Learning disability cost savings plan sparks ‘institutionalisation’ fears

Council looks to save by cutting number of supported living tenancies and moving people to alternative settings, including residential care

A council has defended a set of controversial cost saving plans for learning disability services after campaigners claimed the measures promoted a “shocking” return to institutionalised care.

Rochdale council has tabled proposals to save £1.4m by ‘remodelling’ its supported living offer and moving some people who currently have their own tenancies into alternative settings, including residential care units.

The council said it will consult on the proposals, which would come into effect from next April. A pre-consultation paper said care teams had already considered “possible future living options”, including care homes, for all 263 people potentially affected. The potential reduction in the number of supported living tenancies formed the basis of the savings claims.

‘Value for money’

The council said their supported living arrangements normally involved two to four people sharing one home, with staff on site round-the-clock to support them.

“The model of care therefore does not provide value for money as the same staffing numbers could support a greater number of people in larger premises. In addition not everyone’s needs are the same in a supported living home but the staffing level needs to based on the person with the highest needs,” the council report said.

Supported living worked “very well for some people” but may not be the best option for others, the report added. It gave the example that some older people with learning disabilities may find a specialist residential care home “a more suitable setting”. Shared lives placements and extra care housing were also listed as potential alternatives.

The council rejected “any suggestion” the proposals amounted to ‘re-institutionalisation’ and said service users would only be moving if the new options were assessed as meeting their needs and after “detailed conversations with them and their families”.

‘Institutionalisation’ concerns

The proposals drew fierce criticism from learning disability organisations and campaigners.
Learning Disability England, a membership organisation for people with learning disabilities, described the plans as “shocking” and “a proposal to return to institutionalised services”, adding “we should never return to warehousing people with learning disabilities”.

Rob Greig, chief executive of the National Development Team for Inclusion and a former national director for learning disabilities, told Community Care the proposals should be scrapped.

“This epitomises everything that’s gone wrong with adult social care commissioning. The council is claiming residential care can offer better value for money. What they actually mean is, this is cheaper. It’s not value for money because value for money is about the outcomes you get for what you spend…we know that poorer staff support ratios in large group settings means people have lower quality of lives and they will thus end up being more dependent upon services in the future.

“The other big problem with this proposal is the rights agenda. They are proposing changes that could see people have to move from a situation where they have housing rights which give them the ability to determine where they live, who supports them, who comes in and out of the house and, crucially, allows them go out to paid work. Instead they’ll move to a residential unit. In my view it is legally questionable.”

‘No compulsion’

Sheila Downey, Rochdale’s director of adult social care, said: “Any suggestion that this is ‘reinstitutionalisation’ or ‘warehousing’ people against their wishes to save money is irresponsible and wrong.

“We are trying to improve the service we offer to users and their families because we are over-reliant on one service model, the group home model which doesn’t meet everyone’s needs, particularly in old age.

“Our proposals will improve, enhance and extend the supported living options we offer and we are consulting widely with service users, providers, carers and families on the new models of care. There will be no compulsion, with service users only moving if the new options meet their needs following an assessment and detailed conversations with them and their families.

“I would like to emphasise that no decisions have been made. The interests, care needs and wellbeing of individual service users will always be our main priority.”

More from Community Care

12 Responses to Learning disability cost savings plan sparks ‘institutionalisation’ fears

  1. Stephanie October 1, 2016 at 11:03 am #

    Sheila Downey, your words of wisdom come from the corporate world in which you belong. You surely know deep down in your heart that this is wrong. People with LD and their families have fought for years, for choice, independence and to live life to the full. You know that any kind of group home takes away all of these things, what it actually means is people will once again be medicated to keep them quiet, be in bed by 7pm so staff can watch the soaps. And I could go on, shame on you all for even considering these options.

  2. Julie Owen October 2, 2016 at 11:51 pm #

    We already are ‘warehousing’ people with learning difficulties in some parts of the country. There are units already housing 40-60 people.

    Why do young adults need to be in care anyway? Why can’t they be supported to live at home with their families. Why is it always assumed that they have to be removed from their families?

    The problem is attitudes. People with learning difficulties are seen by Local Authorities as a burden on their families and society. We aren’t going back to ‘institutionalisation’ because we never moved away from the attitudes defined in the Mental Deficiency Act which launched the institutions.

  3. Diana Stevenson October 3, 2016 at 10:41 am #

    This is so scary and is happening everywhere now. Of course it’s about cuts, but no-one will actually come out and say it. People need to be honest about the effects the cuts are having on the most vulnerable, not try and hide it and pretend the changes are in the best interests of the people we support. One day soon someone will come up with a great idea – let’s house all people with learning disabilities in large institutions in the country where they can have inhouse therapy and support – so scared it will all go full circle and we’ll end up back where we were

  4. Andrew Dykes October 3, 2016 at 12:07 pm #

    This is a welcome breath of fresh air and realism, even though it’s bound to spark knee-jerk reactions of the “two legs bad, four legs good” variety. A good residential home is very far from being “warehousing” and it is a plain fact of life that, for people with higher needs especially, supported living is more expensive and often provides inferior outcomes. Anyway. it’s often provided with no separation between landlord and care provider, thus really being “residential care in drag”, as someone once put it, the only advantage of which is access to more funding streams. Some people suit supported living, others don’t, and trying to shoehorn everyone into one model is wrong.

