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Local support for people with a learning disability

A learning disability is generally defined as reduced intellectual ability and difficulty with everyday activities – for example household tasks, socialising or managing money – that affects someone for their whole life.

People with a learning disability have differing support needs. Many of the 930,000 adults with a learning disability in England may never use learning disability support services. There are 129,000 adults who receive local authority social care support. Of these, 28,000 live in residential care or nursing homes. A small proportion (around 2,500), of people with a learning disability and/or autism are in mental health hospitals, some with secure facilities. These people can be considered a danger to themselves or others and have behaviour that challenges services.

The Department of Health (the Department) sets policy for adult learning disability services. Local authorities provide social care services and NHS England is responsible for meeting the health needs of people with a learning disability. The Department for Communities and Local Government sets finance policy for, and allocates funding to, local authorities.

Depending on their support needs, activities to support people with a learning disability focus on increasing employment opportunities, getting people into settled accommodation, and giving them access to healthcare. Since 2012, following the abuse scandal at Winterbourne View the previous year, the Department has largely focused efforts on the approximately 2,500 people with a learning disability who are in mental health hospitals. Many of these people have been in hospitals for several years. The Department set out its commitment to transform the care of these people in Building the Right Support (2015), which is its national plan to reduce the number of beds for people with a learning disability in mental health hospitals by 35% to 50%.

Moving people out of mental health hospitals is a considerable challenge. It cannot be done quickly or cheaply. As we noted in our previous report, efforts to do so date back to the 1980s, and is a difficult task which defies simple solutions.1 It involves a number of complex and interrelated events, processes and services involving building community alternatives to head-off admission, minimising admissions and length of stay and discharging people to safe and supported locations with minimal readmissions. Unless all stakeholders work together it is unlikely that any individual element of effort will be successful or sustainable.

Our report

This report examines how the NHS in England and local authorities seek to improve the lives of the 129,000 people aged 18 to 64 who use local authority learning disability support services (Part One). We also assess the setting up of the Transforming Care programme (the programme) which aims to move some of the 2,500 people with a learning disability and/or autism out of mental health hospitals (Part Two); and progress of the programme (Part Three). Our key questions are:

• How much does the government spend on supporting people with a learning disability?
• Is support improving outcomes?
• Has the Department made progress with its programme to provide community services and reduce mental health hospital beds for people with a learning disability?