Memorandum from Mencap (SPP 68)
BACKGROUND INFORMATION
Mencap is the voice of learning disability.
Everything we do is about valuing and supporting people with a
learning disability, and their families and carers.
We work with people with a learning disability
across England, Northern Ireland and Wales. All our services support
people to live life as they choose. Our work includes:
— providing high-quality, flexible services
in things like housing, employment, education and personal support
that allow people to live as independently as possible in a place
they choose;
— providing advice through our help-line
and website; and
— campaigning for the changes that people
with a learning disability want.
We work with people with a learning disability
of all ages. All our services are tailored to the individual so
we can provide support throughout their life, ranging from support
for a child as they grow up, through adulthood and into old age.
Mencap's housing arm, Golden Lane Housing, provides suitable housing
for people with a learning disability with varying needs as well
as housing support through the Supporting People programme.
People with a learning disability have been
one of the main groups of vulnerable people supported by the Supporting
People programme. Data released by the Department for Communities
and Local Government shows that between 2003 and 2008 the
reported spend on Supporting People services for people with a
learning disability averaged approximately 23% of the total budget.
Over this period the total spend on people with a learning disability
gradually decreased by almost 20% from £426,362,116 in
2003-04 to £346,626,291 in 2007-08.
RESEARCH INTO
SUPPORTING PEOPLE
AND PEOPLE
WITH A
LEARNING DISABILITY
In August 2007, the Joseph Rowntree Foundation
(JRF) published research exploring the impact of the Supporting
People programme on people with a learning disability.[18]
The report found that the impact of Supporting People on housing
and support for people with learning disabilities has been mixed.
On the positive side, the programme has provided a much-needed
injection of cash into services for people with learning disabilities,
which has enabled the development of an increasing number of supported
living services. Importantly, the tenants of these services typically
expressed pleasure with their homes and with the support they
received. Most felt that such services offered them a significant
degree of choice and control, particularly in relation to day-to-day
decisions.
However, JRF also reported a lack of authoritative
guidance on how "housing related support" should be
defined, leading to wide variations at local level. This resulted
in some local authorities choosing to restrict the cost of individual
support packages in different ways, such as limiting support to
a defined list of "eligible support tasks", or capping
the number of support hours per week. Some local authorities felt
that the monies should be used exclusively for individuals who
were not eligible for health or social services under a statutory
duty of care, limiting use to those people with learning disabilities
with lower support needs.
JRF found that the supported living services
being bought with this money were very different in different
parts of the country, sometimes indistinguishable from residential
care. These different types of support had advantages and disadvantages
for the people living in them. People who were in the more individualised
support packages in their own flats had more independence and
control, but were more likely to feel isolated and lonely. People
in shared accommodation often had less independence but were less
likely to be lonely. While Supporting People appears to have increased
the availability of supported living services for people with
a learning disability, this has often come at the expense of abandoning
the principles of supported living so that, in many cases, it
has not fostered as much independence and choice as was hoped.
Fundamental choices, such as where to live, who to live with and
who to receive support from, were still typically made by service
managers or commissioners.
MENCAP'S
EXPERIENCE OF
REDUCED SUPPORTING
PEOPLE FUNDING
The effects of reduced funding for the Supporting
People programme since 2003 indicate how the removal of the
ring-fence may jeopardise tenants with a learning disability in
supported living, particularly those who require less support.
As a housing support provider, Mencap has applied for re-tenders
of its contracts and lost those contracts because of pressure
on local authorities' reduced Supporting People budgets. As a
housing provider, we have witnessed the consequences of those
changes in support to our tenants.
In Cornwall, for instance, a Supporting People
contract, previously held by Mencap, was lost to a cheaper provider,
which offered reduced support, including to Mencap tenants with
moderate learning disabilites. That provider's commitment was
to provide housing related support for only two years and then
withdraw that support. However, people with a learning disability
have ongoing housing support needs and therefore require ongoing
support. Local and national government tend to think of Supporting
People as a programme designed to "cure" those people
who face hospitalisation, homelessness or institutional care by
supporting them on a journey towards full independence. Whilst
such thinking may be aspirationally applied to other vulnerable
people, including people with mental health problems or people
coming out of homelessness, it is of limited relevance to people
with a learning disability. A learning disability is lifelong
and many people with a learning disability will not realistically
be able to lead an ordinary life, including maintaining a tenancy,
unless they receive adequate and ongoing support to do so. In
Cornwall Mencap has therefore been negotiating with the other
provider on behalf of its tenants to argue for ongoing support.
