Community-based day activities and supports for people with learning disabilities
Messages from 'Having a good day' - Smart commissioning
There are three key tasks: planning the transition from centre-based to community services; reconfiguring and using resources in specialist and mainstream community services to meet existing and unmet needs; developing supports that respond to the needs of individuals. Poor strategic leadership, poor partnerships, lack of emphasis on employment, and shortage of properly trained care managers are all issues of concern.
- Many people are now accessing support from a mix of services. But there are still unequal opportunities. The trend for people who need high levels of support is towards small but 'special' bases with tailored equipment and facilities . They do not have diverse opportunities and choices unless they get direct payments. F ew supported employment schemes or social firms serve people with high support needs.
- In modernising day services only a few areas have developed services that are not buildings-based and are providing support directly from people's homes. Rather, the new model of provision is characterised by smaller groups of people meeting at locality bases, which may be within shared buildings, and undertaking programmes of activity from there. It is a first step, but there is much more to do to support people to achieve more ordinary lives.
- Where new community bases have been purpose built for use by people with learning disabilities the financial investment does not appear to be paying off in terms of people's community inclusion and involvement.
- There are still problems meeting demand for employment support, even though some areas have transferred revenue or staff from day services into employment services to extend capacity. Some day services are taking an active role in preparing people for work, but generally the role of day services in relation to employment is not clear and is not being strategically led.
- Capital funding has been secured by many services that are 'modernising' and has been used mainly for new community bases. Some accessible changing facilities in community places have also been achieved using this money. Most new community day opportunities and support are being achieved, though, with no extra revenue funding. There is increased demand on fairly static, if not reducing, budgets and commissioners are having to make pragmatic compromises as a consequence.
- There remains a focus on group activities because of the number of people using community day services set against the available staff for support. Wider networks of support and more flexibility need to be developed. This is both a commissioning and a practice issue, and it is a significant barrier to achieving person-centred community activities (see Key task 3: Organising resources and Key Task 4: Building support around people).
- Removing the division between residential and day supports so that people go out from their home to do things that have a purpose for them, with the support they need, can help people to have a more ordinary life. Person-centred planning needs to be core to the services that deliver such whole-life supports. Service providers who can do this and do it well are relatively rare and need to be nurtured. Monitoring the outcomes achieved for people is essential.
- If people are not already receiving social care services, funding of support to undertake leisure pursuits may not meet Fair Access to Care Service priority criteria. But leisure is a route to new friendships and connections - natural support - which is core to a good, ordinary life as well as potentially reducing demand on social care services. It is a Catch 22 situation. Alternative avenues to support need to be commissioned so that more people can be helped to build friendships and connections through leisure.
- Information from individualised planning is not yet being used strategically to inform future developments. There needs to be a more systematic approach.
- There is no one ideal way. To some extent the shape of developments will depend on local circumstances. For instance, regeneration of community facilities is more prevalent in some areas than others, and in areas with higher levels of unemployment job-seeking may be more difficult for people with learning disabilities.
The work of local commissioners, policy makers and managers should be informed by people with learning disabilities, support workers and families. Think beyond partnership board meetings to reference groups, citizen juries, coffee mornings, open door days and more.
Make sure that everyone is clear about the ends being pursued: what is meant by community inclusion and connections, self-directed supports and so on. Talk about things in ways that everyone can understand. Make it real by unpicking terms like 'community builder', 'independent living', 'all means all', 'self-determination'... Have monitoring systems for community day services that are focused on those ends. The effectiveness of strategic commissioning and purchasing is part of local authority annual performance assessment from 2007. How will you show the effectiveness of day service modernisation and community services locally?
Think about the whole-system and the future, not just about services run by social care agencies and not just about the next year or two. Aim to develop a comprehensive and coherent network of options and support that will meet projected demand while also enabling people to have greater control over their daily lives.
