Despite the gradual move away from residential accommodation and towards supported living in recent years, several models of supported living are beginning to look increasingly less flexible in relation to support options (e.g. requiring a minimum number of hours that are similar or greater to what the individual requires), or are increasingly intense (e.g. 3:1 or more constantly across the week in a small property). Whilst there will likely be a difference in the local market costs (although there are no clear trends such as a north/south or rural/urban divide in the data), supported living certainly looks different across the country. There are differences relating to whether authorities use shared houses, blocks of flats, or individual flats in the community as their primary supported living delivery. Evidence from within the sector suggests that there is three-fold variation in the use of overnight support for similar need levels between authorities in the same region alone. This significant degree of variation in models of provision appears to be an important factor in growth of spend and is therefore a priority area for review. This is made more difficult by the absence of supported living in national data collection returns, despite being the most common support type for learning disability (the largest primary commissioned spend reason for adult social care). The second phase of this programme in 2025 will look to focus on bridging this gap in knowledge and good practice, by showing the different operational and commissioning frameworks authorities are using to deliver quality and cost- effective supported living around the country.
What are the characteristics of individuals in this cohort? Based on the data analysed for this programme from the participating authorities, this cohort makes up 16% of all individuals with a learning disability, and accounts for 28% of learning disability expenditure. 84% of individuals in this cohort are aged 26–39-years-old, and 16% are 18–24-year- olds. 66% of individuals in this cohort are male, compared to the national average of 51%. 39% of individuals in this cohort live in supported living, 38% live in residential care, and 12% receive a direct payment. How can improved outcomes be delivered for this cohort? Individuals in this cohort have largely similar needs to ‘LD cohort two’ but were born 10–20 years later. This means that they are more likely to have their needs met in supported living than in residential accommodation. Whilst the move towards a more community-based setting has the potential to improve outcomes for individuals, in practice not all these placements will provide more independence than their residential alternative. Delivering optimum outcomes for individuals in this cohort involves ensuring that an authority’s supported living model is maximising the autonomy of its residents – this may involve increased flexibility (such as exploring the ratio of support for the individual or sharing support across a number of people); redesigning support to focus more on the individual’s control of their own life (even where individuals cannot complete an activity themselves unsupported – such as meal preparation for example – them being involved in choosing the meal or assisting in the tasks involved); and balancing risk with the individual having greater space and freedom from support (often common in the proportionality of whether waking overnight support is required).
and transformation and change specialists. Whilst navigating the available housing may look different between unitary and two-tier authorities (the former generally having greater control and access to housing), there are examples of two-tier authorities successfully employing this approach and reducing their residential placements in learning disability and mental health. One authority achieved a reduction of over 38% in three years. This was achieved through not only looking at how existing shared houses for supported living were being used, but also through working creatively with commissioning colleagues to buy, rent, or even build new schemes.
Transitioning suitable individuals out of residential care is a complex process. This is primarily due to challenges identifying people who are interested in the move (individuals may have resided in these settings for decades and will often have little awareness of the alternatives available); having a stock of quality and appropriate placements available; and preparing and matching the individuals to these properties. This would be a significant change to the individual’s life and routine, and a large operation for an adult social care service to do at scale. As such, authorities who deliver this most successfully often do so with a dedicated joint team of social work staff, commissioners,
LD Cohort Three: 18–39-year-olds with high needs and whose care package is increasing slightly in cost
Abbas is 29 years old. He has been living in a flat within a supported living block for the last few years, ever since he moved out of his childhood home. Abbas originally found the move hard, but now enjoys having his family come to visit him in his flat which he has decorated exactly how he wants. Abbas has autism and a learning disability. He was diagnosed with Fragile X syndrome as a child, which impacts his ability to communicate in the same way as many other people do. Whilst he overall really likes the 1:1 support staff that he has in the flat, he finds night times harder as different people don’t always understand his routine. This can cause him to feel frustrated and upset with staff. This has resulted in his social workers reviewing the placement more regularly than once a year, and each time has resulted in a slight increase in 1:1 support he receives.
Why is this cohort a priority for improvement? In this cohort, average packages of care are typically high, and large variations in cost are evident between authorities. As a result, this cohort appears to be a high priority for potential improvement activity. Individuals in this cohort typically receive a care package with an average weekly cost of £1,815 per person. This has increased £103 per week per year from 2021 to 2024. The cost ranges from
£1,717 per week in one participating authority to £2,353 in another participating authority. In addition, the data from participating local authorities shows that there is a significant difference in how supported living is being used for this cohort. Within this cohort, the cost of a weekly package varies from below £1,000 a week on average for three of the 16 authorities, to above £2,000 a week for four out of the 16.
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