The other provider has been sympathetic and now agrees with Mencap,
so is providing minimal ongoing support with one face-to-face
meeting per month and one telephone call per week for Mencap's
tenants. We are concerned that if the money available for housing
related support continues to fall, ongoing support such as this
will be withdrawn and people with a learning disability will struggle
to maintain their tenancies.
Furthermore, as a housing support provider via
Supporting People, Mencap has often assisted tenants with non-housing
related support, such as shopping and travel. As other providers
have won these contracts at reduced rates, they have done so by
more stringently limiting their service to housing-related support.
One typical example in Cornwall is of a Mencap tenant who is eligible
for housing-related support but not social care provision and
can not go shopping as it causes them severe anxiety. Mencap previously
supported them to shop as part of our Supporting People contract,
whilst the new reduced-rate provider does not. The tenant is now
dependant on the good will of Mencap staff who occasionally offer
to assist with shopping.
PRESSURE ON
ADULT SOCIAL
CARE SERVICES
The removal of the ring-fence will inevitably
further diminish the resource supporting vulnerable people's tenancies,
as most local authorities divert funds to address their larger
community agendas. This will place greater pressure on overstretched
adult social care services to fill the gaps in support. People
with a learning disability are already experiencing cuts in social
care provision. This is because funding increases in social care
for people with a learning disability are not keeping up with
increases in demand. Recent research commissioned by Mencap and
the Learning Disability Coalition found that the population of
people with a learning disability is increasing at a rate of at
least 3-5 % per year on average over the next five years.[19]
This is due to demographic changes and medical advances that mean
more babies are being born with a learning disability, more children
with a learning disability are surviving into adulthood and more
adults with a learning disability are living well into middle
and old age. These changes are particularly increasing the numbers
of people with profound and multiple learning disabilities, who
have the most complex needs and require the most expensive packages
of support. Meanwhile the Department of Health has been working
under the assumption that demand is increasing by only 1% per
year. Based on the Mencap and Learning Disability Coalition research,
at least an extra £200 million per annum will be required
over the years 2011-14 to address the resultant shortfall.
This shortfall in funding has led to deterioration
in care provision. People with mild and moderate learning disabilities
now tend to receive no support due to tightening eligibility criteria.
Those who are entitled to care have seen their support reduced.
Furthermore some authorities have started charging for previously
free services.
Supporting People has benefited some of those
with mild and moderate learning disabilities who have been abandoned
by the social care system, particularly as some local authorities
seemed to see the monies as intended for those that were not in
receipt of social care funding. An April 2009 survey by the
Local Government Association and the Association of Directors
of Adult Social Services has shown that only 27% of councils now
offer services to people whose needs are assessed as anything
less that "substantial", representing a 3% decrease
over the last year. Mencap is concerned that these people in particular,
with mild or moderate learning disabilities, face a sudden removal
of support unless the social care system is given the sufficient
resource to offset the dissipation of the Supporting People budget.
If a proportion of the money from Supporting People were to be
directly transferred to social care however, there would have
to be formal recognition that social care providers have some
responsibility for housing support.
CONCLUSION
Mencap is primarily concerned that a major funding
stream that is accessed by people with a learning disability to
enable independent living is now under threat as local authorities
are given the freedom to divert it to other priorities. In theory
local authorities should continue to meet assessed needs, but
in practice when funding for support becomes over-stretched, eligibility
criteria are tightened.
Mencap is broadly supportive of some of the
principles behind removing the ring-fence. In particular, Supporting
People has not sat well with the principles of person centred
planning. It therefore makes sense that following the removal
of the ring-fence and successive reductions in the Supporting
People budget, money is re-invested in social care services, which
are increasingly embracing the personalisation framework and are
in desperate need of funding. Without that support it seems difficult
to see how the Government will realise its cross-departmental
commitment to independent living for disabled people.
May 2009
18 The impact of the Supporting People programme
on adults with learning disabilities, Joseph Rowntree Foundation
(2007) Back
19
"Estimating Future Need for Adult Social Care Services
for People With Learning Disabilities in England"; Emerson,
E & Hatton, C; Centre for Disability Research (2008) Back
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