Learning Disabilities and Autism

We want people with a learning disability, autism, or both, to have the same opportunities as anyone else to live healthy, satisfying, and valued lives. This includes being active members of their communities, and having the opportunity to gain and retain real, paid, employment. Our aspiration is that people will be supported to progress and gain new skills, with a focus on their individual outcomes, avoiding overly paternalistic approaches. Our view is that residential care services are not the best option for young people transitioning to adult services, and that they should instead be supported to remain as close to their families and communities as possible. Where residential care is considered, this should be within, or as close to, Somerset as possible.

Care Homes

Somerset Council wants to have a balance between the commissioning of traditional residential and nursing homes and the use of housing with care, which provides security of tenure with the option of flexible onsite care arranged according to need. Residents of Somerset must be given clear choice around their accommodation / housing options.

Within Somerset there are 79 care homes for mainly people with a learning disability or autistic need registered with CQC as of February 2023. Some of these care homes are dual registered to support people with mental health support needs. 12 care providers manage more than 1 care home, with Voyage being the largest provider operating 15 care homes in Somerset.

The care homes registered with the CQC to provide nursing and/ or residential care for people with a learning disability provide 664 rooms.

The Council currently supports 51 people in a care home outside of Somerset.

The Council uses the national care home capacity tracker. As of 4^th April 2023, the national tacker showed:

Learning Disabilities Residential – there were 30 (4.63%) available vacancies.
Learning Disabilities Nursing – there were 0 available vacancies.

At the end of February 2023, the Council supported 237 people in care homes in Somerset at an average cost of £1998 per placement.

The Council, as of end of February 2023, purchased 29.77% of the Learning Disability and Autism Somerset care home capacity. Taking into the very small number of empty rooms, other Local Authorities and people who fund their own care purchase over 65% of all Learning disability care homes rooms in Somerset.

The cost of a care home placement for someone with a Learning Disability and/ or Autistic need is based on an individual’s needs. The Council utilises the iSIE Care Cubed benchmarking tool to ensure that a fair price is being charged by providers and paid by the Council. The Council have offered care providers a 9% uplift for 2023/24[1].

If past trends continue into the future, and we see continued improvements in life expectancy for individuals with a learning disability, we can expect a requirement for additional residential care placements for people who have much more complex conditions.

However, the need for residential care for people with less complex conditions may reduce, in line with current national and local strategies, through continued investment in community services, and more local focus on the development of Supported Living and Shared Lives.

There is an oversupply of care home provision for people with a Learning disability who are supported by Somerset Council. It is estimated that over 60% of Learning disability care homes in Somerset are occupied by people placed by other local Authorities. We would like to discuss with providers how they can meet Somerset need in existing care homes in Somerset and not new provision.

In the future we need:

To increasingly commission outcome focused, time limited placements to enable people to move into supported living.
Fewer placements that provide support for lower-level needs, as people choose alternative services, such as Supported Living
More placements that provide specialist and complex support for people with a greater level of need, and people with a forensic history
Older People residential care home providers to develop their skills set in order that people with a a learning disability can be supported.

Home care

It is the Council’s intention that the new framework will be used to commission bespoke support for anyone who needs it and will therefore not be limited only to people with learning disabilities. Where someone does not require this type of support their home care will be commissioned using the home care service described above. It is preferred that providers will operate from a location that allows a physical presence in Somerset.

Day Opportunities

Somerset Council support provides day opportunities for adults who have a learning disability and who may have additional physical disabilities too.

Day opportunities provide a safe, informal, friendly place for you to make friends and enjoy both community activities and activities in the centres. They can also give carers or family a break from their caring roles and take some time for their own interests.

Day opportunities are varied and include:

building community opportunities and support so that people can have ordinary daily lives.
day service modernisation
community-based services
employment, lifelong learning, leisure, relationships.

Many people with a Learning Disability support their care provision through a Direct Payment. The Council do not have access to how people utilise their Direct Payment and therefore the data on people supported by the Council is for commissioned care only.

Traditionally day opportunities have been based around day centres. Providers are listening to people they support and are transforming their services to expand the offer to people with a learning disability to help them access their local community services.

As part of the Council’s strategy to outsource the Learning disabilities in-house service in 2018, Dimensions were chosen as the key partner, as they had a commitment and track record of providing people with different day opportunities.

For some people traditional day care services is the appropriate opportunity, while for other people building community opportunities is more appropriate.

There are 508 people supported through day opportunities, with an average weekly personal budget of £245 (March 2023), outside the Dimensions contract. Within the Dimensions contract there are 131 people supported (March 2023).

Supported Living

All supported living services should be built around the principle that there should be separation of housing and care, so that people can both have choice as to who provides their care, but all change their care in line with their needs as they progress without having to move home.

During the last few years, the Council has worked with several providers to delivery new supported living schemes. This work is ongoing and with the new unitary council links with housing will be strengthened and a formal housing developer framework for specialist housing for people with complex needs will be developed. These schemes have been a mixture of bungalows for individual people, bungalow and apartment schemes. Some new schemes going forward will need to replace older style shared living schemes.

For 2023/24 the Council have increased the hourly guide price for supporting living by 8.8%. There is a separate contractual uplift for Discovery.

Home care for people with learning disabilities is commissioned using the Learning Disabilities Open Framework. The Framework is in the process of being recommissioned with the new arrangements commencing in April 2024. It is the Council’s intention that the new framework will be used to commission bespoke support for anyone who needs it and will therefore not be limited only to people with learning disabilities. Where someone does not require this type of support their home care will be commissioned using the home care service described above. It is preferred that providers will operate from a location that allows a physical presence in Somerset.

The Council would like to work with housing and care providers:

To ensure people with mental health support needs and / or with learning disabilities can use mainstream housing to access appropriate housing options, giving them control over where they live, who they live with and how they are supported.
To work proactively with providers to ensure we are aware of all new or existing supported living provision across Somerset.
To work with housing providers who can deliver supported living schemes within Local Authority Housing Allowance rates.
Ensure that appropriate new developments are utilising exempt housing benefits rules.
To move away, were appropriate from shared housing to individual flats / bungalows.
To meet an estimated need of standalone housing for people with complex needs of between 3 – 5 properties per year.
To ensure there is a clear split between support provided by thecare and housing provider.
To ensure there is a consistent approach around background, sleep-in and individual care.

Shared Lives

Shared Lives is an alternative to supported living or residential care where someone who needs care is matched with an approved Carer and lives in their home. The Carer shares their family and community life, provides care and support, and helps the person to achieve outcomes in mental and physical health that are proportionally greater than the cost to the local authority.

The Council commission Shared Lives South West. Shared Lives South West have a CQC provider rating of “Outstanding”. Shared Lives South West ( March 2023) support 57 carers who support people in long term and short term placements. There are 16 carers waiting to be matched with someone.

The current contract with Shared Lives South West operates through to November 2024. During 2023 the Council will commence a commissioning program to appoint a provider for the Shared Lives scheme from November 2024.

Shared Lives South West in Somerset has focused on supporting people with a Learning disability. The Council would like to work with Shared Lives South West to understand how more people could be supported autism, mental health support needs, dementia and older people.

The Council and Shared Lives South West are looking for the service to grow by increasing the number of carers by 10 in 2023/24 and a similar increase in future years.

[1] Adult Social Care Fees and Charges