Find ways of empowering providers to achieve excellence, but make expectations clear too. Use the Disability Equality Duty as leverage with mainstream services. Ultimately, if the local authority simply has too many constraints and red tape for community provision to thrive, consider the benefits of 'externalising' services. See the development of Pure Innovations in Stockport as an example.
Use the Checklist for community developments (17kb PDF file), which is based on ordinary life principles, as a starting point to assess every proposed development. The aim is to be able to answer 'yes, we do' on all counts.
Give priority to safeguarding the financial standing of services that are really making progress in helping people achieve ordinary lives. Plan well ahead so that they are not left to end or decline. Give others that aren't doing so well some targets and a timeframe to improve results, but make sure they get support too. Ultimately, d ecommission things that don't work and reinvest in things that do.
Keep focused on routes to employment. Work is a significant feature of ordinary life. Make sure there is a clear role for community day services, and that staff are developed to fulfill it.
Read the rest of this guide!
- Having a good day found quite a lot of services that, in modernising, are actually creating new provision that is either replicating or creating new barriers to inclusion. So, here is our list of don't do's:
- Don't have buildings used by people with learning disabilities that are run by a 'learning disability service', even if they are open to other groups of people.
- Don't have any buildings that are just used by people with learning disabilities during the day.
- Don't build new day centres, however small.
- Don't rent a suite of rooms in a community centre without a clear plan about how people will be supported to break through segregation and do things alongside other members of the public using the building.
North Lanarkshire is a good example of a whole local authority strategy in action, with a strong leadership and values base. The five day centres in the area have now become 'locality bases', and are rapidly moving into providing community support instead of centre-based provision. At the same time, some 300 people have recently left long-stay institutions and are now receiving individualised services for supported living, and have their own tenancies or homes. North Lanarkshire works with a large number of providers, who work together and share their experience rather than competing with each other. They have broken down the division between support for living and support for day activities. Because of this, people with learning disabilities are having true individualised support, with supporters they know and trust.
North Lanarkshire also provides supported employment services, both through the council (former day centre staff have moved over successfully into supported employment) and also within its provider services. Currently 110 people with learning difficulties have real paid jobs, and all of these are over 16 hours a week. Others are starting up micro-enterprises. One person, for example, has a business in car washing, and another is planning to start up a café. Everything is based on a person-centred model and there is emphasis on accessible information and use of multi-media at every level.
One parent of a young man with high support needs describes how she had initially been very concerned about day centre closure. With other parents, she had taken part in active protests. Now, however, her son has one-to-one community-based support from a service that is supporting six young men with complex needs. Support starts from their own homes, and they go out to different places with their supporters, who work closely with parents and family members in a person-centred way. This parent has been totally won over to the new model.
A new community sport centre in Southampton is being created with money released from sale of a day centre combined with a grant from Sport England to refurbish and expand a community centre. The new centre will be managed by local residents, including people with learning disabilities. It is part of a day service modernisation strategy that will re-invest capital money from day centre sales into the development of three community facilities for the benefit of all members of the community.
Pedal Power in Cardiff arose from the work of physiotherapists and has developed into a separate charity. It is run by volunteers with advice from a sessional cycling coach, and has its own adapted bicycles. It's currently based in a caravan park with access to traffic-free parkland and the Taff Trail. People cycle for up to an hour, for exercise, to try cycling out, or just for fun.
- 'Shaping the future together: a strategic planning tool for services supporting people with learning disabilities', A. Cole and A. Lloyd, FPLD (2005)
- 'Relentless optimism: creative commissioning for personalised care', Report of a seminar held by the Commission for Social Care Inspection on 18 May 2006 (CSIP)
- 'Commissioning services for people who challenge', SCIE (forthcoming)
- Commissioning eBook (CSIP)
- 'Keys to citizenship 2: a guide to getting good support for people with learning disabilities', Simon Duffy, Paradigm ( 2006)
- Improvement and Development Agency is a source of information about local area agreements, local strategic partnerships, community engagement strategies and more. You can access local area agreements for first and second wave councils on the website.