what funding is needed to honour the promises the government has made in Valuing People and Improving the Life Chances of Disabled People.
Fundamental questions include: what range of services and support for people with a learning disability should be available in the future, and how will these help them? What specialist services are needed, say, for people with challenging behaviour? Should services for employment, further education, skills training, day and leisure activities be integrated with social care packages?
What outcomes should commissioners and funders seek to deliver to improve people’s quality of life? And how can they be measured? Historically, it has been difficult to measure outcomes for individuals rather than for service outputs.
The review also needs to look at who should be helped, and whether they should just be people with higher support needs. It should examine the level and significance of unmet need, and the impact of failing to support those people who require only limited support but who are vulnerable and unlikely to cope with none.
Only 10% of people with a learning disability work, but 65% would like to. A review should investigate whether this is feasible, and weigh up the likely social and economic benefits if more were in work.
With these questions answered, it ought to be possible to make decisions about the range of services and support that should be available to people with a learning disability. It should also assess the size and composition of the workforce needed to deliver these services – for example, the increase in demand for personal assistants as a result of individual budgets and direct payments.
The next stage should look at what helps or hinders delivery of these decisions. It needs to consider the effectiveness of current policy and services in delivering individually tailored support, by, for example, looking into how the modernisation of day services is affecting individuals and their carers. As well as taking stock of how services are now delivered, it should analyse current spending structures and how they could be improved, and look at how well independent budgets and “In control” are working.
Demographic, health, economic and social trends will affect demand. Is it possible to assess more accurately the number of people with a learning disability and how this will increase? What are the implications of improvements in neo-natal care? Are we managing services in the best interests of those with profound and multiple disabilities? And what is the impact on the overall budget for learning disabilities?
Young people with profound and multiple disabilities are moving through to adult services with higher expectations of leading a full life. Any review needs to consider the effect on them and their carers.
More people with a learning disability are living beyond 60. This will have an impact on services and the supply of suitable accommodation. The review would need to look at what these are, as well as how their care needs differ from those of other older people. It should also consider the contributing factors to challenging behaviour, mental illness and early onset of dementia, and the action needed to address these trends.
The investigations into abuse in Cornwall and in Sutton and Merton found that staff and management were unclear about what constituted “good support”. So a review should examine resources needed not only for staff development, but also for a widespread culture change.
Having examined these and other relevant trends, a review team would then calculate how much money is needed to fund its recommendations. In doing so it would need to take account of the outcomes for people, such as improvements in their daily quality of life the availability of informal care from families and friends and how that contributes to meeting overall demand.
What does this mean for carers, and what is the overall economic impact of their caring? What recruitment and training is needed in the formal care sector to deliver quality outcomes? Do services need reconfiguring, and how can better value for money be achieved without diluting services?
Wanless reviews take a view over the next 20 years. Change is needed earlier than that. So while the review would make cost projections for that period, it should also make recommendations for current spending programmes. The announcement of a review for Valuing People could be a catalyst for tackling these fundamental issues about the funding of services and support for people with a learning disability.
Heather Honour is manager of the Learning Disability Coalition
Community Care is running a conference, “Improving lives for people with learning disabilities: A life like any other”, in London on 4 October. For more details telephone 020 7347 3500.
This article appeared in the 9 August issue under the headline “Worthy target for a Wanless”