    • Charlotte Walker October 6, 2016 at 8:22 am #

      I completely agree.

      • Charlotte Walker October 6, 2016 at 8:35 am #

        Supported living for some individuals with complex needs is actually not only unsuitable but puts those individuals at increased risk. Supported living in these cases are simply residential services that go unregulated. CQC and Healthwatch do not inspect these services. In many cases this is the only difference in those residential services that are now supposedly ‘supported living’ services. The building, staff, service users all remain the same. Users have a tenancy agreement kept on file somewhere and practices continue same as before but quality suffers. Inspections are not only about cracking the whip. Good inspections and quality monitoring is actually about providing guidance, support and inspiration to usually underpaid and overworked staff teams who, in smaller provider organisations feel isolated and cut off from this due to, in some cases, ‘forced’ deregistration. It doesnt matter what the model, one size does not fit all. It’s about ensuring a variety of options are available to ensure individual needs are truly being met. Getting rid of all LD day centres for instance was not personalisation as for some of the older generation this was truly there choice and they lost a lot of what gave them quality if life in those social groups when we took them away without really asking THEY’RE opinions.

  5. Charles Henley October 5, 2016 at 9:53 am #

    Inclusion is a worthy and commendable objective that can also be a delusion. Extreme inclusion has been a disaster and will continue to be a disaster for many severely and profoundly disadvantaged members of our community if its limitations remain unexposed. Verifiable evidence confirms that failure to objectively debate this problem objectively in its early days has set positive development back by 30 years. If the cover up continues a return to institutionlisization on a wider scales is inevitable.
    Charles Henley

  6. colsey October 5, 2016 at 3:38 pm #

    I have 90 LD clients in community living. It is institutionalisation by another name as I constantly see what is done and what is not done. Their “support workers” are in the main youngsters who last a couple of months and move on. They do not take them out, try to integrate them or teach them skills. Everyone “pretends” they are skilling them up to live independently in the community. Yea, of course and after 20 years they still need 24hr support for day to day living/tasks and if you need 24 hr support how on earth is that “living independently” in the community? The support workers (in the main) prefer to sit and watch sky port or sky movies all day – I know because I do unannounced visits. You have profound LD sharing with modest LD yet council has to pay for 24hr care. An older person who has worked all their life and paid into a system does not get 24hr one to one care in their own home, why should LD? clearly the model is not working and is not financially sustainable. LD should not receive preferential treatment and the pot is not infinite. It needs to be re-visited and if that means some move into some sort of residential larger type home then that is that. I have seen this happen and despite everyone’s negativity the client has actually loved it! If you want LD community living then it needs to be revisited and properly thought out. Check how much you would get a week if you lost your job (after years of paying into the system). My clients average £250 pw into their hand so to speak, get their rent and council tax paid too and extra money through a scheme which pays towards their bills and household items such as TV , fridge etc. Their income from the taxpayer is therefore around £500 pw, similar to your wages? I really do not get the “hype” surrounding LD which spews forth from various sources and their rights. What about the rights of older people and those with mental health issues ? From my experience A Dykes is right, supported living is nothing better than a smaller residential care unit (and usually worse)

  7. Charlotte Walker October 6, 2016 at 8:40 am #

    Completely agree

  8. Finola Moss October 7, 2016 at 2:24 pm #

    This, as with all other propaganda concerning disabled care is disingenuous.

    As, the Care Act with only a duty to provide a carers assessment and not support.

    Personalisation, when no support is given is meaningless.

    All is to gain evidence to remove the disabled to residential care, and break carers.

    Google finola moss and read in detail how this happens.

    LA cost cutting, was the excuse for not providing support at home, and would be the defence to a right to family life action under HRA, yet the minimum weekly residential care cost is £3,500, whilst in comparison Carers Allowance is reduced now to £62.50 per week for 7 day 24/7 care and £ 103 DLA.

    The LA have a right to claim up to £180,000 per year, from central government, for each disabled person for health, social care and education if under 25, under the Chronically Sick and Disabled Act 1970, this is the money, that should by law, be available, to the disabled and their families, but has been hijacked by LAs and HSCTs, to pay increasingly venture capital backed private care providers for life, with no accountability for services, which are effectively in secret .

    So now they trying to get even more money, to make even more profit for the monopoly private sector they commissioned.

  9. Adam Sleeman October 8, 2016 at 9:49 pm #

    As a former Registered Manager heavily involved in resettling people from institutions to community supported and independent living and shared lives services, I can only see this as a regressive step despite all the attempts at positive spin. This trend (which is happening elsewhere if less explicitly) also flies in the face of all the recommendations re: Winterbourne. The rationalised ‘economies of scale’ approach is arguably the inevitable consequence of funding reductions and will only compromise choice, control and inclusion – the very things services have been driven by in recent times.

  10. Jill Thomas October 13, 2016 at 4:33 pm #

    The biggest problem is getting supported living to work properly. My son has been in SL for 10 years. Now lives alone in complete isolation from his community. the real problem is the calibre of the staff he has, the regional manager of the latest company says that it’s optimistic to expect staff to understand anything about nutrition, healthy meals, budgeting. Some may be incapable of using a recipe book or not know what a casserole is!! I have now made formal complaints of physical and financial abuse against this company – but they are all as bad as each other. There needs to be better training of staff, but since the county council refuses to pay more than £14 an hour to the agency, there is little incentive to train staff.