When the government published its Valuing People white paper in 2001 it extolled a vision in which day services for individuals with learning disabilities would be modernised, improved and focused on their needs and wants. It was not, presumably, intended to panic vulnerable clients and their parents with the threat of even worse provision than the dismal service some were receiving.
However, it appears that “modernising” day services has been interpreted by some local authorities as an excuse to shut traditional day centres, with the express or implied aim of controlling budgets.
And despite day centres having lost favour with groups campaigning for better opportunities, the prospect of closing them wholesale is causing upset and uncertainty among many service users and their carers – the very people whom this modernisation policy was meant to benefit.
Kathy Carne is a case in point. She is 46 and has been attending a day centre in Cornwall for most of her life. Her sister, Penny Blythe, who has cared for her since their parents died, points out that, although the centre is far from perfect – it is in an old building that lacks adaptations – Carne enjoys going there to meet her friends, some of whom she has known since childhood. Carne does drama, is taken on work placements and attends exercise classes. She also helps in the dining room. Since Cornwall Council announced two years ago that Carne’s need for day services would be reassessed and that the future of the centre was uncertain, Blythe’s anxiety levels have risen.
Blythe says: “There’s been little consultation. The council says there’s a lack of funds and it’ll affect day services.”
But Carol Tozer (pictured), Cornwall’s director of adult social care, contests the assertion on consultation: “Over the past 18 months, we have been developing plans on improving our day services with the help and involvement of the service users, their carers and the learning disability partnership board. There have been meetings in each day service, with families and staff. These are now informing the plans that will come to the learning disability partnership board this autumn. There are no plans to reduce the level of investment in day services. Rather, we want to use that level of funding to achieve choice and control.”
However, when vulnerable people have known only one reality, even the prospect of change can be upsetting. Nor should it be regarded as selfishness that carers need consideration too – they offer years of unstinting, unpaid support, and the respite the centres have offered them for a few hours each day gives them the chance to have some sort of normal life.
Andrew Holman, social care consultant at Inspired Services, is no great advocate of keeping day centres open. But even he says: “There are many people who say they like their day centres a lot. They are then overruled and told that their centre has to close.
“We know that a lot of local authorities whose budgets are strapped have leapt on to the modernisation bandwagon to save money. When people go from a centre and on to direct payments, from a five-day-a-week service to a couple of hours a day, in most cases, that is not meeting their basic needs, let alone anything else.”
Sitting at home doing nothing is not the kind of modernisation that Mencap had in mind when it supported the Valuing People agenda. “One of the principles around changing services is about having tested alternatives in place before anything is closed,” says campaigns manager Carol Herrity. “The snag is that you’re having to fund two parallel services for a while.”
Asking and listening before doing are where local authorities often fall down, says Andrew Lee, director of self-advocacy at People First, which wants day centre provision to end in favour of direct payments and meaningful community integration.
“People with learning disabilities need support to understand and approach change, and to understand that they have a choice. For some individuals, it can be the first time they’ve been asked what they think. And for people with higher support needs taking the time to communicate is key. If local authorities say they are committed to providing support for people with higher support needs, I’d question that, because what we know is that some of them are pulling the funding for self-advocacy groups for people with mild support needs,” he says.
However good the arguments for offering better community-based services, though, closing day centres willy nilly is a philosophy that puts people’s backs up, says Keith Smith at the British Institute for Learning Disabilities. “Through my experience of modernising services, you will not save money if you are serious about supporting people to do things in the day,” he says.
Change and improve
“If you want to change and improve day services, you have to accept that they offer respite. So, if you’re going to change it, you need to have people out of the parental home, doing things that are stimulating.”
This does not come cheap, as people with learning disabilities still have difficulty linking into the community. Smith says: “Most of our community don’t like people with learning disabilities, so it needs real community networking for them to take part in mainstream activities. This is skilful stuff: it can take months and years. I’d like to see investment in training to help people do that, and it may be that traditional day centre staff are not the best people to take on this role.”
There’s a caveat when it comes to people with profound and severe learning disabilities, many of whom have been contained away from the mainstream because society is scared of them. “I’d question what people with high support needs would lose by closing down day centres,” says Smith.
Clearly, the efforts needed to support this group fully in their day-to-day living are going to be even more testing for local authorities. While community integration is the aspiration, and more people will be helped into work, there will always remain a need for good support in the day, says Holman. “If we don’t get the basics right, we’ll be undermining a lot of what is good about modernisation.”
WHAT A GOOD DAY CENTRE CAN BE LIKE…
User-led forums draw up the agenda in Kingston upon Thames
Day centres need not be filled with clients slumped in front of a TV. At the Home Farm Trust’s day centre in Kingston upon Thames, Surrey, there’s certainly a building, but it’s mostly empty, says day services manager Sue Powell.
“That’s because people are out line-dancing, rambling, doing conservation work, or taking part in college courses. And all the learning we do at the centre is applied learning: drama, self-advocacy, communication and catering. “Working in the kitchen preparing lunch for other service users is a popular activity that boosts participants’ self-esteem and their job prospects.
The Home Farm Trust’s day centre is run by user-led forums that discuss and direct the activities that are offered.
There are plans afoot to integrate the mainstream community into the centre’s activities, rather than always shunting service users out to unfamiliar settings where they might be more nervous about taking part.
This article appeared in the 23 August issue under the headline “Shut out in the name of modernisation”