The riddle of the model

The riddle of the model*

There have been a number of straws in the wind (and sometimes more than just straws) that commissioners of health and social care, aided and abetted by ‘care’ service providers, are looking for ways to move more people with learning disabilities (and disabled people generally) into residential and nursing care. This blogpost simply aims to provide some statistics on the number of adults with learning disabilities in England in residential and nursing care, and how much local authorities are spending on these types of service. I think my main conclusion is that, although residential and nursing care may be coming back, they’ve never really gone away.

In 2015/16, local authorities were funding 30,240 adults with learning disabilities in residential care services, and a further 1,815 adults with learning disabilities in nursing homes (all data in this blogpost are from NHS Digital). The graph below shows that the overall trend over time is broadly downwards (this graph includes 1,870 adults with learning disabilities in residential or nursing care transferred from NHS to local authority funding in 2011/12).

The second graph below shows the same information for adults with learning disabilities aged 18-64 years old (this doesn’t include the NHS-LA transfers, as we don’t have this information broken down into age bands). Again, there’s a downward trend over time, but in 2015/16 there were still 24,775 working age adults with learning disabilities in residential care and 1,075 people in nursing care.

The third graph below shows the same information for older adults with learning disabilities, aged 65 years or more. The picture here is different, at best flat over time (assuming the hike in 2011/12 is due to the NHS-LA transfer) and possibly increasing. The increase from 2013/14 to 2015/16 is particularly difficult to explain; the way the information was collected changed at that time point but this led to a big overall reduction in the number of adults with learning disabilities getting social care support reported in the statistics. Why this would result in an increase in the number of older people recorded as using residential or nursing care is puzzling, unless local authorities starting recording for the first time older people with learning disabilities placed in generic older people’s care homes? Overall, in 2015/16 there were 5,465 older adults with learning disabilities in residential care, and a further 740 people in nursing care.

 The fourth and final graph below shows how much localauthorities were spending on residential and nursing care for adults with learning disabilities in 2014/15 and 2015/16 (these are the first years for which spending information on older people with learning disabilities is available). In 2015/16, local authorities were spending £1.7 billion on residential care and £60 million on nursing care for adults with learning disabilities aged 18-64 years. They were also spending £246 million on residential care and £25 million on nursing care for adults with learning disabilities aged 65 years or over – a grand total of just over £2 billion per year.

From the figures above, we can work out rough unit costs for each type of care. Per person with learning disabilities per year, local authorities are paying…

·        £68,525 for residential care for adults aged 18-64 (£1,318 per week)

·        £56,093 for nursing care for adults aged 18-64 (£1,079 per week)

·        £44,922 for residential care for adults aged 65+ (£864 per week)

·        £33,243 for nursing care for adults aged 65+ (£639 per week)

Quite why older people have cheaper support needs than younger people, and specialist nursing care is apparently cheaper than residential care, is beyond me, but the reasons for a push by commissioners towards models of care for adults with learning disabilities that look like nursing care homes for older people is becoming clearer.

So, residential and nursing care has never gone away. Rates of placement in residential and nursing care are already much higher for adults with learning disabilities in England (at 67.5 adults per 100,000 adult population) than in Scotland (42.0 adults per 100,000 population) or Wales (51.2 adults per 100,000 population) (Hatton, 2017). The scale of local authorities’ continuing reliance on residential and nursing care can be summarised in these final few facts (from 2015/16 figures):

·        21.5% of all adults with learning disabilities aged 18-64 getting long-term support from their council are in residential or nursing care

·        42.1% of all adults with learning disabilities aged 65+ getting long-term support from their council are in residential or nursing care

·        19.4% of all adults with learning disabilities in residential or nursing care are aged 65+

·        39.7% of all long-term social care support expenditure on adults with learning disabilities aged 18-64 is on residential or nursing care

·        50.0% of all long-term social care support expenditure on adults with learning disabilities aged 65+ is on residential or nursing care

In the words of Sing Street (almost), I will never unravel, the riddle of the (residential and nursing care) model.

[Updated to include the sources of the data and specific links to where to find them. Many apologies to NHS Digital for not mentioning this in the first place]

* I’ve only just caught up with the excellent Irish film Sing Street, in which our not-quite-inept-enough 1980s teenage hero forms a band so that a girl he fancies will appear in the video of their first song, The Riddle Of The Model. If you haven’t seen I’d highly recommend it (a taster is here https://www.youtube.com/watch?v=PDtUesTfF50 ).