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Transforming Learning Disability Services Opportunities to Improve the Cost Effectiveness of Learning Disability Services in Wales The Social Services Improvement Agency Learning Disability Programme


Background: In July 2011 Alder was commissioned to undertake a programme of work aimed at helping to improve the cost effectiveness of support for people with learning disabilities across Wales. The work was to be in four phases: Phase 1




Tasks Work with the Welsh Government data unit to develop a national benchmarking data set to support the opportunity assessment projects. Consultant facilitated Opportunity Assessment Projects for the “Initial” five local “Demonstration” authorities (this expanded to seven) Five Learning Events. One per regional partnership so learning from the “Demonstration” sites can be shared and partnership collaboration can be planned. National Learning To consolidate learning in each of the five regions and consider how to disseminate best practice across Wales.


Our Opportunity Assessment Approach

Benchmark and review nationally published data

Review local data Opportunities to re-provide

Meet senior strategic and operational managers

Practice Analysis (Case files and reviews)

Lower cost and better outcomes Meet practice staff

Desktop review of strategy and relevant documents 3

Where we worked • • • • • • • •

Pembrokeshire Caerphilly Neath Port Talbot The Vale of Glamorgan Gwynedd and also Bridgend (funded by the Council) Conwy (file review only, including health records

Underpinning Assumptions • People with a learning disability are able to learn – but they learn at their own pace

• They will choose to be more independent than dependent – given a free choice, without undue influence

• The aim of intervention is to help people to make the most of their abilities – and so realise their aspirations for independence 5

Focus on outcomes – financial benefits will follow • Implementation already changing lives - some benefits already being realised • Combined net expenditure on support for people with learning disability by the six opportunity assessment sites in 2010-11 was £81.3m – typically 5-10% of net LD budget

Main financial opportunities: The specific savings opportunities identified fit into into six broad categories. Opportunity

Percentage of Savings

Review high cost cases to (a) right size support, and (b) negotiate a fair price for the “right sized� package


Right size support for people currently supported in 24/7 support models that exceed their needs


Deploy assistive technology more to (a) enable greater levels of independence, and (b) reduce some support costs


Reduce duplication of support by residential care and day care and other community support providers


Access income sources notably continuing health care funding in all appropriate cases


Other incl. using universal services rather than specialist services, using older peoples services where primary needs are age related not LD related and paying a fairer price for respite support.



100% 7

Case File Reviews: There is a need to work harder to help people to learn and do more for themselves. Some times care managers try to reduce risks so much they:

2. Some people get “Stuck” with unsuitable support because:

Give people more support than they need, and

•Support planning does not focus enough on learning,

Make it hard for people to learn to do more for themselves.

•Of a lack of other choices in the local market.

3. Planning to “move on” from the family home or from children’s services is underdeveloped.

So some people who could live more independently move into residential care.

The reviews of cases showed that there is a need to work harder to help people to learn how to do more for themselves. 4. Support planning is not always imaginative nor challenging. So opportunities to help people do more for themselves can be missed.

5. Technology could be used to help more people: • •

Do more things for themselves, and Have more freedom and choice in their lives.

6. If reviews focused more on how to promote independence people would: •

Have more opportunities to do what they want, and

Some support costs might be lower. 8

Opportunity 1: Review high cost support packages. Some high cost packages are too expensive • Support is more than is needed • The price is too high

Is it worth it?

Opportunity 2: Help people who do not need to or want to live in residential care to move into more appropriate accommodation. Provide more flexible options for people who have 24/7 supported living.

Many people would be happier with more control over their lives and do not need all the services they currently get

Is it worth it?

Opportunity 3: Be “Creative� to maximise peoples independence and so minimise unnecessary support Assistive Technology

There are new ways to support people that give people more choice and control

Review support and check funding

Is it worth it?

Opportunity 4: Only attend day care when living in residential care when it is part of a programme to develop independent living skills

At the moment some residential care homes are being paid to provide support when people are not there. Day activities can be used to help people be more independent.

Is it worth it?

Live in Res care AND attend day care.

It is all about achieving successful independent living Successful Independent Living

Commissioning Housing Housing Related Support

Commissioning PCP

Social Care Health Care

Ready Individual Motivated and Skilled

Practice 13

We have learned that: To improve outcomes for people with learning disabilities at the same time as reducing spending on their support, authorities need to develop an integrated health, housing and social care pathway to independence promoting “progression”. This pathway needs to begin before individuals are being fully supported i.e. during the transition period either from: •Children’s Services, or •Later in Life from the community, including the family home. DRAFT


We have learned this has implications for: – Practice: “Progression” needs to be embedded in all work including transition work, assessment, support planning and review processes.

– Commissioning: To develop a market with providers who work in an “enabling” way with user to deliver the “progression” desired. – How practice and commissioning work together: Information about needs not being met appropriately and gaps in the market that practice staff know about needs to be captured, collated and fed into the commissioning cycle so it is more effective. – Support providers (incl: PA’s and family carers): Who need to work in an “enabling” way to help people achieve their “progression” aspirations DRAFT


Thank you for listening! • Any Questions? • Contact: Rob Griffiths 07814 144973

– Nygaire Bevan, SSIA – 16

Transforming Learning Disability Services, Rob Griffiths