The impact of the Supporting People programme on adults with learning disabilities

This study explores how the Government's Supporting People programme is affecting housing and support for people with learning disabilities in England.

Key points

• The Government has only loosely defined 'housing-related support' and this has resulted in significant variation in the type and amount of support available in different areas.
• The introduction of Supporting People appears to have increased the availability of supported living services for people with learning disabilities.
• However, this has often come at the expense of abandoning the principles of supported living so that, in some cases, it is indistinguishable from residential care.
• Interviews with people with learning disabilities showed they were largely in control of choices about their everyday activities, such as what to wear, what to eat or how to spend their time.
• However, the more fundamental choices which framed individual lives – including where to live, who to live with and who to receive support from – were still typically made by service managers or commissioners.
• Different ways of delivering supported living services result in different outcomes for services users:
  • Shared tenancies with accommodation-based support (own bedroom but communal kitchen and living areas, with a dedicated full-time staff team) were associated with higher overall levels of support and less social isolation, but also less independence.
  • Individual tenancies with floating support (single person or couple living in their own self-contained property, with staff providing support for a specified number of hours each week) were associated with lower levels of support and the potential for greater independence, but also loneliness.
  • These differences need to be acknowledged explicitly, so that people with learning disabilities can make informed choices about how they wish to live.
• The analysis of five-year Supporting People strategies suggests that administering authorities intend to focus in future on the development of services which offer individual tenancies and low-level floating support to people with learning disabilities.

Background

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.

Defining 'housing-related support'

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:

• limiting support to a defined list of 'eligible support tasks';
• capping the number of support hours per person per week (limits ranged from ten to 30 hours);
• limiting the cost they were willing to pay per hour of support (limits ranged from £12.05 to £22.00 per hour); and
• capping the cost of support per person per week (limits ranged from £200 to over £500 per week).

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.

Outcomes for service users

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:

• whether people lived alone (individual tenancies) or with others (shared tenancies); and
• whether they received floating support (staff visiting their homes to help with specific tasks) or accommodation-based support (staff teams based in tenants' homes).

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.

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.

Choice, independence and control

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.

Five-year Supporting People strategies

Key points which emerged from analysis of these strategies were:

• Only 5 per cent of authorities had produced a version of their strategy in a format which was accessible to people with learning disabilities.
• Average costs per person per year for people with learning disabilities were around twice the average cost for all service user groups.
• The proportion of local budget spent on services for people with learning disabilities varied hugely: 6 per cent of authorities spent 10 per cent or less on people with learning disabilities, whilst 11 per cent spent 40 per cent or more on this group of service users.
• In the future, authorities indicate that they plan to provide more low-level floating support services to people in individual tenancies.

Conclusion

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.

About the project

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.