An examination of how the Government’s Supporting People programme is affecting housing and support for people with learning disabilities in England.
The Supporting People programme, which began on 1 April 2003, separated housing costs from the costs of the support necessary to allow vulnerable adults to live independently. For people with learning disabilities, this new funding system seemed to offer the prospect of independence and inclusion.
Working across four diverse administering authorities, this detailed qualitative research involved interviews with 31 people with learning disabilities, plus support workers, managers of support provider organisations and local Supporting People teams.
This study explores how the Government's Supporting People programme is affecting housing and support for people with learning disabilities in England.
The Supporting People programme, which began on 1 April 2003, was designed to separate out the costs of bricks-and-mortar housing (which, where needed, would continue to be paid through Housing Benefit) from the costs of the support necessary to enable vulnerable adults to attain or maintain independent tenancies. For people with learning disabilities, this new funding mechanism appeared to offer a much-needed opportunity for some of the changes set out in the 2001 Valuing People White Paper to be made a reality.
This research project set out to examine how local Supporting People teams were interpreting national guidelines in relation to the provision of housing-related support and to explore the impact that this was having on people with learning disabilities. It also hoped to discover the extent to which the Valuing People core aims – of promoting rights, choice, independence and control in the lives of people with learning disabilities – were being supported by this new programme.
The Government has declined to issue authoritative guidance on how 'housing-related support' should be defined and this has led to wide variations in operational definitions at local level. The consequence of this for people with learning disabilities has been significant differences between authorities in relation to the availability of Supporting People funding. Since Supporting People operates within a strictly cash-limited budget, authorities in the study had chosen to restrict the cost of individual support packages by one or more of the following means:
All of these limits, to some extent, restricted the availability of Supporting People services for people with learning disabilities. Some local Supporting People teams were willing to consider developing individual support packages which included elements of both housing-related support and further hours of care – funded from either social service or health budgets. Others, however, argued that Supporting People monies should be used exclusively for individuals who did not attract a statutory duty of care under the 1948 National Assistance Act (that is, who were not eligible for support from either health or social services). In these areas, the availability of Supporting People was, to all intents and purposes, limited to people with learning disabilities who had low support needs.
The housing and support of people with learning disabilities who received Supporting People funds varied considerably, according not only to the amount of support they received, but also to the structure of their housing and support services. The two key dimensions of difference were:
In practice, these dimensions of difference were not independent of one another: shared tenancies were associated with accommodation-based support and individual tenancies were associated with floating support.
The advantages and disadvantages of these different ways of providing housing and support are summarised in Table 1.
Table 1: Advantages and disadvantages of different methods of providing housing and support
|Shared tenancies with accommodation- based support||Individual tenancies with floating support|
|Danger of less individualised support||Fully individual support|
|24-hour staff cover sometimes possible||Limited number of support hours available each day|
|Maximum flexibility of support, as staff are always at hand||Difficult to change support hours at short notice|
|Less privacy/time alone||More privacy/time alone|
|Less chance of being lonely||More chance of being lonely|
|Support and housing often managed by the same organisation||Clear separation between landlord and support provider|
|Possibility of minimising costs per hour of support||Potentially higher costs per hour of support, because of the need to allow for staff travel time|
|System suited to the employment of full-time staff – giving greater consistency of support||System suited to the employment of part-time staff – giving less consistency of support|
Source: Support for Living? The impact of the Supporting People programme on housing and support for adults with learning disabilities
Although all services funded by Supporting People necessarily defined themselves as supported living services, it was difficult to identify how some of the shared tenancy arrangements differed from high-quality, small-scale registered care homes. This was particularly so where some of the basic principles of supported living appeared to be overlooked – by having staff offices within people's homes; staff routinely holding (and using) front door keys; or staff hours of work being based upon a set pattern of shifts.
The lives and lifestyles of individual service users varied according to the extent to which support providers had taken on board the principles and practice of enabling tenants with learning disabilities to exert choice, independence and control. All the tenants interviewed were supported to make choices about everyday activities – such as what to wear, what to eat or what to do. However, there were many important decisions which typically remained under the control of service managers and/or commissioners – including where individuals lived, who they lived with, and who provided their support.
Tenants and support staff interviewed tended to talk in terms of 'choice' and 'control'. By contrast, managers and commissioners were more likely to focus on promoting 'independence'. However, there was no agreement about what 'independence' might constitute for a person with a learning disability. Paid support staff were frequently the main – or only – source of social contact for tenants living alone.
A minority of managers and commissioners wished to place greater emphasis on developing interdependence between tenants and their local community, but successes in this area were few and social networks were heavily dependent on the involvement of family members. Part of the reason for this is that local Supporting People guidelines typically precluded money being used to provide support for either social or employment-related activities. As a consequence, tenants with learning disabilities could find themselves well supported in practical aspects of day-to-day life (self-care, cooking, housework), but socially isolated. A number of people with individual tenancies explicitly talked about being lonely. Difficulties in achieving social integration were often exacerbated (particularly in urban areas) by bullying and abuse from neighbours and other members of the public.
Key points which emerged from analysis of these strategies were:
The impact of Supporting People on housing and support for people with learning disabilities has been mixed. On the positive side, the programme has provided a much-needed injection of cash into services for people with learning disabilities, which has enabled the development of an increasing number of supported living services. Importantly, the tenants of these services typically expressed pleasure with their homes and with the support they received. Despite variations in the way in which both housing and support were provided by different supported living services, there was a consensus amongst tenants that such services offered them a significant degree of choice and control, particularly in relation to day-to-day decisions.
Against this must be balanced the evidence that many important decisions continue to be made by service managers and commissioners. Worryingly, there were also indications that the rapid expansion of self-styled supported living schemes, following the sudden availability of Supporting People monies, may have diluted the meaning of 'supported living'. Schemes based on shared tenancies with accommodation-based support were sometimes little different from the registered care homes they had replaced. This was particularly true where services ignored some of the key legal and ideological differences between supported living and care homes – for example, the importance of tenancy rights; the belief that staff should not have offices in people's homes; the belief that tenants should control access to their own homes.
Moreover, although services funded by Supporting People offer people with learning disabilities the prospect of geographical integration, this research highlighted the continuing failure of most service providers to adequately support the social integration of people with learning disabilities within their local communities.
This research took place across four geographically and socially diverse administering authorities. It included interviews with 31 people with learning disabilities living in a range of differently-configured supported living services, as well as eleven support staff, managers and commissioners, and members of local Supporting People teams. Five-year Supporting People strategies from across England were also analysed.