4. Impact of increase in average level of support per person on expenditure Based on the analysis conducted for this programme, this appears to be the largest unique factor driving expenditure increases for working age adults and individuals with a lifelong disabled condition. The level of weekly expenditure has increased by 31% for working age and lifelong disabled adults since 2019 (as illustrated in Figure 6) lxxiii .
Figure 7: Types of support for individuals with a learning disability
This is due to more individuals (as a proportion of the total volume, which has not changed) receiving higher cost and higher support-level packages. This is the opposite of the trend seen in older adults’ frailty and dementia support, where the average level of support (excluding the level of inflation and changes in levels of net contributions) has seen a slight decrease lxxiv .
% in receipt of other (e.g. day service, befriending, wellbeing visit)
37%
39%
39%
39%
% in receipt of direct payments or homecare
17%
18%
18%
17%
Figure 6: Working age and lifelong disabled adult weekly spend lxxv
% in receipt of residential, nursing, or supported living
46%
44%
43%
44%
2019/20
2020/21
2021/22
2022/23
2023/24
Gross weekly spend % growth gross
£565.21
£591.59
£624.86
£679.67
£735.40
2020/21
2021/22
2022/23
2023/24
100%
105%
111%
120%
130%
Net weekly spend % growth net
The next section of this report looks in detail at the specific needs of different cohorts of working age and lifelong disabled adults, how their needs vary by cohort, and potential opportunities to improve outcomes while reducing cost.
£514.03
£540.50
£569.68
£621.50
£672.45
Summary The data outlined above suggests that expenditure is increasing due to the type of care which working age and lifelong disabled adults are receiving. There is a risk that people are receiving more intensive packages of care than they need, which not only reduces independence but also increases cost. Engagement with participating authorities suggests that this is likely to be due to a combination of factors such as changing societal attitudes to risk, increasing expectations from families, and pressure from providers to maintain certain levels of provision.
100%
105%
111%
121%
131%
One contributor to these various increases in support per person will be the increasing complexity of need – indeed 74% of Directors of Adult Social Care Services reported this in 2024 compared to 67% in 2023 lxxvi . The life expectancy of disabled adults is increasing, so for example, Alzheimer’s is now beginning to present in people with Down’s Syndrome more often. This is likely to lead to more substantial differences in support needs in 10–20 years’ time given the gradual rate of change. As outlined above, analysis indicates that the average cost per person supported is increasing, and that there is a higher proportion of working age and lifelong disabled adults in accommodated support settings (supported living, residential, and nursing care). It is possible that the increase in cost per person could be driven, at least partially, by people with less complex needs no longer being deemed eligible for care. The effect of this change would be an increase in the average cost of care per person supported, however, the underlying driver would be an increase in volume as opposed to a change in the type of care provided. However, given that the data available shows that there is a low level of turnover of this population, this therefore suggests that increasing complexity is driving the increase in costs.
The data analysed for this programme from the 16 participating authorities shows that the proportion of individuals with a learning disability living in residential, nursing, or supported living has increased 3% since 2020/21 (as shown in Figure 7), equating to 9,400 more people. Whilst there has been a slight reduction in overall residential and nursing numbers, this is equivalent to only half of the growth in supported living placements. Analysis suggests that the average cost of these setting types has increased – for the authorities participating in this programme, residential placements for people with a learning disability have increased 18% since 2020, and supported living by 25%. A greater number of people in higher need settings, with each of these being higher cost, has led to the significant increases in commissioning budget for this cohort. Meanwhile, the proportion of individuals who are in receipt of support that might be described as ‘prevention’ such as befriending, wellbeing visits, and day services has reduced by 2%, equating to 6,300 fewer people.
38 HOME
HOME
39
Made with FlippingBook - Online catalogs