Autism or a learning disability

Over 50 young people with learning disabilities and/or autism will transition into Adult Social Care services over next 5 years.

Almost a fifth (30) adults with a moderate or severe learning disability, predicted to be over 45 are living with an ageing parent who is more likely to have developing care and support needs.

The cost of Learning Disability services current forecast spend is £17M for year 2020/21, and includes costs for residential care, supported living and domiciliary care, with about £1m spent on day services. The challenge will be to do better and more with the budget we have, as levels of demand increase.

What we can do differently

50% of residential settings for people with learning disabilities are larger than the recommended 8 beds, and 40% have 12 beds or more, which means they feel more institutional.  We want to commission smaller homes and support residential care providers to improve to the point where we are only commissioning good or outstanding homes.

Additionally, there are over a hundred people (103) in residential care, and 70% are under 64, which makes Torbay is an outlier for using residential care to meet the longer term support needs of younger adults. Torbay has 24% compared to England 14.6% or SW region of 14.2%.

We need to significantly increase supported living and ‘extra-care’ provision for people with learning disabilities, both to enable people to leave residential care, and to divert people from entering it.  As the preferred models of care, supported Living and ‘extra-care’ help to increase self-determination, independence and civic participation, enabling people to be part of their community, develop natural circles of support and improve their perceived social value.

Reducing our use of residential placements would not only benefit individuals but would also reduce future spend and improve value for money, because on average residential care is about £24K more per person per year.  For adults under 65 with a learning disability, we spend:

• GP register shows that in Torbay about 900 people have a learning disability (LD). PANSI data predicts just over 500 adults have a moderate or severe LD, and are likely to be in receipt of services in 2020, with little increase over the next 5 years.
• Torbay is an outlier for ‘longer term support needs of younger adults (18-64) being met by admission to residential care’ - 24% c.f. SW region 14%.
• 50% (11/22) of care homes for people with LDs are larger than recommended 8 beds, and 41% (9/22) have 12 beds or more.
• 175 people with LDs live in supported living.
• About 27% (137/511) of those with a moderate or severe learning disability are predicted to be living with a parent, with about half under the age of 34 years and over a fifth (30) over the age of 45.

Inputs and resources

• Increase Review Team - 2 x staff
• Commissioner time plus procure support from PENchord to help with dynamic modelling
• Procure increased support to older carers living with adults with learning disabilities
• Procure QGIS mapping of supported living
• Commissioner time and procurement advice – to develop a day services and supported living dynamic framework
• Staff time, venue cost, refreshments for engagement with providers and service users.

Activities - what we will do

• Analyse and identify demand to inform procurement.
• Development of a dynamic framework
• Procure more supported living/extra care units.
• Develop cost model using Valuing Care and SW ADASS guidelines
• Develop outcomes and key performance indicators, to match aspirations for day activities
• Identify individuals who need transition planning in 6 months, 12 months, 18 months etc.
• Develop and adopt a supported living quality assurance
• Develop QGIS map of supported living provision
• Planned engagement with providers both in group and 1-2-1 options, incl. remodelling of residential care; analysis of contracts and current delivery

Outputs - what is delivered

Market development:

• Dynamic supported living framework
• Cost modelling for learning disabilities residential care outcomes based day-activity commissioning framework
• Increase of 50 supported living, self-contained, sheltered housing and Extra Care - Housing Strategy 2017
• Development and strengthening of QA for supported living providers
• One third of people over 45 with a moderate or severe learning disabilities, and one third young people under 35 years old, living with parents have planned transitions into independent living
• ASC achieves better value for money - supported living less expensive than residential care by about £500 pp/pw

Outcomes - what needs to change

• 30% reduction in 18-64 adults with learning disabilities in long-term residential settings i.e. from 73 down to 50
• Residential settings with over 8 beds - halved (from 11 to 5)
• Daytime activities/services commissioned offer greater choice, develop community inclusion and deliver more aspirational outcomes.
• Greater housing choice - particularly self-contained supported living, sheltered housing, ‘extra-care’ and access to general needs housing
• More consistency of provision and fewer complaints about the quality of support delivered
• More people with learning disabilities living with parents are diverted from entering residential care and have the opportunity to live as independently as possible
• The quality of support and tenancies in supported living is given more assurance and improvement

Process benefits and system change

• Improved coordination of services.
• Increased efficiency and financial savings
• Increased skills, capacity and knowledge to better support people with learning disabilities.
• Availability of a wider range of service provision
• The increased evidence base for what works