Housing and Learning Disabilities (LD)

Joint Commissioning Intentions for Adults with LD

In January 2014, Somerset County Council (SCC) and Somerset Clinical Commissioning Group (CCG) published their Joint Commissioning Intentions for Adults with Learning Disabilities 2014-2017. This report details existing needs and service provision and sets out a clear vision of how services will develop over the next three years, drawing on national policies together with estimated of demand locally. Extracts relating specifically to housing are provided below, 

Scope of Care and Support Provision

Services for adults with learning disabilities are provided in various ways. SCC directly delivers 48% (52% by financial value) of care and support through the SCC in-house LD service. This covers:

• Residential care
• Domiciliary Care/Supported Living
• Short residential breaks
• Emergency support
• Day Services (including volunteering)
• Employment support
• Shared Lives

The other half of care services are bought from a range of voluntary, not-for-profit and private sector suppliers.

Supported Living
In comparison with many of our nearest statistical neighbours, SCC has historically supported a larger proportion of people with learning disabilities in supported living arrangements rather than residential care. However this is changing as nationally the trend is towards only considering a residential care where a customer has nursing or near nursing needs due to the increased choice and control that the Supporting living model facilitates.

The Supported Living model has helped us to achieve better outcomes for individuals by promoting more independence, while also controlling escalating costs as those in supported living can access a range of housing–related benefits that sit outside the pooled budget. However, many of the existing properties do not offer the correct facilities required of the service in today’s environment. Some of the properties are 8-10 bed properties. Few supported housing properties have an appropriate balance between private and communal space within the buildings or the type of self contained accommodation that is favoured by many young people.

The Balance of Care and Support

Despite the good performance that Somerset already achieves in the balance of supported living and residential care there is still scope for improvement. In order to achieve this we will increase the proportion of people who have their needs met in the community, reducing our reliance on long-term residential care. This will require us to look at improved access to housing, enhancing supported living arrangements and home care, with an emphasis on building independence, whilst extending the use of Shared Lives.

Making accommodation fit for purpose

The Commissioning Intentions include:-

• People have the private living space they need, and more say over who lives with them;
• Investment in new properties and adaptations to existing properties;
• There is enough suitable accommodation for everyone who needs it in the future.

The associated key target is to produce a vulnerable persons' property strategy, including a costed, time limited, plan for any remodelling required, to be completed and signed off by 30th September 2014.

Improving Access to Housing

Our Intentions are to:

• Develop a housing strategy in partnership with District Councils for people with learning disabilities and other vulnerable groups. This will have it it’s heart a recognition that the full spectrum of housing options, from owner occupation to private landlords can be considered
• Work with District Councils and other stakeholders to expand the range of housing options available in Somerset, and improve the support and information available to help people access those options, and specifically those people with high support needs
• Increase access to mainstream housing
• Consider the benefits of, over time, remodelling Supported Living services to self-contained accommodation and, where a shared living environment, no more than 4 people sharing. 
• Promotion of Assistive Technology to enable more independence
• Ensuring there is sufficient options for emergency support in the event of an emergency or crisis for timely move-on, and which avoid the use of residential and nursing care in these situations due to the impact that admission to these services can have on people's housing prioritisation.

 Supported Living and Domiciliary Care

Our Intentions are to:

• Increase capacity in Supported Living services by between 15-30% to reflect new demand and reductions in residential and nursing care capacity
• Commission support for individuals to enable them to remain in their own homes through a competitive, flexible market that can deliver both quality and value for money.
• Develop a framework approach to commissioning specialist domiciliary care providers to meet the needs of adults with learning disability with complex needs.
• Increase the knowledge and skills of staff delivering services - particularly in relation to people who challenge services and/or who have with ASD and challenging behaviour
• All commissioned services to have outcomes targeted that include emphasis on developing independence, progression, community integration and the development of circles of support to reduce reliance of paid services.

 Shared Lives

Somerset has a thriving and successful Shared Lives scheme, which mainly supports people with a learning disability. This will be further developed to provide good quality, cost-effective care in the following areas:

• By increasing capacity in Shared Lives services by between 15-30% to reflect new demand and reductions in residential care capacity
• By expanding the Shared Lives services to include other customer groups
• Short breaks currently delivered in residential care environments
• Emergency and crisis support where customers do not have health, behavioural or mental health needs that require a residential care environment – or example in the event of family carer illness.
• Transition support prior to a permanent move to independent living for people currently living with family carers
• Day and evening opportunities, including at weekends

 Residential Care

In future we will only consider commissioning a new residential care placement where:

• A customer has complex behaviour which challenges services
• Where Deprivation of Liberty prevents them living in other types of provision
• People with complex medical health needs who are under 65 years

Our target is for a 50% reduction in specialist residential care provision for people with learning disabilities across Somerset by 2020. Where customers are over 65, and their primary need does not relate to their learning disability, then our normal approach will be to commission generic residential and nursing care in the same way we would for any older person rather than from specialist providers. In order to achieve this change we will:

• Assess all customers currently living in residential care in or out of Somerset
• Develop a strategy for decommissioning existing residential care services, prioritising larger, ill designed homes, and move towards commissioning smaller supported living homes or small clusters of homes, of no more than 4 people.
• To develop the market to ensure providers can respond quickly to support people with complex needs, including those who might have been placed outside of Somerset in the past.
• To work in partnership to develop the existing nursing home market to make the reasonable adjustments needed to be able to support people whose primary care need is not their learning disability in a non specialist environment.

For more data and information related to Learning Disabilities, please see our LD webpage