Improving outcomes for service users in adult placement - Commissioning and care management

Commissioning adult placement - Local needs

It appears from the project discussion groups that purchasing an adult placement is usually a matter between a scheme and an individual care manager, rarely related to a local strategic commissioning policy. Adult placement is best known and most used by learning disability services. The potential range and flexibility of adult placement services is poorly understood by local commissioners, but schemes can provide many examples of successful placements for people with mental health problems, autistic disorders, and people whose vulnerability and support needs defy labelling.

Participants agreed on the importance of adult placement both influencing and responding to local commissioning plans and priorities. Social services departments and primary care trusts need to understand what adult placement can offer (see Adult placement profile), and schemes should be sensitive to local authority/care trust priorities and requirements.

Project participants identified a number of locally needed services that might be provided through adult placement, including:

• planned, specialist short-stay ('respite’) services
• floating support in service users’ own homes/out and about in the community, including 'good neighbour’ support
• support for people with acquired brain injury and with autistic spectrum disorders
• 'hospital (recuperation, rehabilitation, intermediate care) at home’
• support for younger and older people with dementia
• support for people with complex and multiple needs including 2:1 support (e.g. a placement carer couple or personal assistant)
• support for young people in transition from children’s to adult services
• help for older people discharged from hospital or residential care
• help for people moving from mental health hospitals to the community
• wheelchair-accessible placements.

The first-stage SCIE survey (191kb PDF file) found only a small number of minority ethnic people using adult placement services. Several participating schemes intended that their services should better reflect the ethnic make-up of the community. The SCIE studies support the findings of research carried out in 2004 for Skills for Care, which found a mismatch between the ethnic origins of service users and of adult placement carers, but that the percentage of black and minority ethnic adult placement carers broadly reflected their communities (11). Participants in this project included minority ethnic adult place ment and local authority staff.

The lack of social housing stock for service users wanting to move to their own home was noted by several schemes, and is a particular issue for mental health service users for whom adult placement is usually a stage on the path to or return to independent living. One scheme manager said service users need their care coordinator to help them 'compete’ for available properties. In East Sussex the adult placement scheme acts as a consultancy/advisory service for the local authority, carrying out assessments for a range of accommodation options, not just placements, for people referred by adult social care.

Practice points

Senior managers should:

• Be aware that adult placement can provide a variety of flexible and personalised services for a wide range of individuals, including - with effective advance planning and care management support - those with highly complex needs
• Work with schemes to plan recruitment of adult placement carers with the skills to support local people’s needs, in areas where people want to live.

Adult placement schemes should:

• Work with commissioners to identify areas of unmet need, and plan the development of the adult placement service locally to meet those needs.