The centre cannot hold

Traditional day centre “culture” has been
criticised as inflexible and monotonous, and the government is
looking to move away from this model towards day services directed
at individuals. But will it fund them sufficiently to make a real
difference? Natalie Valios investigates.

Imagine if the only thing you had to look
forward to each morning was a trip to a day centre where the same
activities take place monotonously day after day. This is the
situation for thousands of people with learning difficulties across
the country.

The
white paper Valuing People calls for an end to this
traditional day centre culture, and has set out plans for major
changes to day services for people with learning difficulties. It
outlines a five-year modernisation programme for local authorities
to replace their “inflexible day services” with more individualised
support.

Local
authorities in England have been set the target of modernising
their day services by 2006. Their initial action plans for this
should be ready by January 2003.

They
will be expected to have examined their dependence on the
ubiquitous, large, centralised day centre and redirected resources
into other models, such as person-centred activities in the
community and individual support. Particular emphasis should be
placed on individual needs, flexibility and active involvement of
people with learning difficulties. Local authorities must also
focus on improving users’ work opportunities.

But
although local authorities have a legal obligation to provide day
services, they do not have to cater for every person with learning
difficulties in their locality. So as budgets have been cut and
eligibility criteria tightened, most of those receiving day
services are people with severe or profound learning
difficulties.

England has about 120,000 adults
with severe or profound learning difficulties. An estimated 7 per
cent are employed full- or part-time. The rest need access to work
experience, training, college courses, or some other form of day
activity, argues Mencap.¹

Day
centres account for more than 80 per cent of the gross expenditure
on day services. The number of day centre places is equivalent to
60,000 full-time places but as most users attend part time, the
actual number making use of a centre is greater. The government
estimates that there is a shortfall of 20,000 full-time day service
places for people with severe or profound learning difficulties.
However, Valuing People makes no suggestions as to how
this shortfall can be rectified.

Day
services can also include community-based day services such as
visits to a local pool or library; paid work, an option preferred
by many users; and community businesses or social firms, which are
small firms built around workers with special needs. Mencap says
current day service provision has several disadvantages:

–
Meaningful activities are lacking.

– When
day centres are used, the users are segregated from other people in
the community.

–
Transport costs take up too much of the total budget.

–
Staff usually have no formal training or qualifications.

–
Budget constraints result in local authorities reducing services or
tightening eligibility criteria.

–
Charging causes anxiety and anger for users and carers.

More
imaginative and individual support is inevitably going to cost
money. The government has set aside a learning disability
development fund of up to £50m per year. One priority will be
to use this money for modernising day services. But, according to
Mencap, this needs to be at least £120m per year while another
£140m is needed if day services are to include the 20,000
people with learning difficulties who currently receive
nothing.

Moves
are also afoot to improve the situation for people with learning
difficulties elsewhere in the UK. Scotland differs from England in
that a greater proportion of long-stay hospital places still exist.
However, the Scottish executive has set up a change fund of
£36m over three years. As Scotland has about 20,000 children
and adults with severe or profound learning difficulties compared
with 210,000 in England, Mencap estimates that the English fund, to
be comparable, would have to be £126m per year.

The
Learning Disability Advisory Group to the Welsh assembly has
published a consultation document that makes recommendations on day
services.² The assembly is considering its
responses.

In
Northern Ireland, health and social services minister Bairbre de
Brun has said that policy would follow that of Valuing People. One
of the Northern Ireland’s Department of Health, Social Services and
Public Safety’s priorities for action for 2002-3 is for boards and
trusts to continue to expand provision of day care and respite care
places for people with learning difficulties.

Back
in England, Mencap is concerned that without sufficient funding,
social services departments will end up providing third-rate
services. Roy Taylor, director of community services at the London
Borough of Kingston, says social services directors welcome
Valuing People as a chance to break away from the more
traditional forms of day services. “Many local authorities have
been moving to more modernised services with a variety of social,
educational and work-based alternatives, planned in partnership
with users and families, and with individual plans as a basis,” he
says.

Even
with the cash from the government, the plan falls short of funds
needed to remodel services on the necessary scale, Taylor
says.

Surrey
Oaklands NHS Trust provides services for people with mental health
problems and learning difficulties. It, too, has found there is a
cost attached to making day services more individualised. After
modernising its day services, resource limitations are preventing
things going further, says Peter Kinsey, director of learning
disability services. After listening to users’ wishes, the trust
has set up individual activities that reflect their choices
including fishing, trampolining, and walking dogs for older people
in the community. But the cost of providing services to eight
people with learning difficulties in a day centre with one member
of staff, for example, is obviously going to be less than providing
individual services for eight people all wanting to do different
things.

“There
comes a point when you can’t outreach any more staff because then
you have no-one running core centre-based activities,” says Kinsey.
And although he agrees that it is time to move away from large day
centres, Kinsey feels it is important that the social dimension
they provide is not lost. “Users need to be supported in more
imaginative ways.”  

¹Mencap, A Life in the
Day, Mencap, 2002

²Learning Disability Advisory
Group, Fulfilling the Promises, Welsh assembly,
2001

Riverwood project

Money from Greenwich social services
department and the European Social Fund helped Greenwich Mencap set
up the Riverwood project three years ago. Here, people with
learning difficulties clean the Thames’s shoreline collecting
driftwood that is then carved into craft items which are sold at
London markets (see pictures).

Elsie Hughes’s son Mark attends the Riverwood
project. He has Down’s syndrome and severe learning difficulties,
and she says the project gives him something worthwhile to do. As
her son’s main carer, she is also offered respite by the project on
three days a week: “It’s very important for both of us that he has
something meaningful and positive to do during the day.”

The project trains users in carpentry,
stocktaking, communication skills and sales. “It’s not just
time-occupying – they are learning something,” says project
co-ordinator Phil Meakins. “They feel proud of what they do and it
gives them confidence. It’s far better than sitting around in a day
centre with little sense of purpose.”