Community-based day activities and supports for people with learning disabilities
In this section:
The 'modernisation' of day services and development of community-based options and support has been firmly on the policy agenda since the 1990s.
Moving into the Mainstream (Department of Health, 1998) urged local authorities to diversify the range of residential and day services available to people in need of support, but predicted that the transition from older, industrial employment adult training centre models to resource and recreational models could be slow.
Facing the Facts (Department of Health, 1999) highlighted the dominance of large day centres in service provision and found considerable variations in the amount and type of day provision available across authorities. Concerns were noted about reductions in service levels and loss of structured routines as day services began to reconfigure.
The Same as You? (Scottish Executive, 2000) reflected many of the arguments about day services in England, noting that there were 'people going to day centres for many years without a formal assessment' and that people with learning disabilities and carers described services as boring and lacking in direction. The review gave a cautious lead on the need to access generic adult education and supported employment services, stating that 'there is still a place for sheltered workshops'.
Fulfilling the Promises (Welsh Assembly, 2001) found more community placement options, further education, and work experience in Wales and less reliance on large day centres. A trend towards sessional attendance was identified rather than people spending their whole week in a single setting. Issues were noted in developing supported employment owing to difficulties with the benefits system.
Valuing People (Department of Health, 2001) described day services in England as 'frequently failing to provide sufficiently flexible and individual support'. The white paper set a new objective for services, to enable 'people with learning disabilities to lead full and purposeful lives within their community and to develop a range of friendships, activities and relationships'. While recognising the role that day centres had traditionally played in providing respite for families, a five-year programme was set out to 'modernise' services and improve opportunities. Learning and Skills Councils were to ensure people with a learning disability had equality of access to further education, action was to be taken to outlaw discrimination against people on public transport, and local authority leisure plans were expected to address the needs of people with learning disabilities. In each local authority the learning disability partnership board was required to produce a day service modernisation plan by February 2003.
Fulfilling Lives (Department of Health, 2003) reported on an inspection of eight local authorities in England in the wake of the Valuing People white paper. It highlighted the need for a programme of work to promote social inclusion. However, it is also noted that some seemingly 'traditional' day centres offer a range of outreach and community-based services. It commented that: more had to be done to win the hearts and minds of carers who fear that re-provision and modernisation could lead to reduced services for people.
Improving the Life Chances of Disabled People (Cabinet Office, 2005) recommended that 'b y 2025, disabled people in Britain should have full opportunities and choices to improve their quality of life and be respected and included as equal members of society '. It supported the development of direct payments and i ndividual budgets, greater choice, improved transition arrangements, and improved support and incentives for disabled people to get, and stay in employment.
Independence, Well-being and Choice (Department of Health, 2005) brought individual budgets and self-assessment into the mainstream of social care policy for adults, and made community inclusion a clear goal for all: ' To experience a good quality of life everyone needs to have independence, the ability to achieve their potential and the opportunity to participate fully in the life of their community.' It also reinforced the need to improve transition planning.
Our Health, Our Care, Our Say (Department of Health, 2006) confirmed the vision set out in the green paper, Independence, Well-being and Choice, announcing a radical and sustained shift in the way in which services are delivered to ensure that they are more personalised and that people have a stronger voice in service improvement.
Real Choices, Real Voices: The qualities people expect from care services (Commission for Social Care Inspection) indicates what matters most to people using care services. This is the order in which people put things:
- being like other people and taking risks
- respect and being heard
- fairness and non-discrimination
- cost and value
The Department of Health green paper Independence, 'Well-being and Choice' made it clear that social care services are expected to help people to achieve:
- improved health: good physical and mental health (including protection from abuse and exploitation); access to appropriate treatment and support in managing long-term conditions independently; opportunities for physical activity.
- improved quality of life: access to leisure, social activities and life-long learning and to universal, public and commercial services; security at home, access to transport and confidence in safety outside the home.
- a positive contribution: active participation in the community through employment or voluntary opportunities; ongoing involvement in local activities and involvement in policy development and decision-making.
- exercise of choice and control: through maximum independence and access to information; being able to choose and control services; managing risk in personal life.
- freedom from discrimination or harassment: equality of access to services; not being subject to abuse.
- economic well-being: access to income and resources sufficient for a good diet, accommodation and participation in family and community life; ability to meet costs arising from specific individual needs.
- personal dignity: keeping clean and comfortable; enjoying a clean and orderly environment; availability of appropriate personal care.
To keep up to date with current policy and news:
- Paradigm website policy pages are an excellent source of information:
- Valuing People website news page
- Foundation for People with Learning Difficulties (FPLD) news page
- Department of Health bulletins
- Department for Skills and Education news page (useful to monitor for transition issues):
- Subscribe to the free Interconnections electronic bulletin about children and young people with disabilities (useful for transition issues). Contact firstname.lastname@example.org
- Department for Employment and Learning, Northern Ireland (useful to monitor for employment)