The policy document published earlier this year, “Valuing People Now: A New Three-Year Strategy for people with learning disabilities” (VPN), sets out the government’s strategy for the sector. In effect, the document updates the “Valuing People” paper published in 2001, with a view to setting out how best to deliver the vision set out in that original. The key tenets of the document are to be applauded, advocating equality of choice for those with a learning disability on how and where they lead their lives, whilst promoting opportunity, responsibility, dignity and respect. As someone whose dealings with the sector focus largely on its infrastructure and estate, I am interested in what effect delivery of this vision will have on the properties utilised to accommodate and provide care and who will ultimately provide the service.
VPN is very clear that in order to deliver the vision, those parties who play a crucial role include third-sector and independent providers. From the perspective of many of our clients therefore, there is a clear opportunity to be part of the landscape of learning disability care provision in the future, although the question may remain as to what exactly that future will look like. VPN understandably focuses on choice and within that there is a clear emphasis on independent living and supported living. It also highlights the disparity between those with learning disabilities, in respect of their living environment , when set against that of the general population, as illustrated in the following table:
People with Learning Disabilities General Population
50 - 55% live in family home 70% own their own home
30% live in residential care 29% rent their home
15% rent their own home
Valuing People Now - Chapter 3.18
It has been mooted that this, in effect, spells the end for traditional registered residential care provision in favour of a housing-based alternative model. In reality however, VPN states that “residential care should continue to be available to those who actively choose it...” and observes that “Third sector and independent sector providers will be vital to delivering this vision.” Clearly a setting for care needs to be fit-for-purpose in relation to the particular needs and level of acuity of the intended service user. VPN is clear that “Independent Living does not mean living on your own or having to do everything yourself.” It seems therefore that in delivering suitable care settings to those with learning disabilities, as much thought should be given to the design of the property and the design of the environment, as to the structure of the policy.
Here however is where we run into a problem. However worthy the vision, the “partners” who are delivering the solution are as bound by fiscal constraints as they are by regulatory ones. We could use the elderly care sector as an analogy; We are all familiar by now with the concept of Assisted Living, or Extra Care, or Close Care or Care Villages or whichever name is most appropriate at the time. We are also aware that over many years government policy has advocated care of the elderly within their own homes (be those what were actually historically their homes or newly acquired purpose-built units) in favour of care within a long-term residential setting. This is all very well, except the UK market for Extra Care/Assisted Living is yet to find a settled model. It seems to fall, commercially at least, between a property investment and an operational one. Furthermore, in delivering care to people in their own homes, it is recognised that as the level of frailty or acuity increases, so must the attendant levels of care provided. When this high-level of care delivery is fragmented over a wide geographic area to many individual locations, the model becomes increasingly expensive to deliver effectively.
We have encountered many different varieties of environment over the years offering care for those with learning disabilities. It is clear that this provision is polarised, with some exceptionally well designed and built environments on one hand to those that are depressingly Spartan on the other. If the government’s partners, be they third sector or independent, are to meet the challenges of providing both registered and unregistered housing and living environments fit to deliver the vision, then this must involve those very basic property principles of good design and good location in order to do so. Both of these things come at a price however, and in order to deliver the results as well as the policy, the government must be prepared to commit the funds to do so. I am not convinced that we have truly seen that happen in the elderly care sector, and given the current climate of cuts it remains to be seen if the funding will materialise for those with learning disabilities.
Ian C WilkieOctober 2010