What’s the Plan?

February 25, 2014

Today, yesterday, and tomorrow words on blackboardSensible life planning by authorities for adults with learning disabilities produces the best outcomes and is the most cost effective for commissioners. So why do so few authorities plan for longer than a year? And what is the impact on the lives of the people we support?

Imagine how your life would be if you only knew what the next twelve months would bring. After that, your job, home, friends and lifestyle was a complete unknown. The free spirits out there might feel this was an attractive possibility, but most of us prefer to have some certainty in order to make relationships, become established, invest and plan.

Barriers to longer-term thinking

A report by the learning disability charity Fitzroy has found that an alarming 42% of local authorities plan care packages for just 12 months ahead. One overriding reason for this is, unsurprisingly, cost. To be more accurate, the reason is more likely budget, since funding is usually set for a year at a time and so commissioners would struggle to use any long term planning when they did not know what resources would be at their disposal after the end of the year.

Another reason high on the list for an authority is the time needed to research and plan for lifelong care.  Often the need to plan arises as the result of an untoward event, creating urgency to find a swift solution in a crisis, such as the death of a carer. Worryingly, Fitzroy found that 29% of councils do not see such sudden bereavement as a significant event for people with learning disabilities.

The ideal of person-centred planning cannot be hurried, so it often falls to authorities to find a willing provider with a vacancy quickly. In these cases, the commissioner would be reckless to commit to a long-term plan, in case the placement was not ideal.

What does this mean for the Service User?

This temporary care planning results in poor quality of life for Service Users who struggle to establish themselves when they don’t know what the future holds. Serial new placements can exacerbate challenging behaviour and cause long-term difficulties in forming and sustaining trust and building meaningful relationships. Families are often thrown into disarray when a short-term placement ends and no other is forthcoming, leaving people nowhere to go but back home to mum.

Many social workers have been driven to exasperation over the consequences of funding limits on securing placements to provide the best outcomes for their clients. At the front line, they have to manage the disappointment for Service Users, their families and the providers themselves. Moreover, when questioned, authorities acknowledged that poor planning created additional costs, as inappropriate placements ended in crisis management, costly emergency measures and these often resulted in higher care needs for individuals

The hidden costs of placement planning

As adult services providers, we probably all have examples of people being placed with a short review date and no confirmation of continuity. This is a nightmare for small businesses that need to arrange recruitment and service provision around an individual, all of which take time. The set up costs of a person-centred service are usually made at the expense of the provider and are essentially a loss leader.

Assessment is a notable example of this; we need to establish clear evaluations of a client’s strengths and needs before we can offer a service, yet there is no easy mechanism for charging for such. In the event that our detailed assessment and planning result in a placement, it would take time for the funding to cover the initial outlay, time that might not be available if social services short termism is in play.

Government responsibility to support placement stability?

The Fitzroy report goes on to remind authorities of their new responsibilities under the Draft Care and Support Bill, when they will be under a legal obligation to ensure the longer term wellbeing of people with learning disabilities. This adds another dimension to the business of care planning and makes it incumbent on commissioners to consider, for example, the disadvantages of frequent moves and changes on a person’s quality of life.

This measurement is as yet widely undefined and represents something of a ‘holy grail’ for both commissioners and providers. It offers up an opportunity to measure the real impact of interventions for the client, not just the cost benefit. Too often, the latter is the indicator of choice for commissioners as it is easier to quantify.

When questioned, 74% of authorities agreed that formal measurement of quality of life would assist in justifying long-term planning, support stability and therefore reduce unexpected additional costs. Yet at this time, only half of authorities have an agreed means to measure quality of life and even fewer have a strategy in place to promote wellbeing.

Fitzroy are seeking government intervention to establish an agreed framework for measuring quality of life. They also advocate strongly for government guidelines on how to promote it, so that councils can fulfill their responsibilities to ensure lifelong wellbeing for people with learning disabilities. At the moment, they suggest that the situation for authorities is chaotic and illogical, costing too much and achieving so little.

Care in the community has brought us a long way from the days when the only option for people with learning disability or chronic mental ill health was to spend their years in institutional surroundings. We need to concentrate our efforts on making the future a secure, reliable and meaningful one, not a series of stop-gaps with no stability or certainty.

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Ginny Tyler

Learning Disabilities Specialist


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