Individuals with a learning disability
Individuals with a mental health condition: • MH Cohort One: Individuals with low levels of need whose package of care is not changing in cost • MH Cohort Two: Individuals with high levels of need whose packages of care are increasing slightly in cost • MH Cohort Three: Individuals with average levels of need whose packages of care are increasing significantly in cost Individuals with a physical disability: • PD Cohort One : 40–65-year-olds with average levels of need and whose packages of care are not changing in cost • PD Cohort Two: 40–65-year-olds with average levels of need and whose packages of care are increasing in cost • PD Cohort Three: 26–39-year-olds with higher levels of need and whose packages of care are increasing slightly in cost Section 7 of the report provided a summary of the key findings from this cohort analysis and highlighted the priorities for action and improvement for local system leaders to address the disparity in outcomes and cost identified. This Appendix provides further information on the characteristics of individuals with a learning disability, and then explores in further detail the six additional cohorts of individuals (beyond those prioritised in Section 7). It then follows the same approach for individuals with long-term mental health conditions and individuals aged 18–64 with a physical disability. For each cohort it also makes suggestions for how this information can be used by local authorities to improve outcomes (largely based on experience from previous improvement programmes).
To better understand the working age and lifelong disabled adults receiving adult social care in a meaningful and non-anecdotal way, this programme conducted detailed analysis into the similarities and differences between different individuals and the ways in which they are supported. This provided a rich and data-led articulation of the different groups or cohorts of people who receive support beyond one reason or individual factor. Through the analysis the following cohorts were identified (these are shown below in order of the proportion they account for of the total volume of working age and lifelong disabled individuals in receipt of adult social care): Individuals with a learning disability: • LD Cohort One: Individuals with a very low level of need whose package of care is not changing in cost • LD Cohort Two: 40+-year-olds with high needs and whose care package is increasing slightly in cost • LD Cohort Three : 18–39-year-olds with high needs and whose care package is increasing slightly in cost • LD Cohort Four: Individuals with low levels of need and whose package of care is escalating in cost • LD Cohort Five: Individuals with low levels of need and whose package of care is not changing in cost • LD Cohort Six: individuals with high needs and whose packages of care are increasing significantly
What is known about this group, based on data from the 16 participating local authorities: Volumes • This is the largest cohort in the working age and lifelong disabled adult group, accounting for 48% of the working age and lifelong disabled individuals receiving adult social care support.
Demographics
• 40% of this group are female and 60% are male. This does not reflect the national UK ratio of 51% female:49% male lxxxiv , which suggests that men with a learning disability are more likely than women to be in receipt of a package of support from adult social care. • 92% of this group are white, 3% are Asian/Asian British, 1% are Black/ African/Caribbean/Black British and 2% come from multiple ethnic groups – this mirrors the demographics for the participating authorities. • The population of adults with a learning disability is much younger, on average, than the UK population. For example, Figure 17 shows there are 60% more 18–39-year-olds in this cohort compared to the UK population and that those with a learning disability receiving support are more likely to be under 40 years old than over 55 years old. • Support for individuals with a learning disability accounts for 67% of all expenditure on support for people in the working age and lifelong disabled adult group. • 92% of the total expenditure on support for people with a learning disability is for those aged 18–64, with the remaining support provided to those 65+ years old. • The average weekly cost of support is £941, nearly three times larger than the average cost for older adults with physical needs. However, the distribution of costs is spread more widely, with 20% of people receiving a package costing between £100–300 per week, 20% receiving a package costing £300–700,17% receiving a package costing £701–1,200, and 17% receiving a package costing £1,201–2,000. This is illustrated in Figure 18. • Total net expenditure increased 28% between 2019/20 and 2023/24, which is at a greater rate of growth than minimum wage, inflation, and older adults’ expenditure (as outlined in Section 4).
Expenditure
• Over the course of the four years from 2020/21 to 2023/24 inclusive, package costs increased for 61% of individuals. 37% of packages increased by less than a hundred pounds per week each year, 17% increased by an average of £167 each year, and 8% increased in weekly cost by an average of £1,202 (see Figure 19). Support types • The most common type of support provided is supported living, with 30%
of individuals with a learning disability living in this setting at an average weekly cost of £1,155 (illustrated in Figure 20 below). Interestingly, supported living is not captured in national returns as a sub-category but is one of the largest support types in the country, and is the support type that is used in the largest variety of ways by different authorities. Along with 19% of individuals in residential care (at an average weekly cost of £1,916), this means that 49% of all individuals with a learning disability are supported in an accommodation-based setting rather than in local authority social housing, their own private tenancy, home ownership, or living with family/carers.
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