Congregate services for people with learning disabilities may persist without planned transfer of resources


Yesterday, we posted about the serious case review following the Winterbourne View scandal, which called for Government action to focus on the closure of large specialist assessment and treatment units and the development of local community based alternatives.

Today, we look at an Irish study which looked at changes in residential provision over a ten year period which has interesting parallels, and perhaps some lessons to learn.

The Health Research Board in the Republic of Ireland maintains the ‘National Intellectual Disability Database’ (NIDD) which contains information on specialist health services use. It was set up to address key questions for national planning, including understanding the demographic profile of people with learning disability (age, gender and level of learning disability) understanding the patterns of service usage and understanding need and demand to inform planning.

The researchers in this Irish study used the data from NIDD to look at moves from congregated living arrangements to, community-based accommodation in Ireland. They were concerned that although a key policy objective, the implementation of the objective in not well monitored.

They used the NIDD data to look at changes in service provision that occurred in for nearly 8,000 people in Ireland from 1999 to 2009.

They found that over the ten year period, there was a significant increase in the numbers of people with learning disabilities living in what they describe as ‘community group homes’. By 2009 nearly 50% of people were living in community settings.

There was a reduction in the number of places in congregated settings, but interestingly they found that there were also increasing numbers of people living in new forms of congregated provision, designated as ‘specialist units’. They also found that during the period, nearly half of new admissions to services were to congregated settings.

A small number of people moved to a different type of accommodation, but more people moved from congregated to community settings than vice versa.

There was a significant increase in investment in services for people with learning disabilities during the period under study, but on average, only 70 new places were created per annum – a 1% increase on total places.

The researchers warn that congregated and separated models of residential provision may continue to exist if there is not a sustained investment in new forms of community based provision through a planned transfer of resources.

Changes in the provision of residential care for adults with an intellectual disability: a national longitudinal study, Kelly F & McConkey R, in  Tizard Learning Disability Review, 17 1, 4 – 10

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John Northfield

After qualifying as a social worker, John worked in community learning disability teams before getting involved in a number of long-stay hospital closure programmes, working to develop individual plans for people moving into their own homes. He worked for BILD, helping to develop the Quality Network and was editorial lead for the NHS electronic library learning disabilities specialist collection. This led him to found the Learning Disabilities Elf site with Andre Tomlin as a way of making the evidence accessible to practitioners in health and social care. Most recently he has worked as part of Mencap's national quality team and also been involved in a number of national website developments, including the General Medical Council's learning disabilities site.

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