02: Introduction
Context 40% of people receiving adult social care support in England are individuals aged 18–64 with a disabled condition (a learning disability, a physical disability or a mental health condition) who make up the working age adult population, or individuals aged 65+ with a lifelong disabled condition (a learning disability or long-term mental health condition). On the one hand, there have been radical shifts in how social care services have supported people with physical and learning disabilities or mental health conditions over the last few hundred years, for example from the use of asylums in the nineteenth century to the community model of today. There has been a step change in attitudes, in the efficacy of support, and in the associated outcomes achieved for these individuals. However, evidence also suggests that there is a strong case for doing more – or doing things differently. Historically, there has been less focus on younger individuals with a disabled condition and older adults with a lifelong disabled condition who require adult social care support to maximise their independence. Older adults with needs associated with frailty, declining health, or memory issues tend to receive the primary focus of the national narrative. When asked about social care people will often talk about older adults; when searching for social care on news sites, results will nearly all be about older adults; at national health and social care events, the focus is often on older adults; and in a similar way, much of the historical national policy agenda has focused on older adults. There has been no national policy development specifically aimed at improving outcomes for people with a learning disability since the ‘Valuing People’ white paper in 2001.
Meanwhile, national expenditure on support for working age and lifelong disabled adults has risen by over a third between 2020 and 2023 in England with forecasts for the 2024 financial year even higher. Support for working age and lifelong disabled adults has now become the largest area of expenditure in adult social care, making up 63% of the net adult social care commissioned spend in England in the financial year 2022/23 – £10.1bn x . This is despite the total volume of individuals with a learning disability supported not having risen over this period. At the same time, and most importantly, outcomes for these adults do not appear to be improving in line with this increased expenditure, in terms of health, education, employment, or social interactions and relationships. It is therefore these two cohorts of individuals (working age and lifelong disabled adults) which this programme of work is most interested in exploring in further detail. In doing so, it has sought to put them at the centre of the national conversation on social care and help start a conversation about the key topics and issues that can make a meaningful difference to people’s lives . It has also sought to put forward a series of local and national interim recommendations for how these individuals can be better supported in a way which improves their life outcomes, while also maximising the use of limited resources. The interim recommendations put forward in this report will form the basis of the next phase of this programme, to be delivered in 2025. This second phase will build on the case for change demonstrated in this report and will look in more detail at what the evidence indicates are the practical changes that should be made at a local and national level to deliver better outcomes for working age and lifelong disabled adults.
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