13.Central and local government combined spend approximately £8 billion supporting people with a learning disability. Local authorities spend £4.61 billion on social care services for people with a learning disability. While local authority spending on adult social care has decreased by 8.4% from 2010–11 to 2013–14, spending on learning disability services has been increasing. 39% of spending on adult social care services is on adults (aged 18–64) who have a learning disability. There is currently no cross government strategy for the learning disability population.
14.Proposed changes to the local housing allowance are due to be introduced in 2019 and may cause difficulties for people with a learning disability living in the community, as well as organisations who provide accommodation with support. People who have a learning disability may find that the proposed changes mean that the money they receive in local housing allowance may not be enough to cover the higher rent they are likely to face for specialist accommodation. There is no guarantee of top-up funding from local authorities. The proposed changes are also causing uncertainty among organisations who provide accommodation with support for people with a learning disability. United Response estimates that this uncertainty has delayed around 80% of planned supported housing while organisations assess the impact of the proposed changes. The National Audit Office also found that organisations are concerned about difficulties obtaining capital funding for new supported housing schemes because of uncertainty about future funding.
15.We recognise that the Department is not responsible for policy on supported housing but it still needs to work with other departments to maintain the provision of supported housing for people with a learning disability. The Department told us it is discussing the issue with the Department of Communities and Local Government and recognises the importance of cross-government working to ensure that organisations can continue to provide accommodation with support. The Department confirmed its commitment to being the champion within Whitehall for people with a learning disability, and in particular for securing ‘the right package’ for them on the issue of supported housing.
16.We heard from Mencap that it is important for people with a learning disability to register with their GP as having a learning disability, as this helps them access other services, including health checks. However, only an estimated 23% of people who have a learning disability are registered with their GP as having a learning disability. There is also local variation in the proportion of people with a learning disability who have had an annual health check by their GP, ranging from 6.3% in East Sussex to 59% in Hackney. NHS England reiterated the importance of health checks and told us that research shows that having health checks leads to better outcomes for people with a learning disability. NHS England set out what it is doing to increase the number of health checks, which includes redesigning the template for health checks so it is simpler for GPs to complete. From April 2017, NHS England will also increase the amount GPs get paid per health check from £116 to £140. As a result NHS England is expecting an increase in the number of checks of 10% each year, reaching a target of 75% by 2020.
17.There is also large local variation in the proportion of people with a learning disability and supported by their local authority who are in paid employment. We heard from Mencap that, with good quality support, people with a learning disability can be supported into long-term employment. The Department told us that, for health and disability more generally, it is working with the Department for Work and Pensions and together they have recently published a Green Paper on the subject which aims to pilot different approaches around improving employment support.
18.In addition to monitoring GP learning disability registers and health checks, the Department has two measures of the effectiveness of learning disability social care services: the types of accommodation in which people live; and the numbers of people in paid employment. These measures focus on activity rather than any improvement in people’s lives. Given that Government spends £8 billion a year supporting people with a learning disability, we asked the Department whether it knows, based on the measures it has, if the support provided is improving the lives of people with a learning disability. The Department outlined its work with University of Kent to assess if there are better quality of life and care indicators that it could use. We also heard that some local areas use their own measures and ways of monitoring outcomes.
19.Families often act as the main providers of care and support, in many cases for the whole of a person’s lifetime. Families also play an essential role in advocating for their loved ones, making sure that they get the right care and that their needs are understood. They can make a significant difference in terms of the health and social care people receive. We heard from the Association of Adult Social Services that it is often pressure from family members that prompts people in authority to make changes. The previous Committee found that people with a learning disability, and their families, have too little influence on decisions affecting their admission to mental health hospital, their treatment and care, and their discharge. We heard from Mencap, that, despite the experiences and insights that families give, they are not always respected or listened to enough by professionals. There is also variable engagement with families with the local Partnerships of the Transforming Care programme.
20.The Challenging Behaviour Foundation told us that it is concerned about people with a learning disability who do not have families to speak up for them, as this increases the vulnerability of an already vulnerable group of people. Advocacy groups are vital in filling the gap when there is no family to advocate for people with a learning disability. While United Response and the Association of Adult Social Services told us of some examples of local authorities who are particularly good at supporting families and providing advocacy, this is not consistent across the board.
25 Q116; , paras 7, 1.6, figure 1
26 Qq2, 61, 79; , paras 7, 1.4, 1.8–1.10
27 Q30; , para 3.26
28 Qq29 30, 32, 42
29 , para 3.26
32 Qq11, 12, 14; , para 1.14
34 Qq7, 105; , para 1.18
36 , paras 1.13, 1.14, 1.16
37 Qq27, 116, 117, 129
38 Qq2, 22, 64
39 Committee of Public Accounts, Fifty-first Report of Session 2014–15, Care Services for people with learning disabilities and challenging behaviour, HC 973, p. 7
40 Qq22, 64, 65
24 April 2017